In a study published in the September issue of Archives of Internal Medicine, Dr Michael Haake, University of Regensburg, Bad Abbach, Germany, and colleagues discussed the results of a randomised, multi-centre, blinded, controlled trial of 1,162 patients, comparing six months of verum acupuncture with sham acupuncture and conventional therapy. Entitled, ’German Acupuncture Trials (GERAC) for chronic low back pain randomized, multicenter, blinded, parallel-group trial with 3 groups’, Haake reported that, “To our knowledge, verum acupuncture has never been directly compared with sham acupuncture and guideline-based conventional therapy in patients with chronic low back pain.” The trial, conducted in 340 outpatient practices in Germany, included patients aged from 18 to 86 years with a history of chronic low back pain for an average period of eight years. According to Haake, patients underwent ten 30-minute sessions, generally two sessions per week, of verum acupuncture (n=387) according to principles of traditional Chinese medicine; sham acupuncture (n=387) consisting of superficial needling at non-acupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n=388). Five additional sessions were offered to patients who had a partial response to treatment (10%-50% reduction in pain intensity). The primary outcome was response after six months, defined as 33% improvement or better on three pain-related items on the Von Korff Chronic Pain Grade Scale questionnaire or 12% improvement or better on the back-specific Hanover Functional Ability Questionnaire. Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement, explained Haake. A total of 13,475 treatment sessions were conducted (verum, 4,821; sham, 4,590; and conventional therapy, 4,064). The results demonstrated that at six months, the response rate (primary outcome) was 47.6% in the verum acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group. Differences among groups were as follows: verum vs. sham, 3.4%; verum vs. conventional therapy, 20.2%; and sham vs. conventional therapy, 16.8%. The authors concluded, “The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy. “Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects of contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment.”
