Trigger point acupuncture (TrPAcu) is significantly better than sham treatment at reducing pain and improving function in patients with chronic shoulder pain, say Japanese investigators. Eighteen patients with non-radiating shoulder pain for at least six months were randomised into two groups who received five treatment sessions. The TrPAcu group received treatment at muscular trigger points, while the sham group received acupuncture treatment on the same muscle. After five weeks of treatment, pain intensity in the TrPAcu group was found to have decreased significantly from baseline, while shoulder function had increased significantly. Comparison between the two groups demonstrated a significant difference in favour of TrPAcu. (Randomized trial of trigger point acupuncture treatment for chronic shoulder pain: a preliminary study. J Acupunct Meridian Stud. 2014 Apr;7(2):59-64). http: / /www.ncbi.nlm.nih.gov / pubmed / 24745863

Acupuncture has been found to outperform counselling and usual care for patients suffering from depression complicated by pain. A secondary analysis of data from 755 patients in a UK-based pragmatic randomised controlled trial found that patients with moderate-to­extreme pain did better at three months if they received acupuncture compared to those who received counselling or usual care. Reductions in both depression and pain were most marked in the acupuncture group, followed by the counselling group and then the usual care group. (Acupuncture, counselling or usual care for depression and comorbid pain: secondary analysis of a randomised controlled trial. BMJ Open. 2014 May 2;4(5):e004964). http:/ /www.ncbi.nlm.nih.gov/ pubmed /24793257

 

A secondary analysis of data from the Acupuncture Trialists’ Collaboration has shown that acupuncture is significantly superior to control, irrespective of the type of control used. Data came from a large individual patient data meta-analysis of acupuncture trials involving patients with headache and migraine, osteoarthritis and back, neck and shoulder pain. Twenty-nine trials met the inclusion criteria, 20 involving sham controls (n=5,230) and 18 non-sham controls (n=14,597). Sham controls included non-needle sham, penetrating sham needles and non-penetrating sham needles. Non-sham controls consisted of non-specified routine care and protocol-guided care. The results showed that acupuncture was significantly superior to all categories of control group. For trials that used penetrating needles as sham control, acupuncture had smaller effect sizes than for trials with non-penetrating needles or controls without needles. In trials with non-sham controls, larger effect sizes were associated with acupuncture vs. non-specified routine care than vs. protocol-guided care. The authors conclude that penetrating needles appear to elicit important physiological activity and recommend that this type of sham be avoided in acupuncture studies. (Influence of control group on effect size in trials of acupuncture for chronic pain: a secondary analysis of an individual patient data meta-analysis. PLoS One. 2014 Apr 4;9(4):e93739). http:/ /www.ncbi.nlm.nih.gov/ pubmed /24705624

Chronic low back pain (CLBP) is associated with changes in connectivity in the brain’s default mode network (DMN), but acupuncture can reverse these changes as well as provide pain relief. The DMN, which is associated with pain and emotional processing, consists of brain regions that are more active during rest than during active task performance. Previous studies have shown that disruptions of the DMN may underlie the cognitive and behavioural impairments that accompany chronic pain. Chinese scientists used resting-state functional MRI (rsfMRI) to scan the brains of 20 patients with CLBP, before and after four weeks of acupuncture treatment. They compared the scans with those from 10 age- and gender-matched healthy controls. Less connectivity was found within the DMN in patients with CLBP compared with healthy controls (mainly in the dorsolateral prefrontal cortex, medial prefrontal cortex, anterior cingulate gyrus and precuneus). After acupuncture, connectivities in the patients’ DMNs were restored almost to the levels seen in the healthy controls. Furthermore, reductions in clinical pain were correlated with increases in DMN connectivity. (Acupuncture treatment of chronic low back pain reverses an abnormal brain default mode network in correlation with clinical pain relief. Acupunct Med. 2013 Dec 3. doi: 10.1136/ acupmed-2013-010423. [Epub ahead of print]).

According to American researchers, weekly acupuncture is associated with improvements in pain and quality of life when used as an adjunct to usual treatment for chronic pain in urban health centres. In a quasi-experimental trial, 226 of 495 referred patients initiated acupuncture. Back pain was the most common referring diagnosis, followed by osteoarthritis. Patients were found to be older, often receiving disability payments, and in poor or fair overall health with high baseline levels of pain. Following a mean of 9.7 acupuncture treatments, the results showed a significant improvement in pain severity and physical wellbeing at 12 and 24 weeks compared with baseline. Outcomes of acupuncture for chronic pain in urban primary care. J Am Board Fam Med. 2013 Nov-Dec;26(6):692-700).

