Acupresssure - pushing with the fingertips at the same body points used in acupuncture gave patients better, long-lasting relief for low back pain than conventional physical therapy, Taiwanese researchers report.
"Acupressure was effective in reducing low back pain in terms of disability, pain scores and functional status," doctors at the National Taiwan University reported in the current issue of the British Medical Journal. "The benefit was sustained for six months."
The researchers recruited 129 people with chronic low back pain from a specialist orthopedic clinic. All of them filled out a standard disability questionnaire before being assigned to one of two different treatment regimens, with 64 people receiving six sessions of acupressure and 65 receiving standard physical therapy.
"Acupressure conferred an 89 percent reduction in physical disability compared with physical therapy," the researchers reported. The people who got acupressure also scored better on measures of pain and had fewer days taken off from work or school, the researchers said.
However, they cautioned that the effectiveness of any manipulative therapy such as acupressure "is highly dependent on the therapist's technique and experience." All the people in this study received treatment from the same therapist, to eliminate any difference in the treatment given.
"We hope that this technique can be imparted to other therapists now that its efficacy has been shown in our study, so that acupressure can be used in other populations," they wrote. "How acupressure can be generalized to patients with low back pain is the subject of ongoing research."
Dr. Marcos Hsu is an acupuncture specialist at the University of Maryland Center for Integrative Medicine who got his training in acupuncture and acupressure at the Maryland Institute of Traditional Chinese Medicine. He called the Taiwan report "quite amazing," because the benefits persisted for so long. But he added that he would like more information on the causes of back pain in the people treated in the study.
Hsu said he routinely uses acupressure supplemented with acupuncture to treat low back pain. "I have seen good responses similar to those in the paper, but some people do not respond to it," he said. The response generally is good for musculoskeletal problems such as sprains, Hsu said, but when the pain is caused by problems with structural bones and tissues, as in arthritis, the treatment "may take longer to take effect."
Hsu's patients usually receive painkillers, as well, because "most people who come to us are on painkillers, so it is not advisable to stop," he said. Patients can have anywhere from five to 15 treatments, with pressure applied "by our thumbs, hands, wrists, knuckles, elbows, every joint we can use," Hsu said.
People seeking acupressure or acupuncture treatment for low back pain should be cautious whenever they seek out help, Hsu recommended. "Check their credentials first," he advised.
The Taiwan study does have some flaws, added Richard E. Harris, a research investigator in the rheumatology division of the University of Michigan Medical School, who has also done work on acupressure.
Harris said he'd like a more detailed account of the treatment given -- which acupressure points were pressed, for example. And he noted that the participants weren't blinded to the treatment they were given. Patients who got acupressure knew they were getting it, which might have influenced their response, Harris said.
Nonetheless, the report that acupressure seems to be better than physical therapy for back pain is significant and deserves follow-up, he said.
Specific Research Details:
Research Title: Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. Lisa Li-Chen Hsieh 1, Chung-Hung Kuo 2, Liang Huei Lee 3, Amy Ming-Fang Yen 1, Kuo-Liong Chien 1, Tony Hsiu-Hsi Chen 1*
1 Institute of Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
2 Hsin Kao Mei Orthopedic Special Clinic, Kaohsiung, Taiwan
3 Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
Objective: To evaluate the effectiveness of acupressure in terms of disability, pain scores, and functional status.
Design: Randomised controlled trial.
Setting: Orthopaedic clinic in Kaohsiung, Taiwan.
Participants: 129 patients with chronic low back pain.
Intervention: Acupressure or physical therapy for one month.
Main outcome measures: Self administered Chinese versions of standard outcome measures for low back pain (primary outcome: Roland and Morris disability questionnaire) at baseline, after treatment, and at six month follow-up.
Results: The mean total Roland and Morris disability questionnaire score after treatment was significantly lower in the acupressure group than in the physical therapy group regardless of the difference in absolute score (-3.8, 95% confidence interval -5.7 to -1.9) or mean change from the baseline (-4.64, -6.39 to -2.89). Acupressure conferred an 89% (95% confidence interval 61% to 97%) reduction in significant disability compared with physical therapy. The improvement in disability score in the acupressure group compared with the physical group remained at six month follow-up. Statistically significant differences also occurred between the two groups for all six domains of the core outcome, pain visual scale, and modified Oswestry disability questionnaire after treatment and at six month follow-up.
Conclusions: Acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status. The benefit was sustained for six months.
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