A new clinical trial found that for older adults with chronic low back pain, acupuncture was more helpful in relieving discomfort and improving mobility than prescription medication or physical therapy.
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Acupuncture is a traditional Chinese medicine technique during which a practitioner inserts fine needles into a patient’s skin. Acupuncture has a range of potential uses, but it’s most commonly utilized in the United States for back, joint, and neck pain.
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“Our study findings replicated what had been seen among younger adult populations: Namely, that acupuncture is an effective and safe treatment” for low back pain, says Lynn L. DeBar, PhD, lead author and an investigator at the Center for Health Research at Kaiser Permanente in Portland, Oregon.
Study Compared Acupuncture With Physical Therapy and Prescription Meds
The new trial enrolled 800 men and women ages 65 and older with chronic low back pain.
The participants were divided into three groups, each receiving a different treatment regimen:
- The usual medical care, which included access to physical therapy and prescription medication
- Access to the usual medical care, along with between 8 and 15 acupuncture sessions over 12 weeks
- Access to 15 acupuncture sessions over 12 weeks, plus 6 maintenance acupuncture treatments during the next 12 weeks
The participants answered questions about their pain and physical limitations 3, 6, and 12 months after joining the study.
The researchers found that both acupuncture groups had less pain that impacted their daily life overall compared with the standard treatment group. They also had less intense pain and better physical function after six months compared with those who didn’t receive acupuncture.
Also worth noting: Acupuncture recipients reported fewer anxiety symptoms at 6 and 12 months compared with those who received usual care.
Study Adds to Existing Research
This current study adds to an existing body of research suggesting acupuncture is helpful for low back pain.
Published in 2022, an analysis of 44 randomized controlled trials on more than 8,300 acupuncture procedures found that the therapy was more effective than a placebo treatment at reducing back pain.
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A smaller analysis of four studies, published in 2022, found that acupuncture led to a “clinically meaningful reduction in self-reported pain.”
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Acupuncture Studies Always Come With Caveats
While experts say they’re not shocked by the findings, several point out that research on acupuncture is tough to do.
Acupuncture techniques can vary between practitioners, which makes it hard to have standard treatments in all study participants, says Andrew J Bach, DO, a physiatrist (a doctor specializing in diagnosing and treating physical disabilities) at the Cedars-Sinai Spine Center in Los Angeles.
Another issue in acupuncture studies is that it can be difficult to find a true placebo for comparison, Dr. Bach says. “Outcomes often depend on patient expectations and individual variation,” he explains.
In other words, if someone is predisposed to believe that acupuncture will help them, they may be more likely to report that it has in fact alleviated their pain.
It’s difficult, but not impossible, to have placebo-controlled acupuncture studies, says Karen W. Lin, MD, a family medicine doctor who uses acupuncture in her practice and a professor of family medicine and community health at the Rutgers Robert Wood Johnson Medical School in New Brunswick, New Jersey.
For research purposes, she says, scientists have invented replicas that closely resemble real needles but don’t penetrate the skin.
Why Could Acupuncture Ease Pain?
From an Eastern medicine perspective, acupuncture helps to “unblock the obstruction of energy channels along a pain pathway,” Dr. Lin says. From a Western medicine perspective, acupuncture needles may stimulate the release of neurotransmitters, which can help to work on pain pathways, she notes.
How acupuncture works is not fully understood, Dr. DeBar says. “There is evidence that it may have effects on the nervous system, on other body tissues, and nonspecific — placebo — effects,” she says. Some research suggests that acupuncture increases microcirculation (blood circulation in the smallest blood vessels) and thereby reduces inflammation in the body.
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“Acupuncture has been used for thousands of years for good reason,” Bach says. “Most physiatrists would agree that it can be a useful tool for managing pain. The ongoing question has been to what extent it helps and how strongly it should be recommended.”
Acupuncture Is Not Standard Care for Back Pain in the U.S.
The World Health Organization (WHO) lists acupuncture as a potential treatment for low back pain, noting that it’s probably more helpful than not.
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The Centers for Disease Control and Prevention (CDC) also lists acupuncture as a potential noninvasive, drug-free approach to treating chronic pain.
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But many U.S. health practitioners don’t regularly recommend acupuncture for low back pain. “In general, standard care for chronic low back pain starts with an expert evaluation by a specialist,” Bach says. “From there, treatment is typically individualized and often includes physical therapy, lifestyle and activity modifications, and, when appropriate, over-the-counter medications.”
A healthcare provider might consider options like acupuncture based on a patient’s needs and how well they do with the initial therapy, Bach says.
Acupuncture is eligible for Medicare coverage, but insurance coverage can be tricky. “In my experience, either most insurance companies don’t cover acupuncture, or acupuncturists don’t accept the insurance that does,” Bach says.
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Published in 2024, one study of more than 6.8 million Americans with low back pain found that fewer than 2 percent filed insurance claims for acupuncture treatment.
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Acupuncture Isn’t for Everyone, But It Can Be Helpful to Many
Not everyone should try acupuncture. “Patients who are afraid of needles may not be good candidates for acupuncture,” Bach says. “It should also be avoided in people who shouldn’t have their skin punctured, such as those with active infections like cellulitis.”
DeBar says the older adults in her study were “enthusiastic” about using acupuncture “and reported improved functioning that was sustained for many months.”
Overall, doctors say that acupuncture can be an excellent treatment option for most people with chronic low back pain. Lin stresses that it’s a good alternative to medication, injections, or surgery.
Bach agrees. “Acupuncture for chronic low back pain is definitely worth a try, especially if you have tried the standard treatments and failed to find much relief,” he says.
