Acupuncture provides pain relief, functional recovery in lumbar spinal stenosis

Patients with degenerative lumbar spinal stenosis may find pain relief as well as functional recovery from acupuncture, but current evidence is lacking to support the recommendation that acupuncture provides clinical benefits as compared with noninsertive sham acupuncture, according to a study.

“Eight-week treatment of acupuncture demonstrated clinically relevant benefits for patients with degenerative lumbar spinal stenosis, including reducing disability and pain intensity, as well as physical function,” the researchers said.

This study randomized 80 patients aged >50 years to either the acupuncture group or the noninsertive sham acupuncture for 24 treatment sessions over an 8-week period. The researchers obtained measurements at baseline and 4 and 8 weeks of treatment, and 3 and 6 months after completion of treatment.

The primary outcome of mean changes in the Roland Morris Disability Questionnaire (RMDQ) at the end of treatment were –4.1 (95 percent confident interval [CI], –4.9 to –3.3) in the acupuncture group and –1.5 (95 percent CI, –2.3 to –0.7) in the sham group, with a statistically significant between-group difference of –2.6 (95 percent CI, –3.7 to –1.4). [Am J Med 2020;133:500-507.E20]

“Although changes of RMDQ score at week 8, both within the acupuncture group as well as between groups, were greater than the predefined 2.25-point minimal clinically important difference (MCID), the lower limit of 95 percent CI crossed into the area of MCID,” the researchers noted. “Thus, the true effect of acupuncture on the primary outcome cannot be ascertained.” [Spine 2000;25:3115-3124]

Nonetheless, acupuncture proved to be superior to sham acupuncture in reducing pain intensity (between-group difference: –2.9, 95 percent CI, –3.8 to –2.0 in leg and buttock pain vs –2.3, 95 percent CI, –3.0 to –1.5 in back pain), symptoms and dysfunction (between-group difference: –0.9, 95 percent CI, –1.2 to –0.6 in symptom subscale and –0.8, 95 percent CI, –1.1 to –0.5 in dysfunction subscale).

“We also found that an average of 12 acupuncture sessions was associated with the ideal treatment effect with respect to the RMDQ scores,” the researchers said.

Of note, a previous study found a potential dose–response relationship in acupuncture treatment. The average number of acupuncture sessions in other studies varied from three to 12, while the current study increased it to 24 sessions and extended follow-up to 6 months. [Acupunct Med 2008;26:111-120]

Earlier clinical trials also reported the clinical effectiveness of acupuncture for lumbar spinal stenosis or chronic low back pain. [Acupunct Med 2016;34:267-274; BMJ 2010;340:c332; Arch Intern Med 2007;167:1892-1898]

In a 2013 meta-analysis, results showed that acupuncture as a standalone treatment or as co-treatment with other conservative therapies was more effective than the control intervention in reducing pain intensity, improving overall symptoms, functional outcomes and quality of life. [Complement Ther Med 2013;21:535-556]

“Future studies should take the specific study populations into consideration,” the researchers said. “In addition, although the follow-up rate was satisfactory at 3 and 6 months, the out-of-trial therapies might confound the long-term effects, especially in the sham group.”