Intramuscular or periosteal acupuncture for patients with chronic musculoskeletal pain in the neck and low back : Effects on pain, physical and psychological functioning

Sammanfattning: Background: Periosteal acupuncture has shown promising results in the clinic. No studies of effects in patients with chronic pain in the neck and low back are today available. Aims: The main purpose was to compare intramuscular and periosteal acupuncture. The specific aims were to compare three groups of patients suffering from chronic musculoskeletal pain in the neck and/or low back, one with intramuscular acupuncture, one with periosteal acupuncture and a third information control group with respect to clinically relevant pain relief, intake of analgesics, and physical functioning (Study I) and to psychological functioning and quality of sleep (Study II). Material: Consecutive patients in primary care with nociceptive pain in the neck and/or low back of unspecific origin for >3 months , aged 18-70 years were included. The patients were alternately allocated to intramuscular acupuncture, periosteal acupuncture and an information control group. Methods: Eight acupuncture treatments were administered during a five week period with two voluntary additional treatments after one month. All patients were encouraged to stay active. Pain was estimated in a pain diary employing standard visual analogue scales (VAS) three times a day for seven days. Average pain during the last week was also estimated on a similar VAS. Study I. Clinically relevant pain relief was defined as a reduction of pain comparable with a 30% decrease of the initial value. Intake of analgesics was recorded from the pain diary. Study I. Physical functioning was assessed with the Disability Rating Index. Study I. Psychological functioning was evaluated with the Hospital and Anxiety Scale. Study II and Sleep and mood at awakening were evaluated on a VAS. Study II. All estimations were made one week prior to treatment, one week, one, three and six months after termination of treatment. An additional estimation of actual level of pain, intake of analgesics, sleep, and mood at awakening were recorded in the pain diary in the middle of the treatment period. In the control group the estimations were made at corresponding times (similar intervals), but only for one month after termination of treatment. Non-parametric statistics were used. Results: 144 patients, 59 in the intramuscular group, 55 in the periosteal group and 30 in the control group were included in the analysis. Before treatment there were no differences between the three groups regarding pain, intake of analgesics and psychological functioning. No differences were found between the acupuncture groups regarding any of the outcome variables. There were differences between each of the two acupuncture groups compared with the control group on all test occasions up to one month after treatment with respect to pain diary, one week after treatment with respect to pain last week, and one month after treatment with respect to anxiety. Clinically relevant pain relief with respect to pain diary was obtained in 29 intramuscular acupuncture patients, 25 periosteal acupuncture patients and 5 patients in the control group. The proportions of noncases with respect to anxiety increased in the intramuscular acupuncture group from 39 to 47, in the periosteal acupuncture group from 37 to 49, and in the control group from 15 to 16. Six months after end of treatment, 46% of the patients in the intramuscular acupuncture group and 45% of the patients in the periosteal acupuncture group had obtained clinically relevant pain relief in terms of pain diary. The corresponding figure for pain last week was 29% of the patients in each group. Reduced anxiety was observed in both acupuncture groups up to three months after end of treatment i.e. the number of noncases increased with four in the intramuscular acupuncture group and with seven in the periosteal acu group. Conclusion: Periosteal acupuncture is equally effective as intramuscular acupuncture. One month after end of treatment more patients in both acupuncture groups had obtained clinically relevant pain relief and reduced anxiety compared with patients in the control group. Six months after treatment 45% of the patients in both acupuncture groups had obtained a clinically relevant pain relief. The effect on anxiety remained up to three months for both acupuncture groups.