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Open Access Highly Accessed Research article

Characteristics of patients with chronic back pain who benefit from acupuncture

Karen J Sherman1*, Daniel C Cherkin1, Laura Ichikawa1, Andrew L Avins2, William E Barlow13, Partap S Khalsa4 and Richard A Deyo5

Author Affiliations

1 Group Health Research Institute, Seattle, USA

2 Division of Research, Northern California Kaiser Permanente, Oakland, USA

3 Cancer Research and Biostatistics, Seattle, USA

4 Division of Extramural Research and Training, National Center for Complementary and Alternative Medicine, National Institutes of Health, Bethesda, USA

5 Deparment of Family Medicine, Oregon Health and Science University, Portland, USA

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BMC Musculoskeletal Disorders 2009, 10:114  doi:10.1186/1471-2474-10-114

Published: 21 September 2009

Abstract

Background

Although many clinicians believe there are clinically important subgroups of persons with "non-specific" low back pain, such subgroups have not yet been clearly identified. As part of a large trial evaluating acupuncture for chronic low back pain, we sought to identify subgroups of participants that were particularly responsive to acupuncture.

Methods

We performed a secondary analysis of data for the 638 participants in our clinical trial comparing different types of acupuncture to usual care to identify baseline characteristics that predicted responses to individualized, standardized, or simulated acupuncture treatments. After identifying factors that predicted improvements in back-related function or symptoms, we determined if these factors were more likely to predict improvement for those receiving the acupuncture treatments than for those receiving usual care. This was accomplished by testing for an interaction between the prognostic factors and treatment group in four models: functional outcomes (measured by the Roland-Morris Disability Scale) at 8 and 52 weeks post-randomization and symptom outcomes (measured with a numerical rating scale) at 8 and 52 weeks.

Results

Overall, the strongest predictors of improvement in back function and symptoms were higher baseline levels of these measures, receipt of an acupuncture treatment, and non-use of narcotic analgesics. Benefit from acupuncture compared to usual care was greater with worse pre-treatment levels of back dysfunction (interaction p < 0.004 for the functional outcome, Roland Morris Disability Scale at 8 weeks). No other consistent interactions were observed.

Conclusion

This secondary analysis found little evidence for the existence of subgroups of patients with chronic back pain that would be especially likely to benefit from acupuncture. However, persons with chronic low back pain who had more severe baseline dysfunction had the most short-term benefit from acupuncture.