Britain’s backs are in terrible shape. We spend more time off work because of back pain than for any other ailment, according to the NHS. So it’s not surprising that we are keen to relieve our suffering. A new study on acupuncture and back pain tries to do just this, though in truth it is as confusing as it is informative.

Published in the Archives of Internal Medicine and performed in the US, the study compared 638 patients with chronic back pain. Each person was randomly ascribed to one of four treatments.

One group received “usual care”. The others were given either “individualised”, “standardised”, or “sham” acupuncture. Individualised meant that the therapist prescribed “distinct points” for that person’s particular problems. Standardised meant that the needles were inserted into points which are “considered effective by experts for chronic low back pain”. Sham acupuncture consisted of a series of movements with a toothpick and cotton wool, designed to make the person feel as though they were having needles inserted into the skin, when in fact there was no penetration at all.

This is the gloriously interesting bit. Acupuncture, either prescribed or standard, was effective in relieving symptoms of back pain and in improving back function. It also helped people to reduce their use of anti-inflammatory painkillers. However, sham acupuncture – toothpicks and cotton wool – performed just as well as both these methods. Conventional therapy, meanwhile, was significantly worse in comparison.

So what do we do now? We have a treatment that seems to work – but the sham version of it is just as effective. It would be very useful to find out why. Is it a placebo, working via the empathy and care delivered by the therapist? Only 18 per cent of patients in the “usual treatment” group got around to reading the booklet they were given on back pain.

Perhaps the patients receiving acupuncture were more motivated to do exercises or to be active, and it was this which helped. Or perhaps there is something about touch, or pressure, which triggers a physiological process which eases pain and improves function.

It certainly appears that “sham acupuncture” is therapeutic – so perhaps we need a new term for the practice, because “sham” now seems misleading. It says a great deal for the acupuncturists who involved themselves in this trial, because they were brave enough to question how – and if – their treatment works.

If only their colleagues in the complementary medical world had the same dedication: it may be that there is much more useful knowledge to be discovered.

Margaret McCartney is a GP in Glasgow
margaret.mccartney@ft.com

For lively discussion of the latest medical issues go to Margaret McCartney’s blog at blogs.ft.com/mccartney