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.:Archive of Internal Medicine Aritcle:.
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.:Archive of Internal Medicine Aritcle:. - September 24, 2007 11:32:02 PM
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jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
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Does anyone have access to the full text of the recent Arch of Internal Med article comparing accupunture and "western" medicine?
Vol. 167 No. 17, September 24, 2007
German Acupuncture Trials (GERAC) for Chronic Low Back PainRandomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups
Michael Haake, PhD, MD; Hans-Helge Müller, PhD; Carmen Schade-Brittinger; Heinz D. Basler, PhD; Helmut Schäfer, PhD; Christoph Maier, PhD, MD; Heinz G. Endres, MD; Hans J. Trampisch, PhD; Albrecht Molsberger, PhD, MD
Arch Intern Med. 2007;167:1892-1898.
Background To our knowledge, verum acupuncture has never been directly compared with sham acupuncture and guideline-based conventional therapy in patients with chronic low back pain.
Methods A patient- and observer-blinded randomized controlled trial conducted in Germany involving 340 outpatient practices, including 1162 patients aged 18 to 86 years (mean ± SD age, 50 ± 15 years) with a history of chronic low back pain for a mean of 8 years. Patients underwent ten 30-minute sessions, generally 2 sessions per week, of verum acupuncture (n = 387) according to principles of traditional Chinese medicine; sham acupuncture (n = 387) consisting of superficial needling at nonacupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n = 388). Five additional sessions were offered to patients who had a partial response to treatment (10%-50% reduction in pain intensity). Primary outcome was response after 6 months, defined as 33% improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale questionnaire or 12% improvement or better on the back-specific Hanover Functional Ability Questionnaire. Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement.
Results At 6 months, response rate was 47.6% in the verum acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group. Differences among groups were as follows: verum vs sham, 3.4% (95% confidence interval, –3.7% to 10.3%; P = .39); verum vs conventional therapy, 20.2% (95% confidence interval, 13.4% to 26.7%; P < .001); and sham vs conventional therapy, 16.8% (95% confidence interval, 10.1% to 23.4%; P < .001.
Conclusions Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.
I ask because MSNBC is running an article titled "Acupuncture - real or fake - best for back pain" using the results of this study. Already suspicious when the methodology is Accupunture vs "a combination of drugs, physical therapy, and exercise". Huh? PT and Exercise? Lovely. I just want to know if PT ends up being heat and massage.
I'm sure I'm going to get a patient or two asking me about this, and would like to be informed. Thanks.
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Jason L. Harris, PT, DPT
My PT Blog
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RE: .:Archive of Internal Medicine Aritcle:. - September 25, 2007 11:59:12 AM
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Synergy
Posts: 592
Joined: March 11, 2004
From: Texas
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Jason,
Interesting you posted this because I just saw this on my homepage. I doubt I'll have any patients query me regarding this article, but it would be nice to get a look at it if possible.
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Chris Adams, PT, MPT
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RE: .:Archive of Internal Medicine Aritcle:. - September 25, 2007 3:51:27 PM
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Sebastian Asselbergs
Posts: 1204
Joined: September 29, 1999
From: Barrie, Canada
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A warning: I think this was done in Germany, and much of their PT is quite a different idea than what we have here in North America. So, it may have been "hydrotherapy" with underwater massage, SWD, etc etc. I would LOVE to see the full text as well. Just to make sure.
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Mundi vult decipi
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RE: .:Archive of Internal Medicine Aritcle:. - September 25, 2007 4:37:01 PM
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jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
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Thanks for the information. What concerns me is MSNBC is reporting that this study seems to show accupuncture is the best to treat LBP vs "western" medicine. Forget that "western" medicine seems to have been all lumped together and not controlled in this study (as I can gather from the abstract), or that LBP responds better when catagorized, or that we don't know the definition of PT for this study.
If anyone does eventually get this full text, please let us know the specifics.
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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RE: .:Archive of Internal Medicine Aritcle:. - September 25, 2007 7:10:39 PM
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certMDT
Posts: 154
Joined: April 5, 2004
From: Durham, NC
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From the text:
1162 patients aged 18 to 86 years (mean±SD age, 50±15 years) with a history of chronic low back pain for a mean of 8 years. Patients underwent ten 30-minute sessions, generally 2 sessions per week, of verum acupuncture (n=387) according to principles of traditional Chinese medicine; sham acupuncture (n=387) consisting of superficial needling at nonacupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n=388).
Exclusion criteria
Treatment with needle acupuncture for low back pain at any time in the past
Treatment with needle acupuncture for any other indication within the last year
Sciatica or chronic pain from other disease
Only patients who had been therapy-free for at least 7 days were eligible for screening.
Patients in the conventional therapy group received a multimodal treatment program according to German guidelines.11
The guidelines provide the treating physician with recommendations about the treatment algorithm and assess the various
therapy forms according to the degree of evidence based on a literature search and recommendations of the specialist associations.
Conventional therapy included 10 sessions with personal contact with a physician or physiotherapist who administered
physiotherapy, exercise, and such.
The therapies given in the conventional group were physiotherapy (n=197; mean, 11.7 sessions
per patient), massage (n=180; mean, 9.5 sessions per patient), heat therapy (n=157; mean, 9.7 sessions per
patient), electrotherapy (n=65; mean, 8.8 sessions per patient), back school (ie, a practical education in the management
of back pain) (n=36; mean, 8.1 sessions per patient), injections (n=48; mean, 5.6 per patient), and guidance
(n=56; mean, 4.2 sessions per patient). In a few patients, therapies included infusions, yoga, hydrojet treatment,
and swimming.
My take:
This was a study performed on patients with "simple" (no sciatica) low back pain, with an average length of 8 years (chronic).
The subjects had not had acupuncture previously for back pain, but may have already undergone (unsuccesfully, if they are returning for additional treatment) physiotherapy. I couldn't find any specific mention of previous physiotherapy treatment.
The physio treatment was defined as following German guidelines, and may or may not have been performed by a physiotherapist (ie a doctor may have done the treatment). This treatment was obviously highly varied, and does not in any way indicate a cohesive treatment approach that could be replicated, or that one could reasonably label "physiotherapy".
It may well be that for people who have long-standing, chronic low back pain without lower extremity radiation, and who may have already failed with physiotherapy, inserting needles into the back (whether acupuncture or just random, superficial placement) is more effective in pain control than a variety of physiotherapy treatments.
I would elaborate on what the German physiotherapy guidelines, but I can't access the journals, und ich fershtehe nua ein bession Deutche. (Sorry, phonetic spelling only to those who can actually read and write in German.)
Charlie
< Message edited by certMDT -- September 25, 2007 7:14:00 PM >
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RE: .:Archive of Internal Medicine Aritcle:. - September 26, 2007 7:34:11 PM
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jlharris
Posts: 477
Joined: April 12, 2006
From: Nebraska
Status: offline
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Found the full text. Here is a link to the PDF if anyone else is interested: http://dcscience.net/haake-arch-int-med-2007.pdf
_____________________________
Jason L. Harris, PT, DPT
My PT Blog
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