Toothpicks Match Needles for Acupuncture

A sham form of acupuncture using toothpicks that don’t penetrate the skin works as well as traditional needle acupuncture for relieving back pain, researchers report in the May 11 Archives of Internal Medicine. Both procedures outperformed non-acupuncture alternatives, such as medication alone.

Acupuncture is the ancient Chinese practice of inserting needles into meridians, channels along which practitioners believe vital energy flows. Western medicine has struggled to verify whether these meridians exist, much less understand the biological mechanism by which the penetrations apparently relieve pain and deliver other benefits.

The scientists randomly assigned 638 people with chronic low back pain to one of four treatment groups. Two of the groups received acupuncture treatment: one group received individualized treatment by a practitioner, while the other received the standardized acupuncture regimen. A third group got the sham acupuncture, in which toothpicks were housed in needle guide tubes so participants couldn’t spot the sham. The fourth group received nothing beyond the drugs typically taken for back pain.

Volunteers received 10 treatments over seven weeks. None of the volunteers had previously received acupuncture for back pain, and all were permitted to continue using medication, typically anti-inflammatory drugs or pain relievers, says study coauthor Daniel Cherkin, an epidemiologist at the Group Health Center for Health Studies in Seattle.

A week after the last treatment, about three-fifths of those getting real or sham acupuncture reported significant improvement in disabilities brought on by back pain, compared with only two-fifths of those not receiving any real or simulated acupuncture.

Since the toothpicks didn’t penetrate the skin, the new study “raises questions about acupuncture’s purported mechanism of action,” the authors note.

Cherkin hypothesizes that if acupuncture has a physiological effect, the stimulation of certain points on the skin may result in the same nerve-related benefits, he says. Or it could be the placebo effect, in which a patient’s belief in the treatment induces improvements. Pain relief might even arise from a combination of the two, he says.

—By Nathan Seppa

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