Recommending Acupuncture for Back Pain

The New England Journal of Medicine recently published an article on their blog in support of acupuncture for back pain.  The authors, all respected and established researchers, carefully analyze the current situation with regards to back pain, and even though there is controversy in the research, recommend treatment.

Acupuncture and Moxa for Back Pain

Some skeptics are asking why would these scientists make a recommendation even though the research is unclear? The answer is easy, because it works and it is very safe.

The issue with the research was that the acupuncture group was not different from the placebo acupuncture group.  But both the acupuncture and the acupuncture placebo groups were better than standard treatment.  Yes, you read that correctly, the placebo acupuncture was better than conventional treatment.

The Ouch Point Dilemma

The placebo acupuncture treatment has been a pain for years.  Study after study shows that acupuncture does not work better than the placebo.  Yet, at the same time, both the acupuncture and the placebo have a clinical effect which is better than conventional treatment.   Why?

First, there is the ouch point dilemma.  Ouch points are points which are sensitive and tender when you press them. Often they are not classical acupuncture points, rather they are simply on the muscle in the area of the pain.  When an acupuncture investigator selects points for the placebo treatment, they use points off of the standard acupuncture channels.  Many of the non-channel point may be ouch points and may aid in the pain reduction.

Second, designing a placebo needle that does not have a physiological effect is very difficult.  Often they use a needle with a retractable tip that does not puncture the skin.  This is much like a magicians sword which retracts the blade as he stabs his assistant.  Other needles may be light touch needle, or even toothpicks, that gently prick the skin. But this too may have a physiological effect.  Some styles of acupuncture use this light tapping as a way to relieve pain.

In the end, acupuncture is a physical medicine.  It is difficult to create a placebo intervention that does not have a physiological reaction with the body.

Because it is Safe

The researchers recommend acupuncture for back pain because it is safe and it works better than conventional treatment. Studies after studies show there is minimal risk of severe side effects.  To those with back pain it does not matter if it works better than a placebo.  They just need to feel better.

In my next articles, I will explain how acupuncture works to treat back pain.