Toothpicks: An effective treatment for lower-back pain?

People suffering from chronic low back pain who received acupuncture or simulated acupuncture treatments had better results than those receiving only conventional care, according to a study published this week in the Archives of Internal Medicine.

In this trial of more than 600 adults with chronic lower-back pain who had never had acupuncture, folks were divided up and assigned to receive one of four treatments:

• individualized acupuncture, involving a customized prescription for acupuncture points from a diagnostician;
• standardized acupuncture, using a single prescription for acupuncture points that experts consider generally effective for chronic low back pain;
• simulated acupuncture, which mimics needle acupuncture with toothpicks but does not involve actual penetration of the skin; or
• conventional care, which mostly involved medications, primary care, and physical therapy visits.

After eight weeks of treatment, the patients receiving the three forms of acupuncture all improved significantly more than the patients receiving conventional care. And there was no significant difference between the groups receiving the needle and the toothpick acupuncture.

This study "raises important questions about acupuncture’s mechanisms of action," says lead researcher Daniel Cherkin, Ph.D. of Group Health Center for Health Studies in Seattle. And Josephine P. Briggs, M.D., director of the National Center for Complementary and Alternative Medicine (NCCAM) says "This adds to the growing body of evidence that there is something meaningful taking place during acupuncture treatments outside of actual needling. Future research is needed to delve deeper into what is evoking these responses."

But why did the patients in this study respond so well to toothpicks? "Touch is a complex interaction that involves a completely different approach to a person," says John Santa, M,D, M.P.H., director of the Consumer Reports Health Ratings Center. Our recent lower-back pain survey supports the benefits of a variety of back treatments that involve touch. Chiropractic, acupuncture, massage, physical therapy and injections into the back were all more likely to result in improvement than strategies not involving touch. "When a practitioner touches a patient, they enter a zone that we prefer most people to stay out of. Successful touch involves mutual trust, reassurance, confidence and relationships that each may help to relieve symptoms," says Santa. "The acupuncture study recently published reinforces how important touch can be in a healing relationship."

—Ginger Skinner

Image: Gaetan Lee

Comments

[Nancy Landa]

The first thing I thought of when I saw the title to this post is, "well, that kinda makes sense; sort of like the affects of acupuncture." I have the greatest respect for acupuncture as a therapy to relive pain, though I think it is a bit of a stretch to use toothpicks instead of the needles. Acupuncturists go through in-depth training to learn the proper technique. I doubt they would ever use toothpicks!

~Nancy Landa

[George]

This cure seems really very interesting, but i have doubt whether this is a permanent cure or a temporary one where the pain recurs within a certain period of time.

[henry Robinson]

I started having chronic back pain in late January 1970 after a shell blast blew me off a 15 ft high bunker while in Vietnam. The result was, after my right leg and broken right hip mended, the right leg healed 1" shorter than the left leg and manifested chronic pain from L4-L5, and random upper back spasms for the next 37 years. Othodics, specialized excersize, and daily strectching eliminated my limp, imbalance problems, and reduced chronic pain to a"5" with 10 being the highest.

In May of 2007 at age 63, a large van with an uninsured driver ran a redlight at 35 mph and smashed into my left side door fracturing my hip bones and the sacrum in many places.

Pain was "10" for 5 months and I managed to rid myself of the walker and use a cane. Drugs given were vicadin, ultram, and muscle relaxers.

A year after the accident and a year of western medicine theraphy - shots, rehab, etc. pain had ebbed to a chronic "8", my general practitioner recommended a MD that does accupuncture. The first treatment changed my pain index to a"4" and after 2 more treatments reduced it to a "2".

Accupuncture works! I do not think it has anything to do with a placebo effect. I was sketical before the treatment and now, a year after the treatment, I am still waiting for the treatment to fail as are the pharmacists who are missing my purchase of 5 precriptions for pain/inflammation/relaxation drugs.

More good news is that I do longer need orthodics. I can were regular shoes (I prefer the Finn brand). The hit on the right hip in 2007 corrected the negative effects of the 1970 war injury.

[pain757]

These are the Top 7 non-surgical, natural options for chronic back pain relief: 1. Cognitive behavior psychotherapy 2. Exercise therapy 3. Chiropractic treatment for spinal manipulation 4. Acupuncture 5. Massage 6. Yoga 7. Progressive relaxation techniques

[Hugh Ginn]

This study confirms nothing but the placebo effect. Indeed it proves that poking needles into magic points is no different from tickling someone with a toothpick. Why is this study so misinterpreted by responsible organizations like Consumer Reports?

[eskipper]

Even if a person's back pain is from a physical injury, stress causes that pain to intensify because stress causes our muscles to tighten up. Chronic pain should always be investigated, because letting a back injury go untreated could cause it to intensify or deteriorate furtner. Been there--done that!

[Ailu]

@ Michael: I believe that what you are saying is true in many cases, but certainly not all. I had severe lower back pain for a couple of years before I finally realized that wearing high heeled shoes was the cause of my problem. Dumped the heels, no more back pain. But I do have a friend that by dealing with their stress, was able to eliminate their lower back pain. So it's important to investigate the cause, in order to come up with the correct solution.

[Ivan]

What is teh URL for Dr. Sarno's website?

[Michael]

Dr. John Sarno has determined that chronic lower back pain is stress related. Once a patient "gets it," the pain disappears. Many doctors or chiropractors will show the patient an x-ray showing a spot where the pain comes from. What they don't tell the patient is that millions of others have the same spot on their x-rays and suffer no pain whatever. Anyone with chronic pain that is not related to a physical injury should investigate Sarno's "mind-body connection." He has a website. The best part of this treatment is that there are no drugs, no exercises, no doctors, no books; Nothing except an understanding of where the pain is coming from.