point acupuncture treatment of chronic low back pain in elderly patients -- a blinded randomized control trial 1+ Deep needling to trigger points more effective in the treatment of low back pain in elderly patients than standard acupuncture or superficial needling to trigger points Adverse effects – None reported 5. Kennedy et al (2008) Acupuncture for acute nonspecific low back pain: a pilot randomised non-penetrating sham controlled trial 1- Acupuncture more effective than sham treatment for pain relief Adverse effects – none reported 6. Brinkhaus et al 2006 Acupuncture in patients with chronic low back pain: a randomized controlled trial 1+ Acupuncture is more effective in improving pain than minimal§ acupuncture and no acupuncture treatment in patients with chronic low back pain Duration of treatment effects is unclear Adverse effects – none reported 7. Hahne et al (2010) Conservative management of lumbar disc herniation with associated radiculopathy: A systematic review 1++ Search returned no studies including acupuncture § minimal acupuncture is where the needle is inserted into the skin at a lesser depth than ‘normal’ acupuncture A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 8 Lower back 8. Henderson (2002) Acupuncture: evidence for its use in chronic low back pain 1+/2++ Inconclusive Adverse effects – none reported 9. Furlan et al (2005) Acupuncture and DryNeedling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration 1++ Insufficient evidence to support efficacy of acupuncture or dry needling in acute LBP Adverse effects – 13/245 patients (5%) experienced minor complications 10. Manheimer et al (2005) Meta-Analysis: Acupuncture for Low Back Pain 1+ Evidence inconclusive for acute LBP Acupuncture significantly more effective than sham acupuncture for short term pain relief in chronic LBP No evidence to that acupuncture is more effective than other conservative treatments No adverse effects reported 11. Yuan et al (2008) Effectiveness of Acupuncture for Low Back Pain. A Systematic Review 1++ Moderate evidence that acupuncture is more effective than no treatment Strong evidence that there is no significant difference between acupuncture and sham acupuncture for short term pain relief Strong evidence that acupuncture is a useful adjunct to other convservative treatment in the management of non-specific LBP 3.2 Neck Historically conservative interventions for neck pain include: muscle relaxants, steroid injections, manual therapy, physical therapy, behavioural therapy, traction, cervical collar, electromagnetic therapy and proprioceptive exercises23. Evaluation of RCT’s24 shows there is currently little clear evidence to demonstrate one conservative modality to be most effective. More high quality studies are needed in this area. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 9 Short term reduction of pain has been considered the primary outcome of treatment23. Positive results are reported for short term pain reduction23; however the effectiveness of acupuncture for treating disability and long term pain in the neck remains unproven. A systematic review25 conducting a single meta-analysis comparing acupuncture with sham acupuncture (2 studies), active treatment (4 studies), inactive treatment (8 studies) and wait list control (1 study) concluded that there is moderate evidence to support that acupuncture is more effective in providing both immediate and short term relief from neck pain than sham acupuncture and inactive treatments. A further systematic review23 including quantitative meta-analysis of 14 RCT’s confirmed the short-term effectiveness and efficacy of acupuncture in the treatment of neck pain. The control groups included in this meta-analysis were sham acupuncture, physical therapy, massage, waiting list, anti-inflammatory medication and routine care. Eleven out of the fourteen studies highlighted that real acupuncture is significantly more effective in relieving pain than ‘control’ groups inclusive of sham, inactive treatment, massage and anti inflammatory medication. Conversely five of the fourteen studies found that there was no difference between acupuncture and control groups inclusive of sham acupuncture and physical therapy. In these studies both acupuncture and ‘control’ showed positive therapeutic effects. There is contradictory evidence when considering sham laser acupuncture; 2 high quality RCT’s delivered conflicting outcomes. Systematic reviews23 25 report inconclusive findings around the long term effects of acupuncture on neck pain. However closer examination of the evidence reveals a positive trend towards acupuncture having a long term effect11 26 27. The strongest evidence of long term effects comes from He et al26. Interestingly within this study the dosage of treatment was quite intense; 10 sessions over a period of 3-4 weeks, which may contribute to the long term effects seen in this study. There was no detail of the length of each treatment session. As previously noted, there is a lack of evidence specifically investigating optimal dosage for acupuncture treatment. This may influence the magnitude and duration of treatment effect. Where the literature does report dosage, frequency of sessions ranges from 1 to 14 sessions over a treatment period of 3-12 weeks. Neck