Abstract
Dear Editor:
In a recent article by Moritz et al. 1 in this journal, a retrospective comparison was made between two groups of Canadian patients who had low-back pain (LBP) and who had visited physician (GP) and acupuncture (ACU) clinics, respectively; the authors concluded that the patients were less likely to visit GP for LBP after ACU treatment; the health service spending on LBP was reduced accordingly. I would like to express my comments as follows.
Clinical, Demographic, and Social Characteristics
Certain baseline characteristics of the two groups of patients are lacking in the article; these data are essential for ensuring whether the between-group comparison is justified or not. The data such as body–mass index (BMI) (LBP increases with raised BMI 2 ); races (Asians have higher acceptance of ACU and greater reluctance to use Western medicine, 3 and their BMI is lower than that of other ethnic groups 4 ); day of sick leave for LBP (an ACU practitioner is not able to issue a sick leave certification in Canada, if a patient wanting a medical absence or malingering would only visit a GP); employment (unemployed patients may be more financially restricted, and tend to spend less on food 5 and not consider ACU treatment that is not covered through the public health system in Canada).
Episode of LBP
The article 1 (page 1018, Table 2) clearly indicated that the ACU group had an average of 2 physician visits yearly for LBP and the GP group had an average of 5 visits (250% more frequent); in fact, their conditions were unmatched. Can we logically compare patients with two asthma attacks to those with five attacks yearly for a given drug's effectiveness? Moreover, there were two diverse therapies in the Moritz et al. study. 1
Nature of Treatments
Compared to GP, ACU practitioners usually spent a longer time and had more physical contacts with patients, and might take a longer time to explain posture awareness, answer questions, and alleviate worries; these general and nonspecific clinician–patient interactions could play a significant role for the treatment outcome rather than ACU. Also, a patient choosing ACU may desire to reduce LBP by nonpharmacological means, and likely adheres better to daily life modifications for rehabilitation or prevention of LBP.
The abovementioned are factors predisposing to the use of ACU or GP clinic for LBP. The patients were unlikely to have selected the treatments randomly; consequently the outcomes were not random either. Therefore, the ACU treatment might be linked to the reduced heath resource for LBP, but the efficacy of ACU could not be confirmed because a number of contributing factors were not examined. In other words, it is possible that Moritz et al. 1 found ACU useful for LBP because something meaningful is taking place outside of the needling itself.
Footnotes
Disclosure Statement
No competing financial interests exist.