Acupuncture for chronic low back pain: Diagnosis and treatment patterns among acupuncturists evaluating the same patient

Background. There is increasing need to examine the effectiveness of acupun cture and other alternative therapies for common conditions. However, littl e attention has focused on the variability in acupuncturists' assessment, d iagnosis, and treatment patterns. Methods. Seven office-based acupuncturists practicing Traditional Chinese M edicine evaluated the same patient with chronic low back pain and provided data regarding principal assessment techniques, diagnoses, and therapeutic recommendations. Results. A high diagnostic agreement existed among 5 of 7 acupuncturists. H owever, recommended treatments included varying numbers and locations of ac upuncture points. Recommendations varied between 5 and 14 points requiring 7 to 26 needles, since many points were intended for bilateral application. Of 28 acupuncture points selected, only 4 (14%) were prescribed by two or more acupuncturists. Most recommended various forms of adjuvant heat. Conclusions. Seven acupuncturists agreed considerably in the diagnoses for the same patient with chronic low back pain, but treatment recommendations varied substantially. Clinicians and researchers must recognize treatment r ecommendation variations and the challenges they present for study design a nd interpretation.