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Author (up) Cherkin, D. C.; Sherman, K. J.; Avins, A. L.; Erro, J. H.; Ichikawa, L.; Barlow, W. E.; Delaney, K.; Hawkes, R.; Hamilton, L.; Pressman, A.; Khalsa, P. S.; Deyo, R. A. url  openurl
  Title A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain Type of Study RCT
  Year 2009 Publication Archives of internal medicine Abbreviated Journal Arch Intern Med  
  Volume 169 Issue 9 Pages 858-866  
  Keywords Acu Versus > 1 Control; Acupuncture; AcuTrials; Back Pain; Low Back Pain, Chronic; Fixed Acupuncture Protocol; Individualized Acupuncture Protocol; Low Back Pain; Non Penetrating Sham, Mechanical; Pain; RCT; Restricted Modalities, Acupuncture Only; Sham Control; Usual Care Control, Multimodality; TCM Acupuncture Style; Verum Acupoint Control  
  Abstract BACKGROUND: Acupuncture is a popular complementary and alternative treatment for chronic back pain. Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain. METHODS: A total of 638 adults with chronic mechanical low back pain were randomized to individualized acupuncture, standardized acupuncture, simulated acupuncture, or usual care. Ten treatments were provided over 7 weeks by experienced acupuncturists. The primary outcomes were back-related dysfunction (Roland-Morris Disability Questionnaire score; range, 0-23) and symptom bothersomeness (0-10 scale). Outcomes were assessed at baseline and after 8, 26, and 52 weeks. RESULTS: At 8 weeks, mean dysfunction scores for the individualized, standardized, and simulated acupuncture groups improved by 4.4, 4.5, and 4.4 points, respectively, compared with 2.1 points for those receiving usual care (P < .001). Participants receiving real or simulated acupuncture were more likely than those receiving usual care to experience clinically meaningful improvements on the dysfunction scale (60% vs 39%; P < .001). Symptoms improved by 1.6 to 1.9 points in the treatment groups compared with 0.7 points in the usual care group (P < .001). After 1 year, participants in the treatment groups were more likely than those receiving usual care to experience clinically meaningful improvements in dysfunction (59% to 65% vs 50%, respectively; P = .02) but not in symptoms (P > .05). CONCLUSIONS: Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects  
  Address Center for Health Studies, 1730 Minor Avenue, Seattle, WA 98101, USA. cherkin.d@ghc.org  
  Publisher
  Language Number of Treatments 10  
  Treatment Follow-up 45 Weeks Frequency >1/WK Number of Participants 638  
  Time in Treatment 7 Weeks Condition Low Back Pain, Chronic
  Disease Category Back Pain OCSI Score  
  Notes Approved no  
  Call Number Serial 162  
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