U. S. researchers said on Monday that acupuncture brought relief to patients suffering from chronic low back pain whether it was done with a toothpick or a real needle.

One of the largest studies of its kind reported in the Archives of Internal Medicine found that acupuncture eased back pain in people without the needles even penetrating the skin and worked better than standard treatments did and for many patients the relief lasted for as long as a year.

Study leader Dr. Daniel Cherkin of Group Health Center for Health Studies in Seattle said, "Our study shows that you don't need to stick needles into people to get the same effect."

In the study the researchers studied 638 adults with chronic low back pain who had never had acupuncture before. They were divided into four groups and one group received individualized acupuncture, the second received standardized acupuncture, the third group received simulated acupuncture (with a toothpick without going through the skin but targeting the correct acupuncture "points"), and the fourth received standard care (no acupuncture only medication and physical therapy).

After eight weeks 60 % of the patients who received any type of acupuncture reported significant improvement as compared to those who got the standard treatment of medication and physical therapy.

The researchers however noted that there was no difference in the relief experienced in the group who got acupuncture using needles as compared to the group who used toothpicks.

"We found that the simulated acupuncture, without penetrating the skin, produced as much benefit as needle acupuncture, and that raises questions about how acupuncture works," said Cherkin.

The researchers wrote that some imaging studies have shown that "superficial and deep needling of an acupuncture point elicited similar blood oxygen level-dependent responses." They said that another study reported that just lightly touching the skin could induce some emotional and hormonal reactions, which could explain the benefit.

"Historically, some types of acupuncture have used non-penetrating needles. Such treatments may involve physiological effects that make a clinical difference," said Karen J. Sherman, Ph. D., M. P. H., co-author of the study. "Maybe the context in which people get the treatment has effects that are more important than the mechanically-induced effects."

All in all it seems the best way to treat a chronic backache when all else fails, is acupuncture, real or fake.