Positive Health Online

Abstract

SHERMAN and colleagues, Northwest Institute of Acupuncture and Oriental Medicine, Seattle, Washington, USA, sherman.k@ghc.org, investigated the diagnoses and treatments provided by acupuncturists practising Traditional Chinese Medicine (TCM) for patients suffering from chronic low-back pain.

Background

In order to select treatments that are valid for testing in clinical trials, it is necessary to understand how acupuncturists diagnose and treat specific health problems.

Methodology

The investigators examined two separate sets of treatment records that provided information on the diagnosis and treatment of patients with chronic low-back pain by TCM methods and acupuncture. The records covered more than 150 initial patient visits.

Results

85% of patients received a diagnosis of Qi and Blood Stagnation or Qi Stagnation. 33-51% of patients had a diagnosis of Kidney Deficiency or one of its three subtypes. Less than 20% of patients received other specific diagnoses. On average, 12-13 needles were used per treatment. More than 85 different acupuncture points were used in each of the two data sets. However, only five to six acupuncture points were used in more than 20 treatments in each data set, and only two of these points (UB23 and UB40) were the same in both data sets. More than 50% of patients received other treatments in addition to acupuncture needling, such as heat (36-67%) and cupping (16-21%).

Conclusion

There was a great deal of variability in the treatments provided to different patients for the condition of chronic low-back pain. This presents a substantial challenge for selecting a single treatment for investigation in a clinical trial. The authors recommend that researchers attempt to develop a treatment programme that is considered valid by expert acupuncturists and that has ‘broad features characteristic of patterns of common clinical practice’.

References

Sherman KJ et al. The diagnosis and treatment of patients with chronic low-back pain by traditional Chinese medical acupuncturists. The Journal of Alternative and Complementary Medicine 7 (6): 641-50. Dec 2001.

Comment

Again, the above study demonstrates how difficult it can be to come up with a treatment programme, this time with acupuncture, which would be recognized as valid by acupuncturists and at the same time deals with the type of treatments usually delivered in clinical practice. This study showed that there was very little similarity between treatments carried out in the 150 patient visits. Of course, it may be that there is no such thing as a characteristic acupuncture treatment protocol, and that there has to be great variation in the way treatments are delivered. If this were to be the case, it would argue against using a single treatment regimen to validate acupuncture treatment for low back pain, but would support using clinical case records.