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| Low Back Pain • Clin J Pain. 2005 Sep-Oct;21(5):406-11. |
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September 1, 2005 |
| Author / Title |
A Comparison of Physician and Nonphysician Acupuncture Treatment For Chronic Low Back Pain / Kalauokalani D, Cherkin DC, Sherman KJ. |
| Abstract |
BACKGROUND:: Although up to a third of the 10,000 acupuncturists in the United States are medical doctors, little is known about the acupuncture techniques they use or how their practices compare with those of nonphysician licensed acupuncturists. This is the first study providing descriptive data on physician acupuncture and comparison to nonphysician acupuncture. PURPOSE:: This study describes how a random sample of physician acupuncturists in the United States diagnose and treat chronic low back pain and contrasts their practices with those of nonphysician licensed acupuncturists. METHODS:: A total of 464 questionnaires were mailed to physician acupuncturists randomly sampled from 3 sources: web-based Yellow Pages, American Academy of Medical Acupuncturists (AAMA) membership, and Pain Clinics associated with American College of Graduate Medical Education-approved fellowship programs. Responses (n = 137, 30%) were analyzed using descriptive statistics. The results of this survey were compared with data published from a similar survey of nonphysician licensed acupuncturists in Washington State. RESULTS:: Physicians who perform acupuncture use a mixture of styles and emphasize neuroanatomic approaches to needle placement. Most physicians received training in French Energetic acupuncture. In contrast, most nonphysician licensed acupuncturists use a traditional Chinese medicine approach to needle placement. Despite this apparent difference in their predominant styles of acupuncture, there was a high correlation between physician and nonphysician licensed acupuncturist acupoint selection to treat low back pain. In addition to acupuncture needling, physicians use other medical treatments, whereas nonphysician licensed acupuncturists' employ a variety of traditional Chinese medicine adjuncts to needling. CONCLUSION:: This study provides new information about the nature of physician acupuncture practice in the United States and how it compares to acupuncture provided by nonphysician licensed acupuncturists. Further research is necessary to determine if the different types of acupuncture provided by physicians and nonphysician acupuncturists affect treatment outcomes and costs for patients with chronic low back pain. |
| Conclusion |
This study provides new information about the nature of physician acupuncture practice in the United States and how it compares to acupuncture provided by nonphysician licensed acupuncturists. Further research is necessary to determine if the different types of acupuncture provided by physicians and nonphysician acupuncturists affect treatment outcomes and costs for patients with chronic low back pain. |
| Local |
Department of Anesthesia and Pain Medicine, University of California, Davis Medical Center, Sacramento, California 95817, USA. dkalauokalani@ucdavis.edu |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16093746&query_hl=1 |
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| Low Back Pain • Health Technol Assess. 2005 Aug;9(32):1-126. |
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August 1, 2005 |
| Author / Title |
Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. / Thomas KJ, Macpherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, Fitter M, Roman M, Walters S, Nicholl JP. |
| Abstract |
OBJECTIVES: To test whether patients with persistent non-specific low back pain, when offered access to traditional acupuncture care alongside conventional primary care, gained more long-term relief from pain than those offered conventional care only, for equal or less cost. Safety and acceptability of acupuncture care to patients, and the heterogeneity of outcomes were also tested. DESIGN: A pragmatic, two parallel group, randomised controlled trial. Patients in the experimental arm were offered the option of referral to the acupuncture service comprising six acupuncturists. The control group received usual care from their general practitioner (GP). Eligible patients were randomised in a ratio of 2:1 to the offer of acupuncture to allow between-acupuncturist effects to be tested. SETTING: Three non-NHS acupuncture clinics, with referrals from 39 GPs working in 16 practices in York, UK. PARTICIPANTS: Patients aged 18-65 years with non-specific low back pain of 4-52 weeks' duration, assessed as suitable for primary care management by their general practitioner. INTERVENTIONS: The trial protocol allowed up to ten individualised acupuncture treatments per patient. The