Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: a randomized clinical trial

Moein Jamali Dastjerdi; Mohaddeseh Azadvari; Gholamreza Kordafshari; Bai-Xiao Zhao; Mohammad Sadegh Adel-Mehraban; Reihane Alipour; Mehrdad Karimi; Amir Hooman Kazemi; Arman Sourani; Ali Vafaie Sefti

doi:10.1097/MS9.0000000000001944

Comparative efficacy of acupuncture, venesection, and physical therapy on chronic low back pain outcomes: a randomized clinical trial

Ann Med Surg (Lond). 2024 Mar 18;86(5):2729-2738. doi: 10.1097/MS9.0000000000001944. eCollection 2024 May.

Authors

Affiliations

¹ Department of Traditional Medicine, School of Persian medicine, Tehran University of Medical Sciences, Tehran, Iran.
² Department of Physical Medicine and Rehabilitation, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran.
³ School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China.
⁴ Traditional Persian Medicine and Complementary Medicine (PerCoMed) Student Association, Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
⁵ Department of Traditional Medicine, School of Persian medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁶ International School, Beijing University of Chinese Medicine, Beijing, China.
⁷ Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.

Abstract

Objective: Chronic low back pain (CLBP) imposes considerable financial and social burden with poor response to medical and surgical treatments. Alternatively, acupuncture and venesection(Fasd) are traditionally used to alleviate nociceptive and musculoskeletal pains. This study aimed to evaluate the effectiveness and the safety of acupuncture and venesection on CLBP and patient functionality.

Methods: The current study was a single-blinded, randomized clinical trial with balanced allocation, conducted in the Department of Physical Medicine & Rehabilitation Medicine, in 2022. One hundred five CLBP patients who had no back pain-attributable structural or major diseases were randomly allocated into three parallel arms and received either physical therapy (PTG), acupuncture (APG), or venesection (VSG). Pain severity and functional aspects were evaluated using the visual analogue scale (VAS) and Oswestry disability index (ODI) during the study. VAS and ODI scores were defined as the primary outcomes.

Results: Ninety-five patients were reviewed in the final analysis (PTG=33, APG=30, VSG=31). Demographic data showed equal group distribution. Statistical analysis showed all procedures had reduced VAS score immediately after the first session, after the last session, and after follow-up; however, APG and VSG values were significantly lower (P<0.05). Pain reduction results in follow-up period were more sustainable in APG and VSG as compared to PTG (P<0.01). ODI results revealed global improvement after the last session of the treatment in all groups, while APG had more significant results (P<0.05). During the follow-up period, ODI still tended to decrease in VSG, non-significantly increased in APG, and significantly increased in PTG. Only two patients reported fainting after receiving venesection.

Conclusion: Considering the pain and functional scores, both acupuncture and venesection can reproduce reliable results. Acupuncture and venesection both have sustained effects on pain and daily function of the patients even after treatment termination, while physical therapy had more relapse in pain and functional limitations.

Keywords: Acupuncture; chronic low back pain; oswestry disability index; physical therapy modalities; traditional chinese medicine; traditional persian medicine; venesection.