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And a new study says acupuncture can help ease chronic lower back pain. But as NPR's Allison Aubrey reports, the research does not explain why it works for some people and not others.

ALLISON AUBREY: If the idea of needles piercing your skin reminds you more of a dreaded appointment to have your blood drawn than a healing day at the spa, Margaret Gillard understands. She used to think that the same way.

Ms. MARGARET GILLARD: I'm not terrified of needles, but I don't like them. I don't like getting blood tests and shots, that type of thing.

AUBREY: But about a year ago, Margaret recalls she had a conversation with a friend about her back pain. It was getting worse, despite steady doses of Advil. So she was eager to experiment with something new.

Ms. GILLARD: And she said, well, why don't you try acupuncture if you're open to different treatments? You know, so I did. And it just happened to work really well for my back pain.

AUBREY: She's still going about once a month. And since I was curious about how it all works, Margaret let me sit in with her during a treatment. Her acupuncturist is in an office building in downtown D.C., but when you walk through the door it feels like a spa. The walls are painted a subtle sage, there's bamboo, lavender-like smells and water trickles in a little serenity fountain.

Ms. GILLARD: It's very restful and calming. I come in and I know that it's just going to be a time where I can relax, be by myself.

AUBREY: When she lies down on the treatment table, acupuncturist, Kate Yonkers, explains she's looking to insert needles in very specific points. In this case, she pierces a spot just below Margaret's knee.

Ms. KATE YONKERS (Acupuncturist): You put it into a certain depth, so that you get chi at the point.

AUBREY: By chi she means energy. And Yonkers explains the intention is to get healing energy flowing through the body by stimulating these points. As the needle goes in, I asked Margaret to describe the sensation.

Ms. GILLARD: I just felt a bit of little pressure. It wasn't uncomfortable at all and then I can feel the warmth kind of radiating down my leg.

AUBREY: So it's a good feeling?

Ms. GILLARD: Mm-hmm. Absolutely.

AUBREY: So this is the point in the story to step back a bit and ask whether Margaret's experience fits with what the new research shows. Dan Cherkin is an epidemiologist with Group Health in Seattle. In his latest study, he compared back pain in patients with who got usual care - meaning, medicine and doctors visits - with other patients who got usual care and acupuncture. He tracked about 600 patients for one year.

Dr. DANIEL CHERKIN (Senior Investigator, Group Health Center): What happened in the study is that most people got better in all the groups. It's just that the people who got acupuncture were more likely to do better.

AUBREY: So about 40 percent of the people got better with usual care compared to about 60 percent who had acupuncture. But here's an interesting twist to the findings, some of the back pain patients got just pressure put on the acupuncture points, no needles. And it turns out that these folks did just as well as the people who got standard acupuncture. The results beg the question, what explains the healing effect for those who experience them? And Cherkin says, he doesn't know. It's not clear. It could be that stimulating these standardized points does cause a specific physiological process that reduces pain.

Dr. CHERKIN: Or there's a whole ritual, if you will, of performing this treatment have no specific effects but rather has a generalized effect. That is, the patient is feeling that they are getting a helpful treatment. And as a result, the brain reacts in a way that leads to improvement.

AUBREY: The placebo effect?

Dr. CHERKIN: It is sometimes called the placebo effect. That term is often used to sort to dismiss something as not real.

AUBREY: The effect here, experts agree, is certainly real. Cherkin's study is not the first to find that acupuncture can be beneficial. Physician Brent Bauer of the Mayo Clinic says whether it's the manipulation of chi - as an acupuncturist would explain it - or something akin to the placebo effect, where endorphin-like chemicals are released that block pain signals in the brain, it's just not clear?

Dr. BRENT BAUER (Mayo Clinic): It's probably important at some level to kind of bring some closure to these arguments that go back and forth. But at the end of the day, my greatest interest is, does it help my patients?

AUBREY: In many cases, it clearly does help. And Bauer says a patient's expectations seem to play a role in the outcome.

Allison Aubrey, NPR's News.

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