6017/37 BMAS vol 20(4) 12/2002

Introduction Acupuncture has been frequently applied to low back pain (LBP). A number of randomised controlled trials (RCTs) on acupuncture for LBP have already been published. According to systematic reviews of the relevant RCTs, conclusions regarding the efficacy of acupuncture are contradictory. This maybe because the quality of the trials is generally low. It has been suggested that further investigations with rigorously designed RCTs are needed to demonstrate a convincing conclusion. In recent years the comparability of acupuncture RCTs seems to have gradually improved. However, the quality of acupuncture interventions in RCTs is controversial in terms of external validity, in other words, whether it is actually used in the same way in dayto-day practice. Recently a multi-centre RCT, comparing electroacupuncture (EA) and transcutaneous electrical nerve stimulation (TENS), was published in Japan. This trial was designed and conducted rigorously in partnership with specialists in clinical trials. The results showed that there was no difference between EA and TENS for LBP. However, the method of point selection in this trial seemed to be more simple and formulary than that used in the standard acupuncture practice at our clinic. We hypothesised that sensitivity of an acupuncture trial substantially depends on the choice and the number of points needled. Employing acupuncture method based on standard practice as an intervention may improve the sensitivity of the acupuncture RCTs. In order to assess this hypothesis, we conducted a pragmatic RCT of acupuncture for LBP.