[ Home ] [ acupuncture ] [ alexander technique ] [ aromatherapy and therapeutic massage ] [ chinese herbs ] [ colonic hydrotherapy ] [ counselling and psychotherapy ] [ homeopathy ] [ hypnotherapy ] [ mctimoney chiropractic ] [ osteopathy ] [ nutrition ] [ physiotherapy ] [ reflexology ] [ shiatsu ] [ sports massage ] [ Open Day ] [ Silver landmark ] [ recent news articles ] [ appointments ] [ fees ] [ links ] [ how to find us ]
Acupuncture for low back pain - British Medical Journal - 15th
September 2006
Two papers published in the BMJ which report on the clinical
effectiveness and cost effectiveness of acupuncture for chrinic low back pain:
K J Thomas, H MacPherson, L Thorpe, J Brazier, M Fitter, M J Campbell, M Roman, S
J Walters, and J Nicholl. Randomised controlled trial of a short course of traditional
acupuncture compared with usual care for persistent non-specific low back pain. BMJ, Sep
2006; 333: 623 ; doi:10.1136/bmj.38878.907361.7C
Abstract
Objective To determine whether a short course of traditional acupuncture
improves longer term outcomes for patients with persistent non-specific low
back pain in primary care.
Design Pragmatic, open, randomised controlled trial.
Setting Three private acupuncture clinics and 18 general practices in
York, England.
Participants 241 adults aged 18-65 with non-specific low back pain
of 4-52 weeks' duration.
Interventions 10 individualised acupuncture treatments from one
of six qualified acupuncturists (160 patients) or usual care only (81
patients).
Main outcome measures The primary outcome was SF-36 bodily pain, measured
at 12 and 24 months. Other outcomes included reported use of analgesics, scores
on the Oswestry pain disability index, safety, and patient satisfaction.
Results 39 general practitioners referred 289 patients of whom 241
were randomised. At 12 months average SF-36 pain scores increased by 33.2 to
64.0 in the acupuncture group and by 27.9 to 58.3 in the control group.
Adjusting for baseline score and for any clustering by acupuncturist, the
estimated intervention effect was 5.6 points (95% confidence interval -0.2 to
11.4) at 12 months (n = 213) and 8.0 points (2.8 to 13.2) at 24 months (n
= 182). The magnitude of the difference between the groups was about 10%-15% of
the final pain score in the control group. Functional disability was not
improved. No serious or life threatening events were reported.
Conclusions Weak evidence was found of an effect of acupuncture on
persistent non-specific low back pain at 12 months, but stronger evidence of a
small benefit at 24 months. Referral to a qualified traditional acupuncturist
for a short course of treatment seems safe and acceptable to patients with low
back pain.
J
Ratcliffe, K J Thomas, H MacPherson, and J Brazier. A randomised controlled trial of
acupuncture care for persistent low back pain: cost effectiveness analysis. BMJ, Sep 2006;
333: 626 ; doi:10.1136/bmj.38932.806134.7C.
Abstract
Objective To evaluate the cost effectiveness of acupuncture in
the management of persistent non-specific low back pain. Design Cost
effectiveness analysis of a randomised controlled trial.
Setting Three private acupuncture clinics and 18 general practices in
York, England.
Participants 241 adults aged 18-65 with non-specific low back pain
of 4-52 weeks' duration.
Interventions Ten individualised acupuncture treatments over three
months from acupuncturists trained in traditional Chinese medicine (n = 160) or
usual care only (n = 81).
Main outcome measure Incremental cost per quality adjusted life year
(QALY) gained over two years.
Results Total costs to the United Kingdom's health service during the
two year study period were higher on average for the acupuncture group (£460; 
673; $859) than for the usual care group
(£345) because of the costs associated with initial treatment. The mean
incremental health gain from acupuncture at 12 months was 0.012 QALYs (95%
confidence interval -0.033 to 0.058) and at 24 months was 0.027 QALYs (-0.056
to 0.110), leading to a base case estimate of £4241 per QALY gained. This
result was robust to sensitivity analysis. The probabilistic sensitivity analysis
showed acupuncture to have a more than 90% chance of being cost effective at a
£20 000 cost per QALY threshold.
Conclusion A short course of traditional acupuncture for persistent non-specific
low back pain in primary care confers a modest health benefit for minor extra
cost to the NHS compared with usual care. Acupuncture care for low back pain
seems to be cost effective in the longer term.
