Acupuncture in patients with acute low back pain: A multicentre randomised controlled clinical trial

This multicenter randomized controlled trial investigated the efficacy of acupuncture in the treatment of patients with acute non-specific low back pain in the primary care setting in Spain. Conducted between February 2006 and January 2008, the study enrolled 275 patients diagnosed by general practitioners and randomized them into four groups: conventional treatment alone or supplemented by three different types of acupuncture - true, sham, or placebo. The study methodology was rigorous, with centralized randomization, adequate blinding of patients in the acupuncture groups and of assessors, and a previously validated protocol. Treatment consisted of five 20-minute sessions over two weeks, performed by physicians with at least 700 hours of acupuncture training.

The primary outcome was clinically relevant improvement, defined as a 35% or greater reduction on the Roland Morris Disability Questionnaire after three weeks of treatment. Results showed that all three types of acupuncture were superior to conventional treatment alone. True acupuncture achieved 73.5% clinically relevant improvement, compared with 75% for sham acupuncture, 65.2% for placebo acupuncture, and 44.3% in the control group. After adjustment for confounding variables, the relative risk for efficacy was 5.04 for true acupuncture, 5.02 for sham, and 2.57 for placebo, all compared with conventional treatment.

In secondary outcomes, 53.1% of patients in the true-acupuncture group were pain-free after three weeks, compared with only 27.9% in the control group. In addition, there was a lower need for analgesic medication in the acupuncture groups and lower occupational disability. At long-term follow-up, at 12 months, no patient in the true-acupuncture group reported persistent pain, compared with 13.2% in the sham group. The study found no statistically significant differences among the three types of acupuncture, suggesting that the beneficial effect may not be specifically related to the traditional selection of acupuncture points.

This finding raises important questions about the mechanisms of action of acupuncture, including possible contextual effects, non-specific sensory stimulation, and increased therapeutic attention. Clinical implications include evidence that acupuncture may be an effective adjunctive therapy for acute low back pain, potentially reducing dependence on medication and improving functional recovery. However, limitations include the inability to fully blind the control group, which may have influenced results, and the need for additional research to clarify the specific mechanisms by which acupuncture exerts its therapeutic effects.