Back pain diagnosis and management tools

Pain relief with acupuncture is unaffected by needle location or penetration
Pain relief with acupuncture is unaffected by needle location or penetration
An effective and relatively quick method for zeroing in on the root of back pain coupled with new findings about acupuncture treatment could help clinicians better manage this common complaint from patients.

The Standardized Evaluation of Pain (StEP), a 10- to 15-minute assessment, uses six questions and 10 physical tests to discriminate between neuropathic and other causes of pain (PLoS Med. 2009;6: e1000047). While under development, StEP identified radicular pain patients with 92% sensitivity and 97% specificity.

“The treatments for neuropathic and non-neuropathic pain are quite different,” explains lead author Joachim Scholz, MD, assistant professor of anesthesia at Harvard Medical School in Boston. “If a diagnosis is wrong, patients may receive treatment that does not improve their pain. We showed that StEP is a valuable diagnostic tool for low back pain.”

Once the cause of pain has been established, consider recommending acupuncture. A study funded by NIH's National Center for Complementary and Alternative Medicine compared acupuncture, simulated acupuncture, and usual care in 638 adults with chronic low back pain (Arch Intern Med. 2009;169:858-866). Participants (none of whom had undergone acupuncture before) were assigned to one of four groups:
  • 157 patients underwent 10 individualized acupuncture treatments with needle placement as prescribed by a diagnostic acupuncturist.
  • 158 underwent a standardized course of acupuncture.
  • 162 underwent 10 sessions of simulated acupuncture (needle insertion was mimicked using a toothpick inside an acupuncture needle guide tube).
  • 161 underwent usual care (non-study-related care—mostly medications, primary care, and physical therapy).
After seven weeks, dysfunction scores were significantly improved in all three acupuncture groups. No significant difference was seen between the needle-acupuncture and the simulated-acupuncture groups, indicating that the effectiveness of acupuncture in relieving low back pain does not rely on tailoring the needling sites to an individual patient or penetrating the skin.

“These findings raise questions about acupuncture's purported mechanisms of action,” note the study authors. “It remains unclear whether acupuncture or our simulated method of acupuncture provides physiologically important stimulation or represents placebo or nonspecific effects.”
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