| Objectives. To observe that adding yuan and luo points relieves pain more effectively than standard point alone for treating non-specific chronic low back pain patients.Methods. A randomized controlled trial with four weeks follow up were done. Between December17,2012-December24,2013a total of152people with low back pain come as acupuncture patients in " Imanuel" private primary care Yogyakarta, Indonesia. After screening98subjects who had met the inclusion criteria were invited to participate in the study.36subjects dropped out because of discontinued the treatment, the reasons were too busy to participate due to work schedule conflict, family issues, got some medical emergency that need to be hospitalized, moved to another town. The outcomes were pain scale (Visual Analog Scale, range0-10), Oswestry Disability Questionnaire, Schober’s test. Outcomes were assessed at baseline and after treatment. VAS would also assessed1month after treatment.Results.Among the62subjects, there were20males and42females. Age between31and65years old,50years on average. Body mass index between18.18kg/m2to43.55kg/m2, with26.05kg/m2on average.56participants were non smoker,6were smoker. Education background:6participants were elementary,34were high school,19were undergraduate,3were postgraduate. Work status:23participants were full time,8were part time,6were retired,25were home maker. Work type:6participants were heavy manual handling,37were light manual handling,11were sedentary,8were office. Duration of pain ranged1to30years,9years on average. VAS between6to10, with8,1on average. Schober’s test ranged0to8cm,3.927cm on average. Oswestry disability questionnaire score31to89, with45.82on average.There were no relevant differences in age (50.87±10.062years versus50.06±10.770years)(p=0.504), body mass index (26.18±4.811kg/m2versus25.92±5.021kg/m2)(p=0.384), duration of pain (8.13±7.877years versus10.13±8.562years)(p=0.468) between treatment and control group examined by independent sample t test. Neither were there significant differences in the socioeconomic status of patients at the time of enrollment when comparing two groups:12.9%versus6.5%patients were elementary51.6%versus58.1%patients were high school,29%versus32.3%patients were undergraduate,6.5%versus3.2%patients were postgraduate (p=0.760). Work status of the patients:38.7%versus35.5%were full time,12.9%versus12.9%were part time,3.2%versus 16.1%were retired,45.2%versus35.5%were home maker (p=0.381). Work type of the patients:6.5%versus12.9%were heavy manual handling,54.8%versus64.5%were light manual handling,19.4%versus16.1%were sedentary,19.4%versus6.5%were office (=0.391). Current smoker:6.5%versus12.9%were smoker,93.5%versus87.1%were non smoker (p=0.671) examined by chi square test. There were no significant differences in baseline variables between the2study groups, so the two groups can be compared.In this study, there are some interesting results. Younger of age, male, higher in height had correlation with lumbar range of motion measured by Schober’s test. The Pearson correlation test result showed correlation between younger of age (r=37.2%, p=0.003), male (r=31.9%, p=0.011), higher in height (r=29.1%, p=0.022) and lumbar range of motion.In treatment group VAS after treatment decreased7.45point (p=0.000), and no change1month after treatment (p=1.000). Schober’s test increased1.69point (p=0.000) and Oswestry Disability Questionnaire decreased35.71point (p=0.000). Treatment outcome of31patients in treatment group:healing12(38.7%), efficacious16(51.6%), better3(9.7%), inefficacious0(0.0%). In control group VAS after treatment decreased6.36point (p=0.000), but1month after treatment VAS increased0.32point (p=0.031). Schober’s test increased0.93point (p=0.000) and Oswestry Disability Questionnaire decreased23.33point (p=0.000). Treatment outcome of31patients in control group:healing6(19.4%), efficacious9(29.0%), better14(45.2%), inefficacious2(6.5%).Independent samples t test was used to analyze differences between two groups after treatment. Chi square was used to compare the treatment outcomes. VAS after treatment in intervention group decreased by an average7.45points, from a mean value8.39±0.955to be0.94±.0.998; whilst in control group decreased by an average5.36points, from a mean value7.81±0.910to be2.45±1.841(p=0.011). VAS1month after treatment in intervention change from mean0.94±.0.998to be0.94±1.031; but in control group increased0.32points, from2.45±1.841to2.77±1.978. There was statistically significance between two groups (p=0.003).Schober’s test after treatment in intervention group increased by an average1.69points, from a mean value3.887±1.8198to be5.581±1.2787; whilst in control group decreased by an average0.93points, from a mean value3.968±2.0080to be4.935±1.9695. There was no statistically significance between two groups (p=0.132).Oswestry Disability Questionnaire after treatment in intervention group increased by an average35.71points, from a mean value48.00±11.804to be12.29±7.422; whilst in control group decreased by an average23.33points, from a mean value43.65±8.620to be20.32±5.980. There was statistically significance between two groups (p=0.009).The curative effect between intervention and control group were as follows: completely gone38.7%versus19.4%, much better48.4%versus25.8%, better12.9%versus48.4%, about the same0%versus6.5%, worse0%for each group. There was statistically significance between two groups (p=0.004).After treatment42%of participants had pain free in intervention group, whereas only23%of participants in control group. One month after treatment39%of the participants remained pain free in intervention group, whereas only19%in control group.Frequencies of effectiveness changed in100%of intervention group patients and in93.5%of control group patients.Conclusions.Acupuncture has beneficial and persistent effectiveness against chronic low back pain. The needling of yuan and luo points are significantly more effective to reduce pain and disability more than local points only. |
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