The first pragmatic randomised controlled trial of tai chi for people with low back pain has shown that it can improve pain and disability outcomes in this population. Australian researchers randomised 160 volunteers with persistent non-specific low back pain to either tai chi or a wait-list control group, who continued with their usual health care. The tai chi intervention consisted of 18 forty-minute group sessions over a 10-week period delivered by a qualified instructor. Tai chi was found to reduce the bothersomeness of back symptoms by 1.7 points and pain intensity by 1.3 points (on a 10-point scale). It was also found to improve self-reported disability by 2.6 points on a 24-point scale. (Tai chi exercise for treatment of pain and disability in people with persistent low back pain: a randomized controlled trial. Arthritis Care Res (Hoboken). 2011 Nov;63(11):1576-83).

Yoga is a more effective treatment for chronic lower back pain than conventional GP care, according to the UK’s largest ever study into its benefits. The trial involved 313 people who were receiving GP care for chronic back pain. Participants were randomised to receive usual care alone, or usual care plus 12 weeks of group yoga classes specially designed for those with lower back pain. The results showed that the yoga group had better back function at three, six and 12 months compared with the usual care group. Around 60% of people in the yoga group continued with their practice after the end of the classes. (Yoga for chronic low back pain: a randomized trial. Ann Intern Med. 2011 Nov 1;155(9):569-78). In another study from the USA, 228 adults with chronic low back pain were randomised to 12 weekly classes of yoga, conventional stretching exercises or a self-care book. Yoga was found to be more effective in improving function and reducing symptoms than self-care (-2.5 versus -1.1 points on a 23-point disability scale), but not more effective than stretching (at six, 12 and 26 weeks). (A Randomized Trial Comparing Yoga, Stretching, and a Self-care Book for Chronic Low Back Pain. Arch Intern Med. 2011 Dec 12;171(22):2019-26).

American researchers have found preliminary evidence that acupuncture may be able to help relieve non-cyclic breast pain. Thirty-seven women experiencing breast pain received treatment consisting of four acupuncture sessions over two weeks, with three months follow-up. Patients reported that pain (described as throbbing and heavy) decreased significantly after acupuncture. Following treatment, pain scores decreased by an average of 3.5 points (on a 10-point scale) for the worst pain experienced, by 2.7 points for average pain experienced and by 2.3 points for interference from pain. The percentage of patients reporting a clinically meaningful decrease of two points from baseline to the end of treatment was 67% for the worst pain experienced, 65% for average pain experienced, and 56% for pain interference. (Acupuncture for treatment of noncyclic breast pain: a pilot study. Am J Chin Med. 2011;39(6):1117-29).

Patients with low-back pain (LBP) are less likely to visit physicians for their problem after receiving acupuncture treatment, which leads to reduced healthcare pending on LBP. In a case control study carried out in Canada, 201 cases in which LBP was treated with acupuncture were compared with 804 controls. Each acupuncture group case was matched with four comparison cases from the general population with LBP, based on gender and age. The number of physician visits for the one-year period post-acupuncture decreased 49% for the acupuncture group, compared with the one-year period pre-acupuncture. In the comparison group, there was a decrease of 2% in physician visits for the same time periods. The cost of LBP-related physician services showed corresponding decreases, declining by 37% for the acupuncture group and 1% for the comparison group. (Reduced health resource use after acupuncture for low-back pain. J Altern Complement Med. 2011 Nov;17(11):1015-9).

A German team has compared qigong and exercise therapy in patients with chronic neck pain. One hundred and twenty-three patients with chronic neck pain (VAS 40 mm) were randomised to six months (18 sessions) of either qigong or exercise therapy, or to a waiting list (no treatment). After six months, a significant difference was seen between the qigong and waiting list control groups in terms of neck pain, disability and quality of life. Results in the qigong and exercise therapy groups were found to be similar. (Qigong versus Exercise versus no Therapy for Patients with Chronic Neck Pain – a Randomized Controlled Trial. Spine (Phila Pa 1976). 2010 Dec 20. [Epub ahead of print]).