Acupuncture in low back pain

Evidence Summaries

Level of Evidence = C
Acupuncture for chronic low-back pain may be more effective than no treatment or sham treatment for pain relief and functional improvement in the short-term. When added to other conventional therapies, it may relieve pain and improve function better than the conventional therapies alone. However, effects are only small. The evidence for patients with acute low back pain is sparse and inconclusive.

A Cochrane review 1 included 35 trials with a total of 2,861 subjects. Twenty of the 35 included RCTs were published in English, seven in Japanese, five in Chinese and one each in Norwegian, Polish and German. The results from three trials of acupuncture for acute low-back pain do not justify firm conclusions, because of small sample sizes and low methodological quality of the studies. For chronic low-back pain there is evidence of pain relief and functional improvement for acupuncture, compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and at short-term follow-up (up to three weeks after the end of the session). There is evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, effects are only small. The average pain reduction (measured by continuous scales such as the VAS) in the group that received acupuncture for chronic low-back pain was 32% compared to 23% in those who received sham therapies and 6% in those who received no treatment.

A systematic review 2 including 33 RCTs (n=2,300) was abstracted in DARE. Studies of Chinese, Japanese and Western style acupuncture were eligible for inclusion. 22 studies (n=1,805) were included in a random-effects meta-analysis. In chronic low back pain, there was a statistically significant improvement in short-term pain relief with acupuncture in comparison with sham acupuncture (SMD 0.58, 95% CI 0.36 to 0.80; 4 studies), sham TENS (SMD 0.42, 95% CI 0.05 to 0.79; 3 studies) and no additional treatment (SMD 0.69, 95% CI 0.40 to 0.98; 8 studies). The improvement in long-term (the measurement closest to 6 months after therapy) pain relief with acupuncture in comparison with sham TENS (SMD 0.62, 95% CI 0.03 to 1.22; 2 studies) and no additional treatment (SMD 0.74, 95% CI 0.02 to 1.47; 5 studies) was not statistically significant. There was a statistically significant improvement in short-term functioning effects with acupuncture in comparison with no additional treatment (SMD 0.62, 95% CI 0.30 to 0.95; 6 studies). The evidence for patients with acute pain was sparse and inconclusive. There was no evidence that acupuncture is more effective than other active therapies.

Comment: The quality of evidence is downgraded by severe study limitations (e.g. lack of allocation concealment).

References

1. Furlan AD, van Tulder MW, Cherkin DC, Tsukayama H, Lao L, Koes BW, Berman BM. Acupuncture and dry-needling for low back pain. Cochrane Database Syst Rev 2005 Jan 25;(1):CD001351.  [PMID:15674876]

2. Manheimer E, White A, Berman B, Forys K, Ernst E. Meta-analysis: acupuncture for low back pain. Ann Intern Med 2005 Apr 19;142(8):651-63.  [PMID:15838072]


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