Acupuncture - no longer a pain in the neck

A study by a team of researchers at the University of Southampton has revealed that Western style acupuncture can be effective in treating chronic neck pain. Moreover its beneficial effects may be as much to do with the non-specific but powerful effects of the treatment process as the specific effect of the needles. The results of the study are set out in a paper that appears in the Annals of Internal Medicine on 21 December 2004.

Chronic neck pain presents a substantial problem and may be responsible for as many days' absenteeism as low back pain. It is usually associated with unspecific degenerative changes such as osteoarthritis.

Acupuncture is the most frequently used complementary and alternative medicine (CAM) therapy for the treatment of osteoarthritis, with approximately one million people in the USA seeking CAM treatment each year. However, despite this huge increase in popularity and use, there has been little sound evidence to date that acupuncture helps patients with chronic neck pain.

Led by Dr Peter White and Dr George Lewith of the University's Complementary Medicine Research Unit, this new study aimed to evaluate whether 'Western style' acupuncture is an effective treatment for chronic neck pain. 'Western style' acupuncture involves a conventional diagnosis followed by the use of an individualised acupuncture treatment using a combination of prescriptive points. In contrast, a traditional Chinese approach formulates an individualised diagnosis based on Chinese theories of meridians and energy.

A total of 124 patients with chronic neck pain aged between 18 and 80 years took part in the study. Patients received eight treatments over four weeks having been randomly assigned either acupuncture or mock stimulation to acupuncture points by the same therapist.

Patients were only allowed to use paracetamol for pain relief and were not allowed to undertake any other forms of treatment - even exercises or stretches - during the study or for two months afterwards. During the treatment all patients kept a diary to record pain and also completed questionnaires before, during and after their treatment to assess ease of movement and quality of life.

The results show acupuncture was effective at reducing neck pain and produced a statistically but not a clinically significant effect when compared to the mock treatment or placebo.

Over the 12 weeks of assessment, patients from both groups reported a similar and significant decrease in pain levels of over 60 per cent. The number of patients taking paracetamol also fell, as did the average number of tablets taken by patients. Interestingly, the study also showed that female patients tended to respond better than males and further research is required to establish whether there is a real difference in response in the sexes.

The results of the study cannot be generalised because only one therapist treated all the patients; more information would be gained by using several therapists. It is also impossible to identify whether treating patients with a traditional Chinese medicine-based approach might produce a different outcome so the research team cannot comment on the 'best' type of acupuncture.

Dr Lewith comments: "Our rigorous and methodologically sound study clearly shows that there was significant and long lasting improvement for both treatment groups. The implications for this are two-fold. First, acupuncture was clearly very effective at reducing pain, with patients experiencing large decreases over a prolonged period which would recommend its clinical use. Second, our study also implies that most of the improvement gained from acupuncture was not due to the needling process itself but due predominantly to the non-specific yet powerful effects which are probably part of the treatment process."