Acupuncture ‘effective and safe’ for treating chronic low back pain in older adults

Key takeaways:

• Both standard and enhanced acupuncture reduced pain-related disability in older adults.
• These benefits persisted months after treatment concluded, a “promising” finding, a researcher said.

Acupuncture needling greatly improved pain-related disability in older adults with low chronic back pain compared with usual care, a randomized controlled trial demonstrated.

“Acupuncture may be an effective and safe pain management tool for many older adult patients,” Lynn L. DeBar, PhD, MPH, a researcher at Kaiser Permanente Center for Health Research, told Healio. “While it is unlikely to take away all the pain, this study suggests that it can decrease pain-related disability substantively.”

DeBar and colleagues explained in JAMA Network Open that the ACP recommends acupuncture as a first-line treatment for low chronic back pain but “the optimal dose and timing of acupuncture are unknown for older adults.”

In the study, 800 adults aged 65 years or older with chronic low back pain were assigned 1:1:1 to either standard acupuncture, enhanced acupuncture or usual medical care.

The standard acupuncture group received eight to 15 treatment sessions over 12 weeks plus usual care, while the enhanced acupuncture group received eight to 15 treatment sessions of standard acupuncture plus four to six maintenance sessions during the subsequent 12 weeks.

The primary outcome was change in chronic low back pain-disability at 6 months based on the Roland-Morris Disability Questionnaire (RMDQ). Secondary outcomes included pain intensity and the percentage of patients with clinically meaningful improvements, defined as 30% or more improvement.

The researchers reported that RMDQ change scores at 6 months were significantly better in the standard acupuncture (adjusted mean difference [MD] = 1; 95% CI, 1.9 to 0.1) and enhanced acupuncture groups (adjusted MD = 1.5; 95% CI, 2.5 to 0.6) vs. the usual care group. RMDQ change scores did not significantly differ between the standard acupuncture and enhanced acupuncture groups.

“The pain-related benefits lasted many months after the acupuncture treatment was concluded, which is promising as pain-related medications both carry more safety risks for many older adults and are only effective while still actively taking the medications,” DeBar said.

The adjusted percentage of patients with clinically meaningful improvements was greater in the standard acupuncture (39.1%; 95% CI, 33.1%-46.1%) and enhanced acupuncture (43.8%; 95% CI, 38%-50.4%) groups vs. the usual care group (29.4%; 95% CI, 24.3%-35.5%).

Both acupuncture groups also had greater improvement in pain intensity over the usual care group, while serious adverse events were low among all the groups, and only one such event was possibly acupuncture-related.

According to DeBar, Medicare does not reimburse acupuncturists in “free-standing community practices (the manner in which most acupuncturists practice)” for their services unless they are “directly supervised by a conventional medical provider.”

Thus, “more research to align treatment and reimbursement is needed,” she said.

DeBar emphasized “that the impact of acupuncture is more than a placebo effect,” something patients and physicians often wonder.

“Earlier studies often used sham acupuncture (acupuncture needles placed in non-acupuncture positions or pressure devices akin to acupressure in same locations) as a comparison and sometimes failed to show a difference between sham and regular/full acupuncture,” she told Healio. “What we now know more about is that these ‘sham’ treatments still have a physiological effect (are not inert), so their use in studies may result in underestimating the outcomes of acupuncture in clinical settings.”

For more information:

Lynn L. DeBar, PhD, MPH, can be reached at primarycare@healio.com.