Survey data indicate that back pain is one of the most common reasons for referral to acupuncturists. Even though several plausible mechanisms may explain the efficacy of treatment with acupuncture, reviews of published data on the benefits of using acupuncture are inconclusive. Ernst and White performed a meta-analysis of randomized, controlled trials that evaluated acupuncture in the treatment of back pain.

The adequacy of the acupuncture therapies cited was assessed by six consulting acupuncturists. Although 12 studies were available for analysis, only nine provided suitable data, according to strict criteria that included outcome measures. There was no heterogeneity among the studies and the expert acupuncturists held divergent opinions about the adequacy of the treatments in nearly all the studies.

A total of 377 patients with chronic back pain or those who had failed to respond to conventional therapy had been recruited for the studies. Only two studies excluded patients with previous back surgery. Thus, the majority of patients were associated with a poor prognosis, and treatment would have been considered a challenge at best. In three studies, the outcome was markedly more positive than in the other studies. The lack of uniformity in the inclusion criteria, acupuncture approach, setting and end points could not account for the divergence of the data. Collectively, these data suggested that acupuncture is an effective treatment for back pain. The fact that the overall result is positive suggests that acupuncture can be helpful even in difficult cases of chronic back pain.

The authors conclude that the combined results of the studies show acupuncture to be superior to various control interventions. The analysis of the literature in this area included only randomized, controlled trials, thus lending weight to the findings. Results of this meta-analysis reveal the complexity of defining efficacy in studies of alternative medicine.

editor's note: Previous surveys have indicated that 15 percent of smokers would use alternative therapies to give up smoking. In another article in this issue, a randomized trial on the use of acupuncture to reduce nicotine withdrawal symptoms included 66 adults who desired to stop smoking. Results indicated that there was no significant difference in the mean reduction of withdrawal symptoms from day 1 to day 14. The effects of acupuncture were entirely nonspecific, suggesting that acupuncture is a powerful placebo for smoking cessation. Acupuncture appeared to have little value in preventing relapse and should be used in conjunction with other smoking aids to effect a positive response.—b.a.