According to new research, people being treated for lower back pain with acupuncture are likely to gain less benefit from the treatment if they have low expectations of how effective it is.
The study, published in The Journal of Clinical Pain, also suggests that patients who are positive about their back pain and feel in control of their symptoms go on to experience less back-related disability while receiving acupuncture.
“The analysis showed that psychological factors were consistently associated with back-related disability,” says study author Dr. Felicity Bishop. “People who started out with very low expectations of acupuncture – who thought it probably would not help them – were more likely to report less benefit as treatment went on.”
Well established as a form of complementary therapy, acupuncture is commonly used to treat a wide range of health problems. The World Health Organization (WHO) has stated that acupuncture is an effective form of treatment for 28 conditions, including lower back pain and the following:
Evidence also suggests that acupuncture could be beneficial in the treatment of many other diseases, symptoms and conditions, although the WHO believe further proof is needed.
However, previous research has also found that factors other than the insertion of needles into specific areas of the skin play a part in how effective acupuncture is. These factors include the patient’s belief in the therapy and the relationship between the patient and acupuncturist.
For the study, 485 people receiving acupuncture for lower back pain were recruited, being seen by a total of 83 acupuncturists. The participants completed questionnaires prior to the commencement of their treatment, and then again after 2 weeks, 3 months and 6 months.
The questionnaires measured demographic characteristics and lower back disability, as well as variables from four different psychological theories for predicting lower back pain outcomes: the fear-avoidance model, the common sense model, expectancy theory and social-cognitive theory.
As hypothesized by the authors, psychological variables were associated with changes in disability among the participants and were accountable for two thirds of the variance in disability.
Dr. Bishop explains that when individual patients were able to see their pain in a more positive light they would go on to experience less back-related disability:
“In particular, they experienced less disability over the course of treatment when they came to see their back pain as more controllable, when they felt they had better understanding of their back pain, when they felt better able to cope with it, were less emotional about it, and when they felt their back pain was going to have less of an impact on their lives.”
The authors acknowledge that it is difficult to assess how representative the sample of patients in the study is. Compared with a British survey of acupuncture users, the participants were similar in age and sex but fewer had previous acupuncture experience.
Dr. Stephen Simpson, director of research at Arthritis Research UK, says that the study emphasizes how the placebo effect influences pain. “The process whereby the brain’s processing of different emotions in relation to their treatment can influence outcome is a really important area for research,” he adds.
The authors of the study suggest future research should test whether integrating acupuncture with psychological interventions targeting illness and self-perceptions can improve patient outcomes.
“Factors such as the relationship between practitioner and the patient can inform this and we should be able to understand the biological pathways by which this happens,” concludes Dr. Simpson. “This understanding could lead in the future to better targeting of acupuncture and related therapies in order to maximize patient benefit.”
Last year, Medical News Today reported on a study published in JAMA finding that acupuncture is not beneficial for knee pain.