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

Giles 2003
Methods
Participants
Interventions
-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)
-Data analyst blinded
-Funding: Queensland State Government. Partly supported by Townsville General Hospital.
-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: 115 were randomised. Six dropped out before treatment for reasons not related to outcomes. 69/109
(63.3%) were followed.
-Analysis: Based on “intention-to-treat analysis”. Checked for possible confounders and interactions by multiple
regression and logistic regression
109 patients with uncomplicated spinal pain for a minimum of 13 weeks (average duration was 6.4 years)
Diagnosis: mechanical spinal pain
Excluded: nerve root involvement, spinal anomalies, pathology other than mild to moderate osteoarthrosis, spondylolisthesis
exceeding grade 1, previous spinal surgery and leg length inequality >9 mm
Median age: 39 years old
60 males and 49 females
Working status: 29% skilled trade, 20% pensioner or unemployed, 20% manager, clerk or sales, 12% professional,
18% other
Previous treatments: not described
Co-morbidity: not described
1) The clinician determined the form of acupuncture technique. The Near and Far technique consists of: needling
the trigger point and distal analgesia producing sympatholytic acupuncture points below the elbow or knee.
Acupuncture was performed by one of two experienced acupuncturists using sterile disposable acupuncture guide
tube needles (length 50 mm, gauge 0.25 mm) during 20-minute appointments.
For each patient, 8 to 10 needles were placed in local paraspinal intramuscular maximum pain areas and approximately
5 needles were placed in distal acupuncture point meridians depending on the spinal pain syndrome being treated.
Once patients could tolerate the needles, needle agitation was performed by turning or “flicking” the needles at
approximately 5-minute intervals for 20 minutes. The needles were inserted to a length of 20 to 50 mm, in the
maximum pain area, and up to approximately 5 mm in the distal points.
Two treatments per week up to the defined maximum of 9 weeks of treatment.
Randomized to this group: 36. Two were lost before treatment, 2 during treatment and 10 changed treatment because
of no effect
2) Spinal manipulation. 20-minute appointment. High-velocity, low-amplitude thrust spinal manipulation to a joint
was performed as judged to be safe and usual treatment by the treating chiropractor for the spinal level of involvement
to mobilize the spinal joints. Two treatments per week up to a maximum of 9 weeks.
Randomized to this group: 36. One was lost before treatment, 1 during treatment and 8 changed treatments because
of “no effect”
3) A medication could be selected that had not already been tried by a patient randomised into the mediation arm of
the study. The patients normally were given Celecoxib (200 to 400 mg/day) unless it had previously been tried. The
next drug of choice was Rofecoxib (12.5 to 25 mg/day) followed by paracetamol (up to 4 g/day). Doses, left to the
sports physician’s discretion, were related particularly to the patient’s weight, with the severity of symptoms playing
a minor role. The treating sports physician also was allocated 20 minutes for follow-up visits.
Randomized to this group: 43. Three were lost before treatment and 18 changed treatment (11 for “no effect” and
8 for “side effects”)
Acupuncture and dry-needling for low back pain (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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