No significant reduction in pain severity was found with electroacupuncture vs sham therapy for chronic low back pain in a double-blind, randomized clinical trial published in JAMA Network Open. There was, however, a greater reduction in back-specific disability in study participants who were randomized to receive electroacupuncture.
Patients with chronic low back pain (N=121) with a pain intensity of at least 4 on a 0-10-point scale and had received no acupuncture during the previous 3 years were recruited. Patients were randomized to receive either electroacupuncture (n=59) or sham (n=62) treatment that consisted of 12 sessions over 6 weeks in which patients received 30 minutes of either active or sham electrical stimulation after needle placement while in a prone position.
A total of 14 study participants withdrew from the study before completing 9 treatment sessions (electroacupuncture group n=6; sham group n=8). Withdrawal occurred due to scheduling conflicts, family emergencies, pain, or because they did not want to continue. Final study completion was achieved by 50 participants in the treatment group and 53 participants in the placebo group.
Study participants in the active and sham groups had a mean age of 46.8±11.9 and 45.6±12.8 years, respectively. In the active and sham groups, 61.0% and 53.2% were women, mean National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity T-scores were 50.49±3.36 and 51.71±4.79, and mean Roland Morris Disability Questionnaire (RMDQ) scores were 10-16±4.76 and 10.03±5.45, respectively.
At 2 weeks after study conclusion, T-scores decreased by -4.33 (95% CI, -6.36 to -2.30) among the treatment and -2.90 (95% CI, -4.85 to -0.95) among the sham groups. These score decreases were not significantly different (adjusted difference, -2.09; 95% CI, -4.27 to 0.09; P =.06).
RMDQ scores were more greatly reduced among the treatment group (-2.77; 95% CI, -4.11 to -1.43) than among the sham group (-0.67; 95% CI, -1.88 to 0.55) compared with baseline (adjusted difference, -2.11; 95% CI, -3.75 to -0.47; P =.01).
Of study participants in the electroacupuncture treatment group, 58.3% correctly guessed they were in the treatment group compared with 42.5% who correctly guessed they were in the placebo group. After correcting for the failure of blinding among the treatment group, the decrease in RMDQ score due to treatment remained significant (b, -2.23; 95% CI, -4.03 to -0.42; P =.02).
After removing a single outlier and correcting for blinding, T scores (b, -2.61; 95% CI, -4.90 to -0.33; P =.03) and RMDQ scores (b, -2.24; 95% CI, -4.07 to -0.41; P =.02) changed significantly from baseline among the electroacupuncture group.
The major limitation of this study was the choice to compare electroacupuncture vs acupuncture and not to include a true sham treatment in a third study arm.
The study authors concluded there was little evidence to support the use of electroacupuncture to alleviate chronic low back pain. These data did support, however, the use of electroacupuncture to improve disability associated with low back pain.
Kong J-T, Puetz C, Tian L, et al. Effect of electroacupuncture vs sham treatment on change in pain severity among adults with chronic low back pain. JAMA Netw Open. 2020;3(10):e2022787.