Traditional Chinese acupuncture has more to offer 21st century sufferers of back pain than anything modern medicine can provide, researchers report today.
The 4,000-year-old practice of sticking needles in patients helped alleviate their pain more effectively than the standard NHS treatment of physiotherapy, drugs and manipulation, and the effects lasted for at least two years, according to the study.
Researchers from the University of York studied 241 patients aged between 18 and 65 who had suffered with persistent lower back pain for up to a year. Half received up to 10 sessions of acupuncture over three months while the remainder were given "normal NHS treatment". Two years later those who received the acupuncture had less pain, were less worried about their backs, were less likely to be taking painkillers and expressed greater satisfaction with their treatment.
Although the differences between the groups were small, and the acupuncture was more expensive (£460 compared with £345 for the NHS treatment), the improvement represented a "clinically worthwhile benefit" that was cost-effective, the researchers say.
The findings, published in the British Medical Journal, represent the latest salvo in the war between alternative practitioners and orthodox doctors, each vying for dominion over one of medicine's most puzzling ailments. Acupuncture is used by 800,000 people a year (2 per cent of adults) for a range of conditions but fewer than 80,000 are treated on the NHS, the researchers say. Some use it instead of traditional medicine while others have it to complement orthodox therapy or drugs.
The jury is still out on whether it works. There is good evidence that it helps to relieve pain and nausea following surgery and in the treatment of musculo-skeletal conditions such as painful joints. It has also been shown to reduce the need for medical consultations and drugs.
It is time consuming, with consultations lasting an hour, and expensive when paid for privately, with sessions costing from £40 to £80. There is also a small risk of infection from improperly sterilised needles.
One of the greatest puzzles is whether the needles have to be placed according to the traditional Chinese practice or whether they are just as effective when placed randomly over the body. Acupuncturists say there are 350 pressure points that must be stimulated, which are said to tap into a dozen meridians or body energy channels.
A study published in the BMJ last year found that placing needles randomly was almost as effective at relieving headaches among 270 patients in a trial at Munich University. Previous studies have also suggested that "sham" acupuncture was as good as the real thing.
Back pain is the third most common reason for consulting the doctor, after headaches and tiredness, but the problem rarely has to do with the state of the spine. An American study of 100 people judged to be at high risk of back pain found the most accurate predictor of those who would succumb was psychological tests of their coping skills rather than MRI scans showing cracks and tears in their vertebrae.
Six out of 10 people suffer bad backs that are severe enough to disrupt normal activities at least once in their lives. One in seven adults consult their GP for help each year. The cost to the NHS of treating back pain is about £480m but this is dwarfed by the amount lost in productivity and sickness benefits - £10bn a year.
Gillian Cain, 37: 'It has a real benefit, but it is no miracle cure'
Gillian Cain's back problems started with the birth of her son James three years ago. She was aged 34.
"I was in extreme pain and I had a lot of investigations which finally revealed disc damage. It must have occurred during pregnancy or labour. I saw two spinal specialists and had seven or eight steroid injections into my back, but nothing worked. The only thing left was surgery and I wasn't prepared to accept that," she said.
She started to research alternative treatments on the internet and found acupuncture. She was treated by one of the University of York researchers.
"I started with treatments twice a week for a few months and then went down to once a week. I finished treatment 18 months ago - and I have had no problems since. I don't take painkillers and I have had no other treatment.
"I couldn't recommend acupuncture enough. It doesn't work miracles and it can't repair the damaged discs. But it has helped the knock-on effects. That has been the real benefit and made such a difference for me. The effect back pain can have on your life is huge."
Does it work?
YES: German scientists wrote last year that acupuncture halved headaches for chronic sufferers.
NO: At least 26 trials had previously been published showing no convincing effect.
YES: Sarah Brown, wife of the Chancellor, Gordon Brown, is believed to have turned to acupuncture to conceive the couple's second child.
NO: A study of 45 women found no great difference in the effect of acupuncture.
YES: Acupuncture has been shown in trials to be useful in treating pain and nausea in surgery, and painful joints.
NO: Edzard Ernst, of Exeter University, says evidence for usefulness is not convincing, and best evidence suggests it is probably of no real value.