Shooting, stabbing or even throbbing pain radiating from your back to buttock, upper thigh and even your toes! Tingling and numbness, muscle aches and spasms. Limited flexibility. If you can relate to these symptoms, then you probably know all about chronic back pain (CBP). CBP is low back pain that persists for more than 3 months and can make life miserable. It is very common and unfortunately, has no specific pathology. This means any possible treatments prescribed are done so to alleviate the pain and increase range of motion rather than to cure. Effectiveness of conventional standard treatments, such as drug therapy or surgery, has yet to be clearly established. There are, however, many adjunctive and alternative therapies that have been shown to provide some temporary relief from pain. Therapy options may include acupuncture, exercise/physical therapy, and spinal manipulation.
I will be concentrating on acupuncture, which is used by 11% of people afflicted with CBP. Witt et al. investigated the effectiveness of acupuncture in the treatment of CBP in a randomized control trial (RCT) plus a nonrandomized cohort. The study was very interesting and insightful when comparing the effects of acupuncture in randomized and nonrandomized groups. I started filling out the STARTM Blocks with the details of the study. I placed my Main Statistic as “Pain Resolution” and then realized that this would be troublesome since pain is subjective and difficult to score. Therefore, I used the same main outcome as the RCT, “Back Function” where the Hannover Functional Ability Questionnaire was used for scoring. You will notice that my Relevance score (out of a maximum 100) is 90. Even though this is a very well designed RCT with a control group, it has some limitations. These include no blinding of the providers (physicians) or patients to the treatment and a fairly short follow-up time of 3 months. Hence my score of 90. The study details can be found below:

The Treatment Grade for acupuncture in CBP patients is “E”. 

I was surprised by this score, especially since the study was a well-controlled RCT and had highly significant results showing acupuncture was associated with marked clinical improvements.

But what about the side effects, whether positive or negative, of acupuncture? Do they have an effect on the Treatment Grade? Tune in to Part 2 to see if my prediction of the Treatment Grade changing once I readjust the Treatment Score based on positive and negative side effects such as quality of life and needle pain, respectively. In part 3, I will create more STARTM Blocks by including additional RCTs comparing acupuncture to sham and routine treatments for CBP in order to strengthen my Treatment Score. (See the disclaimers below)

  1. Last AR et al. Chronic low back pain: evaluation and management. Am Fam Physician 2009;79(12):1067-74.
  1. Witt CM et al. Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain. Am J Epidemiol 2006;164:487-496.
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