Research is the systematic and rigorous process of enquiry which aims to describe phenomena and to develop explanatory concepts and theories (Bowling 1997). A research question should be feasible, of interest to the researcher, original, relevant and ethically sound (Sim and Wright 2000). Evidence based health care involves the conscientious, explicit and judicious use of current best evidence about care of individual patients (Sackett et all 1996). In order to approach evidence based care in an evidenced based way the evidence available needs to be reviewed. A health care professional which practices in an evidence based way continues to improve their knowledge base and increase confidence and clinical decision making.
One of the most significant causes of suffering and distress in the UK is chronic pain. Most diagnoses are for back pain, arthritis and widespread joint pain (National Institute of Neurological Disorders and Stroke (NINDS 2008). Between 5 and 10 per cent of people have chronic pain with no formal diagnosis (Nursing Standards 2010). This does not mean that their pain is imaginary. McCaffery said: ‘Pain is what the experiencing person says it is and exists whenever the experiencing person says it does’ (McCaffery and Pasero 1999).
Chronic pain can be complex and difficult to manage. There needs to be a greater awareness among patients and healthcare professionals of the wide variety of treatment options in pain management. Some will not be suitable for all patients, some will fail but others will improve pain and function. Lower back pain affects 60-80 per cent of people at some stage in their lives (Nursing Standards 2004).
Recent statistics about acupuncture use estimate that in England each year, one million treatments are given in the NHS, and two million in the private sector (University of York 2001). Of the many non drug treatments available for pain, acupuncture receives the most positive reports in relation to effectiveness and long term management. I intend to critically appraise three pieces of research regarding acupuncture in the treatment of chronic lower back pain.
Recently I attended a lecture about complimentary therapies in university which I found to be interesting and a good alternative to drugs as a medication. I feel there is not enough complimentary therapies offered to patients with chronic pain. I would like to find out the effectiveness of acupuncture as a therapy for pain looking specifically at lower back pain.
To discover the research question ‘Is acupuncture effective in the treatment of chronic lower back pain?’ I looked on the SHU lit search which is linked to databases holding research documentation. I used the Cochrane library which has systematic reviews of evidence based healthcare literature including randomised controlled trials. I used this database to find the most relevant information I needed.
Searched words used included ‘acupuncture’ and ‘chronic lower back pain’. The database found 6153 articles. To cut the amount of articles down I entered ‘clinical trials’ into the date base. It then found 63 articles. I then changed the dates to 1998-2010 because I wanted to find the most relevant and up to date research. The search brought up 40 articles. I looked through the articles and at the abstract information to finalise my choice of 3 research articles. The papers selected were Acupuncture in Patients with Chronic Low Back Pain (2006), Acupuncture treatment of chronic low-back pain (2001), a randomised placebo controlled prospective study and finally a Acupuncture for low back pain (1999). All three articles had a common aim which was to identify whether or not acupuncture was effective within the treatment of lower back pain. I will look at how the research was carried out in my chosen papers and appraise each paper with the aid of a universal critical appraisal tool that has been adapted from Hawker et al (2002). "Critical appraisal is...