Three types of acupuncture therapy, an individually tailored program, standard therapy and a simulation involving toothpicks at key acupuncture points, are equally effective for chronic low back pain, even though the third option is probably only a placebo. How can we tell what’s real and what’s fake?

Researcher Daniel Cherkin says, “Back pain is the leading reason for visits to licensed acupuncturists, and medical acupuncturists consider acupuncture an effective treatment for back pain.”

During a seven-week treatment period, 157 participants received 10 acupuncture treatments in a manner individually prescribed by a diagnostic acupuncturist; 158 underwent a standardized course of acupuncture treatments considered effective by experts for low back pain; 162 received 10 sessions of simulated acupuncture, in which practitioners used a toothpick inside of an acupuncture needle guide tube to mimic the insertion, stimulation and removal of needles; and 161 received usual care. Participants reported around the same improvement in their symptoms and in the amount of dysfunction caused by their back pain by phone after eight, 26 and 52 weeks.

Several possible explanations exist for the effectiveness of simulated acupuncture. Superficial stimulation of acupuncture points may directly stimulate the processes that result in reduced pain and improved function. Or the improvement may be due to the patient’s belief that the treatment will be helpful. Cherkin says, “These findings raise questions about acupuncture’s purported mechanisms of action.”

Does this mean that an untrained person can do an effective job using only a book illustrating pressure points and toothpicks? Does it mean that your back pain will be relieved if a Chinese person simply walks into your room? Who knows how far placebo power goes!

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