Acupuncture and dry-needling for low back pain (Review)

Giles 1999
Methods
Participants
Interventions
Outcomes
-Randomized (method not described). Person drew an envelope out of a box with 150 well-shuffled envelopes, each
containing one of three colour codes (50 envelopes per intervention)
-Outcome assessor and data analyst blinded
-Funding: Green Projects Donation fund Limited via the Royal Melbourne Institute of Technology and partly
supported by Townsville General Hospital and James Cook University
-Setting: Outpatient pain clinic in a hospital setting. Townsville Australia.
-Informed written consent was obtained.
-Ethical approval by the Northern Regional Health Authority’s Townsville General Hospital
-Follow up: 77 of 130 randomised (59%)
-Analysis: Based on “adherers only principle”, i.e.. discarded those who did not comply with the treatment assigned.
Checked for possible confounders and interactions by multiple regression and logistic regression
77 patients with spinal pain for at least 13 weeks (median 6 years)
Diagnoses: 82% lower back pain; 42% neck pain and 34% upper back pain
Excluded: nerve root involvement, spinal anomalities, pathology other than mild to moderate osteoarthrosis, previous
spinal surgery and leg inequality > 9mm
Median age: 42 years old
30 males and 47 females
Working status: 56% blue collar, 26% white collar, 13% academic, 5% retired
Previous treatments: 77% drugs, 42% manipulation, 40% physiotherapy and 6% acupuncture
Co-morbidity: not described
1) The treating clinician decided which form of acupuncture to use.
One of four experienced medical acupuncturists using sterile HWATO Chinese disposable acupuncture guide tube
needles 50 mm long with a gauge of 0.25 mm for 20 minutes. An average number of 8 to 10 needles were placed
in local tender points and in distant acupuncture points according to the “near and far” technique, depending on
the condition being treated. Once patients could satisfactorily tolerate the needles for 20 minutes, low-volt electrical
stimulation was applied to the needles. Six treatments were applied in a 3 to to 4-week.
Randomized to this group: 46
Drop-outs: 26 (52%). Reasons: unrelated to the outcome
2) Spinal manipulation was performed as judged to be safe and appropriate by the treating chiropractor for the spinal
level of involvement only. A high-velocity, low-amplitude spinal manipulation was performed. Six treatments applied
in a 3 to to 4-week period.
Randomized to this group: 49
Drop-outs: 13 (26%). Reasons: same as in the acupuncture group
3) Medication: tenoxican (20 mg/d) and ranitidine (50 mg x 2/ day). Medication was given to the patients for the
defined 3 to 4-week treatment period. Treatment times were standardized by arranging 15 to 20-minute appointments
for all visits to eliminate a potential placebo effect originating from different lengths of exposure to the clinician
Randomized to this group: 31
Drop-outs: 10 (33%). Reasons: same as in the acupuncture group
1) Pain: Visual Analog Scale (VAS) from 0 to 10 cm
2) Pain frequency on 5-ordered categories: 1/month, 1/week, 1/day, frequent and constant.
3) Function: Oswestry Disability Index
4) Cross over to another intervention after the study period
All outcomes were measured immediately after the end of the treatment period
Costs: Not reported
Complications: No side effects occurred for acupuncture or manipulation. Three medically treated subjects had
gastric symptoms
Acupuncture and dry-needling for low back pain (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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