acupuncturist determined the content and the number of treatments according to patient need. MAIN OUTCOME MEASURES: The Short Form 36 (SF-36) Bodily Pain dimension (range 0-100 points), assessed at baseline, and 3, 12 and 24 months. The study was powered to detect a 10-point difference between groups at 12 months post-randomisation. Cost--utility analysis was conducted at 24 months using the EuroQoL 5 Dimensions (EQ-5D) and a preference-based single index measure derived from the SF-36 (SF-6D). Secondary outcomes included the McGill Present Pain Index (PPI), Oswestry Pain Disability Index (ODI), all other SF-36 dimensions, medication use, pain-free months in the past year, worry about back pain, satisfaction with care received, and safety and acceptability of acupuncture care. RESULTS: A total of 159 patients were in the 'acupuncture offer' arm and 80 in the 'usual care' arm. All 159 patients randomised to the offer of acupuncture care chose to receive acupuncture treatment, and received an average of eight acupuncture treatments within the trial. Analysis of covariance, adjusting for baseline score, found an intervention effect of 5.6 points on the SF-36 Pain dimension [95% confidence interval (CI) -1.3 to 12.5] in favour of the acupuncture group at 12 months, and 8 points (95% CI 0.7 to 15.3) at 24 months. No evidence of heterogeneity of effect was found for the different acupuncturists. Patients receiving acupuncture care did not report any serious or life-threatening events. No significant treatment effect was found for any of the SF-36 dimensions other than Pain, or for the PPI or the ODI. Patients receiving acupuncture care reported a significantly greater reduction in worry about their back pain at 12 and 24 months compared with the usual care group. At 24 months, the acupuncture care group was significantly more likely to report 12 months pain free and less likely to report the use of medication for pain relief. The acupuncture service was found to be cost-effective at 24 months; the estimated cost per quality-adjusted (QALY) was 4241 pounds sterling (95% CI 191 pounds sterling to 28,026 pounds sterling) using the SF-6D scoring algorithm based on responses to the SF-36, and 3598 pounds sterling (95% CI 189 pounds sterling to 22,035 pounds sterling) using the EQ-5D health status instrument. The NHS costs were greater in the acupuncture care group than in the usual care group. However, the additional resource use was less than the costs of the acupuncture treatment itself, suggesting that some usual care resource use was offset. CONCLUSIONS: Traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain. Acupuncture care and usual care were both associated with clinically significant improvement at 12- and 24-month follow-up. Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up. No benefits relating to function or disability were identified. GP referral to a service providing traditional acupuncture care offers a cost-effective intervention for reducing low back pain over a 2-year period. Further research is needed to examine many aspects of this treatment including its impact compared with other possible short-term packages of care (such as massage, chiropractic or physiotherapy), various aspects of cost-effectiveness, value to patients and implementation protocols. |
| Conclusion |
Traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain. Acupuncture care and usual care were both associated with clinically significant improvement at 12- and 24-month follow-up. Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up. No benefits relating to function or disability were identified. GP referral to a service providing traditional acupuncture care offers a cost-effective intervention for reducing low back pain over a 2-year period. Further research is needed to examine many aspects of this treatment including its impact compared with other possible short-term packages of care (such as massage, chiropractic or physiotherapy), various aspects of cost-effectiveness, value to patients and implementation protocols. |
| Local |
School of Health and Related Research (ScHARR), University of Sheffield, UK. |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=16095547&query_hl=1 |
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| Low Back Pain • Acupunct Med. 2004 Dec;22(4):189-202. |
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December 1, 2004 |
| Author / Title |
Low back pain assessment for the medical acupuncturist. / Cummings M. |
| Abstract |
