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1.  Acupuncture for acute non-specific low back pain: a protocol for a randomised, controlled multicentre intervention study in general practice—the Acuback Study 
BMJ Open  2012;2(3):e001164.
Some general practitioners (GPs) treat acute low back pain (LBP) with acupuncture, despite lacking evidence of its effectiveness for this condition. The aim of this study was to evaluate whether a single treatment session with acupuncture can reduce time to recovery when applied in addition to standard LBP treatment according to the Norwegian national guidelines. Analyses of prognostic factors for recovery and cost-effectiveness will also be carried out.
Methods and analysis
In this randomised, controlled multicentre study in general practice in Southern Norway, 270 patients will be allocated into one of two treatment groups, using a web-based application based on block randomisation. Outcome assessor will be blinded for group allocation of the patients. The control group will receive standard treatment, while the intervention group will receive standard treatment plus acupuncture treatment. There will be different GPs treating the two groups, and both groups will just have one consultation. Adults who consult their GP because of acute LBP will be included. Patients with nerve root affection, ‘red flags’, pregnancy, previous sick leave more than 14 days and disability pension will be excluded. The primary outcome of the study is the median time to recovery (in days). The secondary outcomes are rated global improvement, back-specific functional status, sick leave, medication, GP visits and side effects. A pilot study will be conducted.
Ethics and dissemination
Participation is based on informed written consent. The authors will apply for an ethical approval from the Regional Committee for Medical and Health Research Ethics when the study protocol is published. Results from this study, positive or negative, will be disseminated in scientific medical journals.
Trial Registration Number Identifier: NCT01439412.
Article summary
Article focus
Does acupuncture treatment contribute to faster pain recovery in acute LBP compared with standard treatment in general practice provided in accordance with the Norwegian national guidelines?
Does acupuncture treatment for acute LBP improve function and reduce drug use and sick leave?
Is acupuncture treatment for acute LBP a cost-effective treatment in general practice?
Key messages
This project will increase the knowledge about the effects of acupuncture treatment for acute LBP.
The primary outcome is the median time in days for recovery from pain.
A faster pain relief will aid the patients to earlier return to normal, everyday activities, including return to their work.
Strengths and limitations of this study
The methodology of the trial is stronger than previous studies.
There are still methodological challenges in acupuncture trials; in this trial, neither the patient or the GP will be blinded, and the consultation time will be longer in the intervention group.
PMCID: PMC3383982  PMID: 22734119
2.  Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study 
BMJ Open  2011;1(1):e000130.
To examine the effect of opioid maintenance treatment (OMT) on somatic morbidity in a cohort of OMT patients.
Retrospective cohort study.
OMT programme in two Norwegian counties.
200 OMT patients, participation rate 71.2%.
Main outcome measures
Incidence rates (IR) before, during and after OMT for acute/subacute hospital-treated somatic disease incidents (drug-related, non-drug-related, injuries) and rates for inpatient days and outpatient treatment contacts.
IR for drug-related hospital treatment episodes were 76% lower during compared to before OMT (before versus during incidence rate ratio (IRR) 4.2 (95% CI 2.9 to 6.2), p<0.001) and 11 times higher after compared to during OMT (after versus during IRR 11.1 (6.6 to 18.5), p<0.001). For non-drug-related treatment episodes, IR were 35% higher during than before OMT (before versus during IRR 0.7 (0.6 to 1.0), p=0.02) and 32% higher after compared to during OMT (IRR 1.4 (0.9 to 2.2), p=0.15), while injuries showed little change according to OMT status. Although patients with on-going drug-taking during OMT showed less reduction in drug-related hospital-treated incidents during treatment than patients not using illicit drugs, the quartile with most drug-taking showed a significant reduction (before versus during IRR 3.6 (2.4 to 5.3)). Patients who had experienced cessation of OMT showed a significant reduction in drug-related treatment episodes during OMT (before versus during IRR 1.7 (1.0 to 2.9)), although less than patients without OMT interruptions (before versus during IRR 6.1 (3.6 to 10.6)), and a significant increase after OMT cessation compared with during OMT (IRR 5.4 (3.0 to 9.7)).
Acute/subacute drug-related somatic morbidity is reduced during compared to before OMT. This was also found for patients with on-going drug-taking during OMT. However, acute drug-related health problems show an increase after OMT cessation, and this is a matter of concern. Further studies on somatic morbidity after OMT cessation should be carried out.
Article summary
Article focus
Opioid maintenance treatment (OMT) is the most widely used treatment for opioid dependence, but the effects of OMT on physical health problems have received relatively little attention.
This study investigates how acute somatic morbidity (drug-related, non-drug-related, injuries) varies according to OMT status (before, during, after OMT) in a cohort of 200 OMT patients.
The research questions were: Is somatic morbidity reduced during OMT compared to before and after treatment? If so, what types of disease incidents are reduced? How is the effect of OMT status on somatic morbidity influenced by various patient characteristics?
Key messages
Acute drug-related somatic morbidity (overdoses, injecting-related, other) is substantially reduced during compared to before OMT.
This was also found for ‘problem patients’ with on-going drug-taking during OMT, but to a lesser degree than for patients not using illicit drugs.
Strengths and limitations of this study
Participation rate was high, selection bias limited, observation period long and the evaluation of morbidity changes was based on assessment of full-text hospital records.
The study focused on acute health problems treated in hospital, but elective hospital contact due to chronic health problems and primary healthcare contacts were not included.
PMCID: PMC3191421  PMID: 22021771

Results 1-2 (2)