Evaluating the Efficacy of Acupuncture and Baclofen for Chronic Non-specific Low Back Pain

This is a review of a randomized controlled trial (RCT) conducted in Iran evaluating the efficacy of acupuncture and baclofen.

by Hitomi Asano L.Ac

Low back pain is a leading cause of disability among US adults. Most patients with acute low back pain will recover quickly. However, those who continue to deal with low back pain over 12 weeks will develop chronicity and prognosis becomes less favorable. Low back pain is usually classified as specific or non-specific. Approximately 10% of people with low back pain are diagnosed with a specific pathology. The vast majority will be labeled as having non-specific low back pain (NSLBP). Non-specific low back pain is of unknown cause and not attributed to a specific pathology. Due to the nature of this condition, there is no specific treatment. Management of non-specific chronic low back pain (NScLBP) include education, medication, and non-pharmacological therapies.

Zaringhalam et al. (2010) evaluated whether acupuncture, baclofen, or combined treatment with acupuncture and baclofen can alleviate symptoms of non-specific chronic low back pain. Baclofen is a non-benzodiazepine muscle relaxant that is used as a symptomatic treatment for chronic low back pain.

84 men aged between 50-60 years were recruited and randomized into four groups: control (C), acupuncture (AC), baclofen (BA), and baclofen plus acupuncture (BA+AC). Each group had 21 participants and followed a treatment course of five weeks. The C group did not receive any treatment. The AC and BA+AC group received acupuncture twice a week for five weeks (10 treatments). The following acupuncture protocol was used: bilateral needles at BL-23 shenshu, BL-25 dachangshu, BL-28 panguanshu, BL-32 ciliao, BL-60 kunlun, GB-30 huantiao, GB34 yanglingquan with electrical stimulation at 4-6 Hz for 20-25 minutes. The BA and BA+AC received orally administered baclofen 30mg/day (15mg bid).

The primary outcomes measured were pain intensity using a visual analog scale (VAS) and pain disability using the Roland-Morris Questionnaire (RDQ). VAS scores were measured at baseline before the first treatment and subsequently at one, two, three, four, five, and ten weeks after the first treatment. RDQ was measured at baseline before the first treatment and subsequently at five and ten weeks after the first treatment.

The BA group showed a significant decrease in VAS at one and two weeks of treatment compared to baseline and the C group. However, after the third, fourth, fifth, and tenth week, the VAS score was not significantly different from the baseline and the C group. The AC group showed a significant decrease in VAS score at the second, third, fourth, fifth, and tenth week compared to the BA group. The BA+AC group showed a significant decrease in VAS score at the first, second, third, fourth, fifth, and tenth week compared to the AC group.

The BA group showed a significant decrease in RDQ scores at the fifth week compared to the baseline and the tenth week. The RDQ scores in the AC and BA+AC groups significantly decreased in the fifth and tenth weeks compared to the baseline and BA groups. The RDQ scores in the BA+AC group reduced the most compared to the AC and BA groups.

In conclusion, the AC and BA+AC treatments for NScLBP were more effective in reducing pain and improving disability than the baclofen treatment alone. However, the best results were obtained by the BA+AC group. The BA+AC group showed the most significant decrease in VAS and RDQ scores compared to C, BA, and AC groups. For the best results, it is important to incorporate acupuncture with the use of baclofen for the management of NScLBP.

Zaringhalam, Jalal, et al. Reduction of Chronic Non-Specific Low Back Pain: A Randomized Controlled Clinical Trial on Acupuncture and Baclofen. Chinese Medicine, vol. 5, no. 15, 2010, doi:10.1186/1749-8546-5-15.

Posted in: Low Back

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