Acupuncture: New Data on Effectiveness

The May 11, 2009 issue of the Archives of Internal Medicine contains an article comparing needle acupuncture to simulated (sham) acupuncture and to "usual care" in the treatment of chronic low back pain (LBP).^[1]

The Archives study states that Americans spend $37 billion on LBP medical expenses annually. US productivity losses equaled $19.8 billion in 2008. Escalating expenses for spine care have not improved self-assessed health status.^[2]


Acupuncture comes to us by way of ancient and modern Chinese physicians and practitioners. Chinese philosophy holds that disease and pain reflect an imbalance of the yin andyang,two "primal forces of nature" balanced in the human body by acupuncture.^[3]

Acupuncture beliefs hold that life force balance can be restored by directed transcutaneous needle stimulation along 12 paired and two unpaired meridians, "channels of energy that run head-to-toe." Early "needles" were made of stone; then bone or wood; then iron, bronze , copper, silver or gold, and now stainless steel.

Acupuncturists insert thin, sharp needles at one point or any of hundreds of other points along the meridians. Once in place, the needles are twirled intermittently, generally at 10 minutes into the treatment and at the end (20 minutes).

A combustible material (moxa or mugwort herb) may be applied to a needle and ignited—called "Moxibustion" ( 灸)-- believed in traditional Chinese therapy to stimulate the immune system and relieve pain (Ancient Chinese people warming themselves at fireside noted pain relief, hence moxibustion was added to the practice of acupuncture.)^[4] In modern times, electric current may be applied to the needles, or various herbal treatments from the old country.

Theories exist concerning acupuncture "biophysiology":

1] meridians actually exist, and stimulation of meridian points improves systemic organ function;

2] acupuncture releases endorphins;

3] acupuncture triggers signals in the CNS, blocking incoming pain stimuli;

4] acupuncture manifests the "healing touch."

In 1987, The World Book Encyclopedia stated: "In the United States, ^[3]


Medical research gives some support to the use of acupuncture in painful conditions, such as chronic low back pain.See below:

Acupuncture and dry-needling for low back pain


A systematic review of thirty-five RCTs (Randomized Controlled Trials) composed of 2861 patients found insufficient evidence to recommend the use of acupuncture or dry-needling (sham acupuncture) for acute low back pain.^[5]


Acupuncture relieves chronic LBP more effectively than no treatment. Three months after treatment, acupuncture more effectively improves range of motion and function in LBP patients than those with no treatment.^[5]


Going head-to-head with other "alternative" low back pain treatments, acupuncture equals its rivals. Adding acupuncture to conventional therapies gives superior pain relief and functional improvement. Sham acupuncture appears equal in efficacy to standard acupuncture as an adjunct to conventional treatments of chronic low back pain. Most studies reviewed in this article lacked high quality methodology. Better studies are needed to answer questions regarding the place of acupuncture in the standard practice of medicine in the USA.^[5]


2000 years ago authoritative Chinese acupuncture texts recorded the use of blunt needles in therapy. The current Archives study reports a large RCT (Randomized Controlled Trial) of subjects randomized to standard acupuncture (protocol needle insertion for chronic low back pain), individualized acupuncture (random needle insertion techniques targeting any posterior site from scalp to legs), and sham acupuncture using needle guards and toothpicks to simulate standard acupuncture. Moxibustion, electric current, and herbs were not used during the trial. ^[1]


Findings reported in the Archives of Internal Medicine article include these points:

1. Individualized acupuncture is no better than standard acupuncture therapy for LBP.

2. Sham acupuncture is no better than standard or individualized acupuncture as a treatment of chronic low back pain, measured at up to 52 months as a reduction in "bothersomeness" of LBP and improvement in function.

3. Any of these treatments in the USA is better than "usual care," which, by the nature of this study, could be zero medical intervention, with only a back care pamphlet given to participants.

What does this mean? Is needle penetration of the skin, as used in acupuncture, not the point of the process? Is tactile stimulation of the body in the area of "key meridians" not necessary?

Human touch bridges therapist attention to human medical need and transcends somatic ties. Massage, physical therapy, checking a pulse, liver palpation, listening to the chest, removing a kidney cancer, and acupressure --these are a few examples of "therapeutic touch."

Could "real" and sham acupuncture reflect a continuum of the placebo effect, where touch is the independent variable and all forms of acupuncture compulsive forms of tactile stimulation? Are dull needles displacing sharp ones? Is this vision, afforded by intelligent scientific study, a glimpse into the "black hole" of the placebo?

[1] Cherkin DC, Sherman KJ, Avins AL, Erro, JH, et al. "A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain." Arch Intern Med. 2009; 169(9):858-866.

[2] Martin BI, Deyo RA, Mirza SK, et al. JAMA. 2008; 299(6):656-664.

[3] The World Book Encyclopedia, 1988 Edition. 1987: pp.31-32.

[4] n.wikipedia.org/wiki/Moxibustion

[5] Furlan AD, van Tulder MW, Cherkin D, Tsukayama H, Lao L, Koes BW, Berman BM. "Acupuncture and dry-needling for low back pain." Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD001351. DOI: 10.1002/14651858.CD001351.pub2. Last assessed as up-to-date: June 02. 2003. (We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003.)