Medical Acupuncture For Non-Radicular Low Back Pain: A Preliminary Investigation Of A Treatment Protocol And Outcome Measures

Medical Acupuncture For Non-Radicular
Low Back Pain: A Preliminary Investigation Of A Treatment Protocol And Outcome Measures
Michael Fredericson, MD
John Giusto, MD
Medical Acupuncture

ABSTRACT
Background Randomized controlled trials to date do not clearly indicate whether acupuncture is effective in the treatment of low back pain.
Objectives To find a more sensitive measure for evaluating the effectiveness of medical acupuncture, and to determine a reproducible treatment protocol for non-radicular low back pain.
Design, Setting, and Patients Case series at Stanford University Physical Medicine Clinic, including 5 patients with sub-acute, non-radicular low back pain, all of whom had not improved after at least 6 weeks of standard physical therapy.
Intervention Six treatments of medical acupuncture supplementing continued physical therapy.
Main Outcome Measures Visual analog scale, Oswestry Questionnaire, Short Form-36 Questionnaire Global Health Survey (SF-36), and the Patient-Generated Index (PGI) for low back pain.
Results In a relatively high-functioning patient population, the Oswestry Questionnaire did not reflect clinical improvements, whereas the SF-36 and visual analog scale, in combination with the newer PGI, appeared to be more sensitive to treatment effects.
Conclusions This study suggests a combination of outcome measures more sensitive for determining the usefulness of medical acupuncture for non-radicular low back pain. It also defines a modular treatment protocol for a reproducible approach to the range of conditions contributing to low back pain in an outpatient clinic setting.
KEY WORDS
Acupuncture, Low Back Pain, Outcome Assessment, Visual Analog Scale, Oswestry Questionnaire, Short Form-36 Questionnaire Global Health Survey (SF-36), Patient-Generated Index (PGI)

INTRODUCTION
Non-radicular low back pain does not reliably respond to epidural steroids,1 intradural steroids,2 or facet injections,3 and is rarely considered an indication for surgery. Although there is interest in the use of intradiscal therapy (electrothermal heating of the annulus) for discogenic pain confirmed by discography, the results of this treatment are still preliminary, the treatment is invasive, and long-term consequences are unknown. Investigation is necessary into other treatments for non-radicular low back pain, whether from disc, facet joint, ligamentous, or soft tissue pathology.

Despite the historical use of acupuncture to treat low back pain and the increasing interest in its applicability in the United States, acupuncture for the common clinical entity of non-radicular low back pain is not well studied in Western medical literature. A recent review4 of 11 randomized controlled trials did not clearly indicate acupuncture's effectiveness in the treatment of low back pain. Some of the problems in the studies included limited information on the training of acupuncturists, a lack of detailed description of the points needled or the frequency and duration of acupuncture treatment, and an inability to define which types of low back pain best respond to acupuncture.

The purposes of our study were to gain experience in the use of a modular treatment protocol and to determine which outcome measures might be sensitive to the effects of this treatment in non-radicular low back pain.

METHODS
The study was approved by the Stanford University Investigations Review Board, and all subjects signed informed consent prior to beginning the study.

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