The reference is
DC Cherkin et al. A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain. Archives of Internal Medicine 2009 169: 858-866but evidence-based healthcare knowledge collater, Bandolier has written a plain, easy-to-digest synopsis of the paper here.
The study looked at four therapies; individualised acupuncture, standardised acupuncture, simulated acupuncture with toothpicks and lastly, usual care. From Bandolier:
This large trial involved 638 adults, with follow up of 90% or above up to 52 weeks. Participants had an average age of about 47 years, with about 60% being women. About 70% had back pain for at least a year. The average initial RMDQ score was about 10.5 on a 0-24 scale, and average initial bothersomeness score 5 on a 0-10 scale.
The main results were these:
* There was no difference between individualised acupuncture, standardised acupuncture, or sham acupuncture.
* RMDQ scores fell from 11 to 6 for acupuncture of any sort by 52 weeks, compared with 7.9 for usual care. Any form of acupuncture was better than usual care.
* Bothersomeness scores fell from 5 to 3-5 to 4 for all four groups, with no difference between them.
* Use of medications (about 65% at baseline) fell to 47% with acupuncture, but remained at 59% with usual care.
* There was no difference in SF-36 mental and physical component scores.
* Cutting down on usual activities for more than seven days in the last month at 52 weeks was more common with usual care (18%) than with acupuncture.
* More participants with usual care missed work or school for more than a day (16%) than with acupuncture (5%-10%).
* There was no difference in total costs of back related health services between groups ($160-$221), though costs of acupuncture were not included.
* Adverse events occurred in 12/315 with real acupuncture, compared with 0/162 for simulated acupuncture, with one serious adverse event for real acupuncture.
* One patient in the usual care group went on to have back surgery.
There are a few interesting things that came out of the study.
The difference between standard care and intervention is significant, and confirms previous discussions suggesting the more theatrical the intervention the larger the placebo effect.
Secondy, the cost comparison is interesting - no real cost difference, and indeed acupuncture costs weren't included. So even the 'cost effective' argument is unfounded.
Thirdly, adverse effects - one serious adverse effect and 12 lesser, compared with zero for the toothpicks. This means about 4% of the patients had an adverse effect from a treatment which had absolutely no demonstrable benefit compared to toothpickery.
So let's see: there's no patient benefit, no cost benefit and increased risk of adverse effects. So why are NICE approving it for lower backpain?
Perhaps I'll drop them a line.
(How long do you reckon it'll be before a quackupuncturist declares that this proves acupuncture works, and the toothpicks were "accidently" letting the Qi energy move as it should?)