Back Pain and Acupuncture

The ancient technique of acupuncture has become increasingly popular as a treatment for pain along with other conditions. When back pain is caused by inflammation, acupuncture can be used to directly help reduce said inflammation. Acupuncture can help correct other more subtle internal imbalances that may be contributing to the back pain as well. Acupuncture can prove to be an effective natural remedy for back pain.

Thus far, research has not produced clear evidence of acupuncture’s effectiveness for back pain.⁵² In a review of 23 randomized trials involving over 6,000 patients with chronic low back pain, researchers concluded that acupuncture is more effective than no treatment for short-term pain relief, but there was no significant difference between the effects of true and sham.⁷⁹

A 6-month, double-blind trial of 1,162 people with back pain compared real acupuncture, fake acupuncture, and conventional therapy.⁷² Both real and fake acupuncture were twice as effective as conventional therapy according to the measures used. However, there was only a minimal difference between real and fake acupuncture, which shows the significant power of the placebo effect.

Similarly, in a single-blind, sham-acupuncture, and no-treatment controlled study of 298 people with chronic back pain, use of real acupuncture failed to prove significantly more effective than sham-acupuncture.⁵⁸ Also, in a fairly large randomized trial involving 638 adults with chronic back pain, there was no difference in pain at one year in patients receiving real compared to fake acupuncture (with neither group improving significantly over standard care). Both real and simulated acupuncture were, however, associated with improved function at one year.⁸⁰ Other studies have failed to find benefit as well; in several controlled studies enrolling a total of over 300 people, real acupuncture again failed to prove more effective than sham-acupuncture or other placebo treatments.^19,29,32,53

One study compared the effects of acupuncture, massage, and education (such as videotapes on back care) for 262 people with chronic back pain over a 10-week period.²⁸ The exact type of acupuncture and massage was left to practitioners, but only 10 visits were permitted. At the 10-week point, evaluations showed benefit with massage but not with acupuncture. One year later, massage and education were nearly equivalent, and both were superior to acupuncture.

Low level laser therapy (LLLT) is a technique similar to electro-acupuncture that uses precision laser energy instead of electricity conducted through a needle. In a detailed review of 7 randomized trials, researchers were unable to draw any conclusions regarding the effectiveness of LLLT for nonspecific low back pain.⁷³

Many other studies have compared acupuncture to such treatments as transcutaneous electrical nerve stimulation (TENS), physical therapy, chiropractic care, and massage.^14,33-37,59 In many of these trials, acupuncture provided benefits comparable to the other options tested. However, because TENS, physical therapy, and so forth, have not been proven effective for back pain, studies of this type cannot be taken as evidence that acupuncture is effective. One study did find acupressure massage more effective than standard physical therapy; however, it was performed in a Chinese population that may have had more faith in this traditional approach than in physical therapy.⁶⁰

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Safety Issues

Serious adverse effects associated with the use of acupuncture are rare. ¹,² The most commonly reported problems include short-term pain from needle insertion, tiredness, and minor bleeding. There is one report of infection caused by acupuncture given to a person with diabetes. ³ Some acupuncture points lie over the lungs and insertion to excessive depth could conceivably cause a pneumothorax (punctured lung). Because acupuncturists are trained to avoid this complication, it is a rare occurrence.

A recent report from China contained an example of another complication caused by excessively deep needling. ⁴ A 44-year-old man was needled on the back of the neck at a commonly used acupuncture point just below the bony protuberance at the base of the skull. However, the acupuncturist inserted the needle too deeply and punctured a blood vessel in the skull. The client developed a severe headache with nausea and vomiting; a CAT scan showed bleeding in the brain, and a spinal tap found a small amount of blood in the cerebrospinal fluid. The severe headache, along with neck stiffness, continued for 28 days. The man was treated with standard pain medication, and the condition resolved itself without any permanent effects.

Infection due to the use of unclean needles has been reported in the past, but the modern practice of using disposable sterile needles appears to have eliminated this risk.