Clinical Question: Is acupuncture effective in treating acute or chronic low back pain?
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Bottom Line
Acupuncture is an effective treatment for decreasing pain in patients with chronic low back pain. It doesn’t seem to be a placebo effect; acupuncture produces a significantly greater effect on pain than sham acupuncture. There is not enough research to allow a conclusion for the treatment of acute low back pain. (LOE= 1a)
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Study Design: Meta-analysis (randomized controlled trials)
Setting: Various (meta-analysis)
Synopsis: In Western medicine, with many traditionally trained physicians cross-trained in its use. This meta-analysis assembled 22 randomized controlled trials comparing acupuncture with no treatment, sham acupuncture, or another active treatment such as massage or analgesics in the treatment of chronic low back pain. Sham acupuncture is used to convince patients they are receiving acupuncture and consists of inserting acupuncture needles either superficially or at inappropriate sites, or by using the acupuncture needle tube or other blunt device to provide pressure without actual penetration.
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FAST TRACK
Acupuncture was more effective than sham or no treatment; it was not better or worse than massage, medication, or TENS
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The studies (in any language) were identified by searching 7 databases, contacting experts, hand-searching a Japanese acupuncture journal, and using previous review articles. Two authors independently selected the studies and abstracted the data. Results of sham-controlled studies were homogeneous. One study of the 5 studies that compared acupuncture with no additional therapy produced heterogeneous results favoring no treatment as compared with acupuncture. Publication bias could not be assessed.
For patients with chronic low back pain, lasting at least 3 months, acupuncture was more effective than sham acupuncture, sham transcutaneous nerve stimulation (TENS), and no treatment for short-term pain relief. It was not significantly better or worse than massage, medication therapy, or actual TENS treatment, and was significantly less effective than spinal manipulation. It provided long-term pain relief as compared with sham TENS or no treatment but was not different from sham acupuncture or active TENS.
There is not enough data on the effectiveness of acupuncture for acute back pain to provide a conclusion. Three studies evaluated the use of acupuncture in the treatment of antenatal low back pain; all 3 studies found a benefit, though their results could not be combined.
