Low Back Pain Project

Foundation for Research into
Traditional Chinese Medicine

A centre for acupuncture research

296 Tadcaster Road York YO24 1ET England, UK

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York Acupuncture for Back Pain (YACBAC) Trial

Evaluating the effectiveness of acupuncture in the treatment of low back pain.

Back pain is a major cause of ill health and time lost from work. Conventional medical treatments often have limited success and the NHS has identified back pain as a priority condition for research. Systematic reviews of the literature show promising evidence that that acupuncture can be an effective treatment and this needs confirmation in rigorous high quality trials.

The Foundation for Research into Traditional Chinese medicine first conducted a feasibility study in which GPs referred four patients with chronic low back pain to an acupuncture clinic in York for a course of ten treatments (Fitter & MacPherson, 1995). The purpose was to test out our methods of assessing the outcomes of treatment. These results were encouraging in terms of procedures, end-point measures and outcomes. A full pilot study was undertaken with twenty patients being referred to two acupuncture clinics in York by local GPs and also by consultants in the Pain Clinic at the NHS hospital in York (MacPherson et al 1999).

people+ needle.jpg (140690 bytes)
This picture shows Hugh MacPherson, Lucy Thorpe and Kate Thomas with one of the trial patients.

With Kate Thomas as principal investigator, and funded by the NHS Health Technology Assessment , we then conducted a pragmatic randomised controlled trial to evaluate the clinical impact and cost effectiveness of acupuncture for chronic low back pain (for the protocol, see Thomas et al 1999). In the trial, a total of 43 general practitioners referred 241 patients for up to 10 acupuncture treatments provided by six local acupuncturists. Patients were randomised to an acupuncture group or to a control group. Both groups continued to receive conventional primary care from their general practitioner. The key outcome measure was bodily pain, as measured by the SF-36, at 12 and 24 months after randomisation.

The results were in favour of the acupuncture group at 12 months and became significant at 24 months. Adjusting for baseline score and for clustering by acupuncturist, the estimated intervention effect was +5.6 points on the SF-36 Pain dimension (95% CI –0.2 to 11.4, p=0.06) in favour of the acupuncture group at 12 months, and +8 points (95% CI 2.8 to 13.2, p=0.003) at 24 months. Acupuncture patients also reported a significantly greater reduction in worry about their back pain.

Full details were published in the British Medical Journal (Thomas et al 2006). In addition the acupuncture service was found to be cost-effective (Ratcliffe et al 2006). A sub-study explored the traditional acupuncture diagnosis and treatment in the trial, including the level of diagnostic concordance among the six acupuncturists (MacPherson et al 2004). We have also explored the patient-practitioner interactions that go beyond the acupuncture needling (MacPherson et al 2006). More recently we have followed up patients for a further six years, and found the effects of acupuncture were reduced to the point of no longer being significant (Prady et al 2007).

Key publications:

Prady SL, Thomas K, Esmonde L, Crouch S, MacPherson H. The natural history of back pain after a randomised controlled trial of acupuncture vs usual care – long term outcomes. Acupuncture in Medicine 2007;25(4):121-129.

MacPherson H, Thomas K. Traditional acupuncture for low back pain: developing high quality evidence while maintaining the integrity of the intervention. European Journal of Oriental Medicine. 2007. 5(4): 26-30.

MacPherson H, Thomas KJ, Thorpe L. Beyond needling - therapeutic processes in acupuncture care: a qualitative study nested within low back pain trial. Journal of Alternative & Complementary Medicine, 2006; 12(9): 873-880.

Thomas KJ, MacPherson H, Thorpe L, et al. Randomised controlled trial of a short course of traditional acupuncture compared to usual care for persistent low back pain. British Medical Journal, 2006; 333: 623-626.

Ratcliffe J, Thomas KJ, MacPherson H, Brazier J. A randomised controlled trial of acupuncture care for lower back pain: cost effectiveness analysis. British Medical Journal, 2006; 333: 626-628.

Thomas KJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell M, Roman M, Walters S, Nicholl, J. "Longer term clinical and economic benefits of offering acupuncture to patients with chronic low back pain." Final report to NHS Health Technology Assessment Programme, 2005. [HTA Executive summary pdf] [Full HTA monograph pdf]

MacPherson H, Thorpe L, Thomas KJ, Campbell M. "Acupuncture for low back pain: traditional diagnosis and treatment of 148 patients in a clinical trial." Complementary Therapies in Medicine. 2004; 12(1): 38-44.

MacPherson H, Gould AJ, Fitter M. "Acupuncture for low back pain: results of a pilot study for a randomised controlled trial." Complementary Therapies in Medicine, 1999; 7(2): 83-90.

Thomas KJ, Fitter M, Brazier J, MacPherson H, Campbell M, Nicholl JP, Roman M. "Longer term clinical and economic benefits of offering acupuncture to patients with chronic low back pain assessed as suitable for primary care management." Complementary Therapies in Medicine, 1999; 7(2):91-100.

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