MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Really? Acupuncture for chronic back Pain?

If you doubt it, the following announcement might amaze you:

In response to the U.S. opioid crisis, HHS is focused on preventing opioid use disorder and providing more evidence-based non-pharmacologic treatment options for chronic pain. The Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and that National Institutes of Health (NIH) are collaborating in this effort. The Agency for Healthcare Research and Quality published a systematic review of noninvasive, nonpharmacological treatment for chronic pain in June 2018 (https://effectivehealthcare.ahrq.gov/sites/default/files/cer-209-evidence-summary-non-pharma-chronic-pain.pdf). This review included assessment of several nonpharmacological interventions, including exercise, acupuncture, spinal manipulation, and multidisciplinary rehabilitation for CLBP. The NIH recently issued a Funding Opportunity Announcement for interested parties to apply to conduct an efficient, large-scale pragmatic trial to evaluate the impact of, and strategies to best implement, acupuncture treatment of older adults (65 years and older) with chronic low back pain. The announcement can be found here: https://grants.nih.gov/grants/guide/rfa-files/RFA-AT-19-005.html.

CMS is opening this national coverage analysis (NCA) to complete a thorough review of the evidence to determine if acupuncture for CLBP is reasonable and necessary under the Medicare program. CMS is soliciting public comment on this topic. We are particularly interested in comments that include scientific evidence and discuss appropriate clinicians and training requirements to provide acupuncture that improves health outcomes. In addition, for commenters recommending Coverage with Evidence Development, we are interested in comments related to appropriate outcomes and study designs. While CMS has conducted previous national coverage analyses on acupuncture, the scope of this current review is limited to acupuncture for chronic low back pain.

END OF QUOTE

The evidence whether acupuncture is effective for chronic back pain is far from clear. NICE recently stated that it no longer recommends acupuncture because the evidence is not strong. Others have shown that acupuncture is superior to sham as well as no acupuncture control for back pain, with differences between groups close to .5 SDs compared with no acupuncture control, and close to .2 SDs compared with sham. A further systematic review stated that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention.Yet another systematic review found that acupuncture for chronic nonspecific low back pain was associated with significantly lower pain intensity than placebo but only immediately post-treatment (VAS: -0.59, 95 percent CI: -0.93, -0.25). However, acupuncture was not different from placebo in post-treatment disability, pain medication intake, or global improvement in chronic nonspecific low back pain. Acupuncture did not differ from sham-acupuncture in reducing chronic non-specific neck pain immediately after treatment (VAS: 0.24, 95 percent CI: -1.20, 0.73). Acupuncture was superior to no treatment in improving pain intensity (VAS: -1.19, 95 percent CI: 95 percent CI: -2.17, -0.21), disability (PDI), functioning (HFAQ), well-being (SF-36), and range of mobility (extension, flexion), immediately after the treatment. In general, trials that applied sham-acupuncture tended to produce negative results (i.e., statistically non-significant) compared to trials that applied other types of placebo (e.g., TENS, medication, laser). Results regarding comparisons with other active treatments (pain medication, mobilization, laser therapy) were less consistent Acupuncture was more cost-effective compared to usual care or no treatment for patients with chronic back pain.

Confused?

Me too!

My reading of these and other papers is that acupuncture might have a small and probably not clinically relevant effects which is hard to differentiate from bias and confounding.

Is this enough for reimbursement from the public purse?

In my view, the answer is no.

I am sure that others will have different interpretations of the published evidence. If so, you have until 14 February to write to the CMS.

8 Responses to Acupuncture is effective for chronic back pain!!! If you disagree, tell the CMS

  • There is no reason to say more on the subject than what Novella / Colquhoun have concluded in 2013: Acupuncture is theatrical placebo. Why is the mill of “evaluating” acupuncture only repeatedly thrown up? And now even with attitude by the CMS?

