Date Published: June 12, 2018
Publisher: Public Library of Science
Author(s): Wonil Koh, Kyungwon Kang, Yoon Jae Lee, Me-riong Kim, Joon-Shik Shin, Jinho Lee, Jun-Hwan Lee, Kyung-Min Shin, In-Hyuk Ha, Qinhong Zhang.
Low back pain (LBP) is a globally prevalent disorder with high social significance. Invasive surgical procedures are increasingly being used to treat LBP despite a lack of solid evidence supporting their long-term benefits. This nationwide retrospective cohort study investigated the association between acupuncture treatment and lumbar surgery rate in patients with LBP.
Using the National Health Insurance Service Sample Cohort Database for 2002–2013, we identified newly diagnosed LBP patients in Korea between 2004 and 2010 and divided them into an acupuncture group and control group according to whether or not they received acupuncture. Propensity scores based on age, sex, income, and Charlson Comorbidity Index were matched between the two study groups. The lumbar surgery rate in the two years following the first visit (control group) or the first acupuncture session (acupuncture group) was calculated. In addition to the overall analysis, stratified analyses were also conducted in different age, sex, and income strata. Sensitivity analyses were further performed using varying definitions of acupuncture treatment.
After matching, 130,089 subjects were included in each study group. The lumbar surgery rate was significantly lower in the acupuncture group than in the control group (hazard ratio [HR] 0.633, 95% confidence interval [CI] 0.576–0.696). Decrease in HR was consistently observed in the acupuncture group for all age strata, except for patients in their 20s (HR 1.031, 95% CI 0.804–1.323). HR for lumbar surgery tended to be further reduced in the older age groups upon acupuncture treatment, with no apparent sex-related differences. Lowered HR in the acupuncture group was continuously observed across all income groups; the higher income group showed a tendency of greater decrease. Sensitivity analyses showed that the number of acupuncture sessions had no major impact on the likelihood of lumbar surgery, but also that more intensive acupuncture treatment was associated with further reduction in lumbar surgery rates.
The present results found that administration of acupuncture treatment is associated with lower lumbar surgery rates for LBP patients in Korea. Prospective studies are warranted in the future to further investigate the effect of acupuncture treatment on lumbar surgery incidence.
Low back pain (LBP) is one of the most prevalent disorders worldwide. According to the World Health Organization, six or seven out of every ten individuals will experience at least a single episode of LBP in their lifetime . A review of 165 studies in 54 countries reported that the point prevalence of LBP was 11.9 ± 2.0% and that the one-month period prevalence was 23.2 ± 2.9% . Furthermore, a global analysis using years lived with disability (YLD) showed that LBP was the leading cause of disability, incurring 57.6 million YLDs, and a similar analysis on disability-adjusted life years (DALY) found that LBP, together with neck pain, was one of the three most common causes for DALYs [3, 4].
The current study investigated whether administration of acupuncture treatment is associated with a change in lumbar surgery rate for LBP patients. Of all modalities used to treat and manage LBP, lumbar surgery tends to be accompanied by more complications (e.g., infection and failed back surgery syndrome), poses a greater financial burden than non-invasive procedures, and does not necessarily ensure successful outcomes . A retrospective observational study of 200,000 patients in the U.S. reported that the mean direct cost for LBP patients was $7,211, whereas the mean direct cost of the subset who underwent surgery was $33,931 . Non-invasive management of LBP, where appropriate, is therefore of heightened importance both for individuals and the overall health care system.
The present study investigated whether acupuncture treatment is associated with lumbar surgery rates in patients with LBP by analyzing the NHIS Sample Cohort Database. As the results show, acupuncture treatment was associated with a significant decrease in HR for lumbar surgery, and the findings were consistent across all sex, income, and age groups with an exception of subjects in their 20s. This decrease tended to become greater with advancing age and in groups with higher incomes. Sensitivity analyses with adjustment for the acupuncture treatment period and frequency confirmed the robustness of the study findings, and suggested that intensive implementation of acupuncture after the onset of LBP was associated with a greater reduction in the likelihood of lumbar surgery. The findings of this nationwide, retrospective cohort study indicate that acupuncture is associated with significantly lowered lumbar surgery rates in patients with LBP.