Back Pain: Update of a Meta-Analysis
Dr Adrian White
University of Exeter, University of Exeter
Three recent systematic reviews of acupuncture for the treatment of back pain have reached discordant results. One review is unreliable since the authors included neck pain and omitted several papers that were already included in previous reviews.1 Two other reviews included about 12 studies each. In one review, the authors combined studies of different forms of acupuncture and different types of patient in order to reach an overall conclusion about the effectiveness of acupuncture.2 Acupuncture was significantly superior when compared to all forms of control, and was also superior when compared with sham acupuncture, though in this case the difference did not reach significance. The authors concluded that the data 'suggested that acupuncture is an effective treatment for back pain', although there was not sufficient to form a firm judgement. The authors of the final review decided not to combine the results of studies since they were heterogeneous, and concluded that the results 'did not clearly indicate that acupuncture is effective in the treatment of back pain' and 'would not recommend acupuncture as a regular treatment for low back pain patients'.3 These discordant results are due to differing methodologies and cannot easily be resolved from the evidence existing at that time. However, the number of studies that may be included in a review has approximately doubled in the intervening period, and the time is ripe for a further review. The initial findings of the review will be presented.
1. Smith LA, Oldman AD, McQuay HJ, Moore RA. Teasing apart quality and validity in systematic reviews: an example from acupuncture trials in chronic neck and back pain. Pain 2000;86:119-32.
2. Ernst E, White AR. Acupuncture for back pain: a meta-analysis of randomized controlled trials. Arch Intern Med 1998;158:2235-41.
3. Tulder MWv, Cherkin DC, Berman B, Lao L, Koes BW. Acupuncture for low back pain (Cochrane Review). The Cochrane Library, Issue 1, Oxford: Update Software, 2000.