    In Germany, the G-BA, the licensing agency for health insurance reimbursements, approved acupuncture for non-specific back and knee pain in 2006 on the basis of the GERAC studies (German Acupunctue Trias), but expressly NOT because evidence for acupuncture was seen as a method. The G-BA reported:

    “Although there is no clear evidence of the superiority of ‘real’ acupuncture, we have made a positive decision in the interest of patients and with regard to the care situation in pain therapy (written 2006!). The study results show that both “real” and sham acupuncture help better than standard therapy in the treatment of back and knee pain. Therefore, the G-BA has decided that patients should receive acupuncture treatment as a health insurance benefit.”

    Instead of putting acupuncture back on the map again, on the contrary it would be time to check the justification of this exceptional decision. Especially since this decision of the G-BA has always been marketed by interested parties as “evidence of acupuncture”.

    We see the same picture as with homeopathy: the matter is done, but it is still kept on the hot stove over and over again.

  • It’s interesting that the US seems to be more in favour of acupuncture than other countries. The Lancet low back pain series last year assessed three national guidelines and only the US one made recommendations in favour of acupuncture. I’ve written more about that here: https://complementaryandalternative.wordpress.com/2019/01/01/should-you-have-acupuncture-for-your-low-back-pain/ I wonder why there seems to be a more positive view in the US than the clear negative stance of e.g. NICE.

    • There is a little-known part of the brain—yes, unknown even among you medical professionals—that regulates decisions that, on the surface, seem silly but are actually quite dangerous.

      This part of the brain, called the cerebellar collapsum (located just northwest of the left eyeball), allows people to think, for example, that acupuncture works. It’s the same part of the brain that allowed Americans to vote for Trump. It seemed like a silly idea at the time but turned out to be quite dangerous.

      They didn’t teach you that in medical school, now did they?

  • Another country that pushes accupuncture is North Korea, with the sanctions, lack of reources and a cruel dictator, the people there have little else. Americans have been hoodwinked, duped and lied to. Quackery has been heavilily marketed online. Deceptive marketers even jump in on medical sites, peddlding their cures. The NIH allows “Accupuncture Studies’ to be posted on their site, and deceptive marketers point to that as proof. We havev not heard much about the “Battlefield Accupuncture Studies, they were touting a few years ago. With this form of deceptive marketing, they anounce a “Study” as if it is meaningfull. The accupuncture industry got some fairly credible academic institutions to endorse their work, wealthy foundations are generous when it comes to research money for nonsese.

    Accupuncture has already been peedled as cost saving. much less expensive than conventional medicine, and jsut as good, according to accupuncturists. The Chinese have played a big joke on us, and for them this is a profitable joke. Accupuncturists in my community are branching out, now that they have duped our state legialstors. They offer “Stem Cell Therapy” and Infusions. They target desperate people who have been failed by conventional medicine. Most succsesful accupuncturists are good salespeople, they know how to work a mark.

    In parts of the country, where there are not enough physicians, and underfunded healthcare, these quacks are presented as a solution.

  • People are suffering from various pains in the body. Main factor is the bad posture and we cannot forget stress also.
    People are resorting to non-invasive techniques. This includes physiotherapy, exercises. But recently Acupuncture is gaining popularity in pain management.
    Acupuncture, Acupressure are age-old traditional chinese medical techniques.
    I believe , if pain can be cured with these techniqyes then one can surely avoid the side effects of pain-relieving medicines-which are composition of chemicals.

    • Aniima Sur said:

      if pain can be cured with these techniqyes

      That ‘if’ just collapsed under the strain of the work you put it under.

    • Acupuncture is gaining popularity in pain management

      Popularity has very little to do with truth. Ask the advertising industry.

      if pain can be cured with these techniqyes then one can surely avoid the side effects of pain-relieving medicines

      And if it can’t?

      medicines-which are composition of chemicals

      As is everything else.

  • But recently Acupuncture is gaining popularity in pain management.

    It is actually the other way around. Acupncture has not proven itself in health care and is mostly abandoned as useless.

    I suggest admin remove the spammy link under the commenters name promoting a business venture.

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