Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back painBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.38878.907361.7C (Published 21 September 2006) Cite this as: BMJ 2006;333:623
- K J Thomas, reader1,
- H MacPherson (), research director2,
- L Thorpe, research associate1,
- J Brazier, professor1,
- M Fitter, director2,
- M J Campbell, professor1,
- M Roman, general practitioner principal3,
- S J Walters, senior lecturer1,
- J Nicholl, professor1
- 1 School of Health and Related Research, University of Sheffield,
- 2Foundation for Traditional Chinese Medicine, York YO24 1ET,
- 3Selby and York Primary Care Trust, York
- Correspondence to: H MacPherson
- Accepted 3 May 2006
Objective To determine whether a short course of traditional acupuncture improves longer term outcomes for patients with persistent non-specific low back pain in primary care.
Design Pragmatic, open, randomised controlled trial.
Setting Three private acupuncture clinics and 18 general practices in York, England.
Participants 241 adults aged 18-65 with non-specific low back pain of 4-52 weeks' duration.
Interventions 10 individualised acupuncture treatments from one of six qualified acupuncturists (160 patients) or usual care only (81 patients).
Main outcome measures The primary outcome was SF-36 bodily pain, measured at 12 and 24 months. Other outcomes included reported use of analgesics, scores on the Oswestry pain disability index, safety, and patient satisfaction.
Results 39 general practitioners referred 289 patients of whom 241 were randomised. At 12 months average SF-36 pain scores increased by 33.2 to 64.0 in the acupuncture group and by 27.9 to 58.3 in the control group. Adjusting for baseline score and for any clustering by acupuncturist, the estimated intervention effect was 5.6 points (95% confidence interval −0.2 to 11.4) at 12 months (n = 213) and 8.0 points (2.8 to 13.2) at 24 months (n = 182). The magnitude of the difference between the groups was about 10%-15% of the final pain score in the control group. Functional disability was not improved. No serious or life threatening events were reported.
Conclusions Weak evidence was found of an effect of acupuncture on persistent non-specific low back pain at 12 months, but stronger evidence of a small benefit at 24 months. Referral to a qualified traditional acupuncturist for a short course of treatment seems safe and acceptable to patients with low back pain.
We thank the patients, primary care staff, acupuncturists, and members of the trial advisory group, particularly Trevor Sheldon, Sally Bell-Sayer, and David Laverick our patient representative. © Crown copyright 2006.
Contributors KJT was principal investigator and grant holder. She is guarantor. KJT, HMacP, MF, JB, JPN, and MJC developed the protocol, secured initial funding, and implemented the study. HMacP, LT, and JB secured funding for the 24 months' follow-up. LT recruited patients and managed the trial. MR advised and helped recruit the general practitioners. HMacP supervised the clinical intervention. KJT, MJC, and JPN carried out the statistical analysis. SJW undertook independent statistical analysis of the primary outcomes. KJT wrote the original draft with HMacP. All authors commented on the draft and contributed to the interpretation of the findings.
Funding This study was funded by the UK NHS Executive health technology programme. The views and opinions expressed do not necessarily reflect those of the NHS Executive. York Health Authority funded the treatment costs of the acupuncture. The National Coordinating Centre for Health Technology Assessment reviewed the protocol and the final report but had no direct involvement in the research process. KJT and JB joined the commissioning group of the National Coordinating Centre for Health Technology Assessment after funding for this study was awarded. Jon Nicholl is currently chair of the National Coordinating Centre for Health Technology Assessment commissioning group.
Competing interests None declared.
Ethical approval: This study was approved by York research ethics committee.