Acupuncture relieves chronic low back pain

The literature evaluating acupuncture for low back pain has been reviewed at least twice before, with conflicting results. The latest update, including 23 extra trials, shows that acupuncture can work, at least for people who have had back pain for more than three months. A thorough search found 33 randomised trials comparing acupuncture with sham acupuncture, no treatment, or other active treatments such as massage. Only 10 of the trials had been reviewed before. The others were new, unpublished, or in languages other than English, including Chinese, Japanese, and Polish.

Overall, acupuncture worked significantly better than sham acupuncture or no treatment in people with chronic back pain. The authors found a difference between acupuncture and sham acupuncture equivalent to 14.5 mm on a 100 mm visual analogue scale measuring pain. Acupuncture was no better than other active treatments at relieving chronic pain, however, and looked significantly worse than spinal manipulation (two trials) or massage (one trial).

It's still unclear whether acupuncture works for acute back pain. These reviewers, and others before them, found too few decent trials to be certain.

Annals of Internal Medicine 2005;142: 651-63

New drug treatment for heart failure increases mortality

Nesiritide, a new drug treatment for acute on chronic heart failure, looked promising until a recent meta-analysis found that it was associated with a suspicious increase in deaths. The analysis included data from three trials comparing the new intravenous drug with conventional treatments for decompensated heart failure, usually vasodilators and diuretics. Inotropes such as dobutamine were excluded. Four per cent of 377 patients given control treatments died within 30 days, compared with 7.2% of 485 patients treated with an infusion of nesiritide (hazard ratio 1.8, 95% CI 0.98 to 3.31, P = 0.057; figure).

The analysis isn't perfect, and the findings aren't strictly significant in the conventional sense, but the authors …