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

Grant 1999
Methods
Participants
Interventions
Outcomes
Notes
- Random numbers were used (method not described) to generate a sequence of sealed envelopes containing the
treatment code, the next available envelope being opened on the patient’s entry into the trial.
-Outcome assessors were blinded.
-Funding: Grant from the Trustees of the Liberton Hospital Endowment Funds
-Setting: Outpatients clinic in the United Kingdom
-Informed consent: not reported
-The study was approved by the Lothian Research Ethics Committee
-Follow-up: 57 out of 60 randomised
-Analysis: No intention-to-treat. Mann-Whitney U-tests for between group differences
60 patients aged 60 years or over, with a complaint of pain of at least 6 months duration
Diagnoses: chronic low-back pain.
Excluded: treatment with anticoagulants, systemic corticosteroids, dementia, previous treatments with acupuncture
or TENS, cardiac pacemaker, other severe concomitant disease, inability of patient or therapist to apply TENS
machine
Mean age: 73.6 years old
6 males and 54 females
Previous treatments: not reported
1) Two sessions of manual acupuncture weekly for 4 weeks, i.e. eight sessions in total. The needles were of a standard
size (32 gauge, 1.5 inch length with guide tube). Points were chosen for the individual patient as in routine clinical
practice, only using points in the back. Six needles were used on average at each treatment with a minimum of two
and a maximum of eight. Treatment sessions lasted for 20 minutes.
Randomized to this group: 32. Two dropped out during the study. Reasons: influenza and dental problem
2) TENS: Standard machine (TPN 200, Physio-Med-Services) using 50 Hz stimulation with the intensity adjusted
to suit the patient, again as a routine clinical practice. The patient was given her/his own machine to use at home,
and instructed to use it during the day as required for up to 30 minutes per session to a maximum of 6 hours per
day. She/he was also seen for 20 minutes, twice weekly, by the physiotherapist, ensuring the same contact with him.
At each visit, symptoms were reviewed, treatment discussed and the optimum use of the TENS machine ensured.
Randomized to this group: 28. One dropped out due to acute depression
Co-interventions: The patients were advised to continue existing medication but not to commence any new analgesics
or any additional physical treatments for the duration of the trial
1) Pain: visual Analog scale (0 to 200 mm).
2) Pain subscale of the 38-item Nottingham Health Profile part 1.
3) Analgesics consumption
4) Spinal flexion
These outcomes were taken at baseline, 4 days and 3 months after last treatment session
Costs: not reported
Complications: 3 acupuncture patients reported dizziness and 3 TENS patients developed skin reactions. (Comparison
07.08)
The two groups appear different at baseline with respect to the four outcome measures. Patients in the acupuncture
group have higher VAS and NHP pain scores, reduced spinal flexion and lower tablet consumption compared to the
TENS group
Because the authors had not adjusted for baseline values, no conclusions can be made based on this study
We could try to obtain raw data from authors and run ANCOVA, but the data is also skewed and transformation is
not appropriate
Results:
Acupuncture and dry-needling for low back pain (Review)
Copyright © 2011 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
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