Standardized versus Individualized Acupuncture for Chronic Low Back Pain: A Randomized Controlled Trial

Daniel Pach, Xiaoli Yang-Strobel, Rainer Lüdtke, Stephanie Roll, Katja Icke, Benno Brinkhaus, Claudia M Witt, Daniel Pach, Xiaoli Yang-Strobel, Rainer Lüdtke, Stephanie Roll, Katja Icke, Benno Brinkhaus, Claudia M Witt

Abstract

We aimed to compare the effectiveness of standardized and individualized acupuncture treatment in patients with chronic low back pain. A single-center randomized controlled single-blind trial was performed in a general medical practice in Germany run by a Chinese-born medical doctor trained in western and Chinese medicine. One hundred and fifty outpatients with chronic low back pain were randomly allocated to two groups (78 standardized and 72 individualized acupuncture). Patients received either standardized acupuncture or individualized acupuncture. Treatment encompassed between 10 and 15 treatments based on individual symptoms with two treatments per week. The main outcome measure was the area under the curve (AUC) summarizing eight weeks of daily rated pain severity measured with a visual analogue scale (0 mm = no pain, 100 mm = worst imaginable pain). No significant differences between groups were observed for the AUC (individualized acupuncture mean: 1768.7 (95% CI, 1460.4; 2077.1); standardized acupuncture 1482.9 (1177.2; 1788.7); group difference, 285.8 (-33.9; 605.5) P = 0.080). In this single-center trial, individualized acupuncture was not superior to standardized acupuncture for patients suffering from chronic pain. As a next step, a multicenter noninferiority study should be performed to investigate whether standardised acupuncture treatment for chronic low back pain might be applicable in a broader usual care setting. This trial is registered with ClinicalTrials.gov NCT00758017.

Figures

Figure 1
Figure 1
Recruitment, treatment, and follow-up of patients with chronic low back pain.
Figure 2
Figure 2
Mean symptom severity VAS of daily data over 8 weeks, nonadjusted data. Dashed lines represent the borders of the area under the curve.
Figure 3
Figure 3
Mean (with 95% confidence interval) pain intensity over the last 7 days (VAS) at week 8 and at week 26, nonadjusted data. At baseline, VAS was different between both groups (0.014), but not for the latter time points.

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