Low back pain frequently presents to medical acupuncturists, many of whom are general practitioners working in the public sector. Under these circumstances there is often limited time to devote to an initial assessment of a patient's presenting complaint. This paper presents an assessment process that is aimed at informing management decisions for medical acupuncturists, although much of the process may be useful to a wider range of practitioners. The assessment is divided into an initial screening procedure, and a further more detailed assessment. The initial screening procedure can usefully be applied in a brief consultation. Using this assessment tool, practitioners with medical acupuncture training will be able to select the cases most likely to be helped by their acupuncture skills. |
| Conclusion |
Using this assessment tool, practitioners with medical acupuncture training will be able to select the cases most likely to be helped by their acupuncture skills. |
| Local |
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| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15628776&query_hl=5 |
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| Low Back Pain • Clin J Pain. 2003 Nov-Dec;19(6):364-70. |
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November 1, 2003 |
| Author / Title |
Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. / Kerr DP, Walsh DM, Baxter D. |
| Abstract |
OBJECTIVE: To assess the efficacy of acupuncture in the treatment of chronic low back pain. METHODS: Patients (n = 60) with chronic low back pain were recruited and randomly allocated to either Acupuncture therapy or Placebo transcutaneous electrical nerve stimulation (TENS) groups. Patients were treated weekly for 6 weeks, and blinded assessments were carried out pre- and post-treatment using the McGill Pain Questionnaire (MPQ) and visual analog scales (VAS) for pain, the Short-form 36 quality-of-life questionnaire, and a simple range of motion measurement. A total of 46 patients completed the trial and were followed up at 6 months. RESULTS: Analysis of results using t tests showed that in both groups there were significant pre-post improvements for all scores, except for MPQ scores in the Placebo-TENS group. There was no significant difference between the 2 groups for any of the outcome measures at the end of treatment. Results from the 6-month follow-up would suggest that the response was better in the acupuncture group. DISCUSSION: Further research is necessary to fully assess the efficacy of this treatment in combating chronic low back pain using larger sample sizes or alternative control groups. |
| Conclusion |
Further research is necessary to fully assess the efficacy of this treatment in combating chronic low back pain using larger sample sizes or alternative control groups. |
| Local |
Rehabilatation Sciences Research Group, School of Rehabilitation Sciences, University of Ulser at Jordanstown, County Antrim, Northern Ireland. |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14600536&query_hl=7 |
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| Low Back Pain • Spine J. 2003 Nov-Dec;3(6):442-50. |
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November 1, 2003 |
| Author / Title |
Compliance with clinical practice guidelines in family physicians managing worker's compensation board patients with acute lower back pain. / Bishop PB, Wing PC. |
| Abstract |
BACKGROUND CONTEXT: Family physician compliance with acute lower back pain clinical practice guidelines remains uncertain. PURPOSE: To determine the degree of guideline compliance of family physicians managing patients with workers' compensation claims and acute mechanical lower back pain. STUDY DESIGN: Observational study. PATIENT SAMPLE: One hundred thirty-nine family physicians in British Columbia. OUTCOME MEASURES: Compliance with guideline recommendations for history, examination procedures, diagnostic testing and treatments. METHODS: Physician workers' compensation board patient reports for acute lower back pain without leg symptoms and not greater than 2 to 3 weeks duration were scored for guideline adherence up until 12 weeks after onset. RESULTS: Physicians demonstrated a high degree of compliance with the guideline-recommended history, examination procedures and medications, but low compliance with recommended imaging and many treatment recommendations. CONCLUSIONS: Recently published clinical practice guidelines regarding the management of patients with acute mechanical lower back pain have not been fully implemented into the patterns of practice of the family physicians. |
| Conclusion |
Recently published clinical practice guidelines regarding the management of patients with acute mechanical lower back pain have not been fully implemented into the patterns of practice of the family physicians. |
| Local |
Combined Neurosurgical and Orthopaedic Spine Program, Heather Pavilion, Vancouver General Hospital, Vancouver, BC, Canada. |
| Web |
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=14609688&query_hl=1 |
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