Acupuncture for chronic nonspecific low back pain - PubMed (original) (raw)

Meta-Analysis

Acupuncture for chronic nonspecific low back pain

Jinglan Mu et al. Cochrane Database Syst Rev. 2020.

Abstract

Background: Chronic nonspecific low back pain (LBP) is very common; it is defined as pain without a recognizable etiology that lasts for more than three months. Some clinical practice guidelines suggest that acupuncture can offer an effective alternative therapy. This review is a split from an earlier Cochrane review and it focuses on chronic LBP.

Objectives: To assess the effects of acupuncture compared to sham intervention, no treatment, or usual care for chronic nonspecific LBP.

Search methods: We searched CENTRAL, MEDLINE, Embase, CINAHL, two Chinese databases, and two trial registers to 29 August 2019 without restrictions on language or publication status. We also screened reference lists and LBP guidelines to identify potentially relevant studies.

Selection criteria: We included only randomized controlled trials (RCTs) of acupuncture for chronic nonspecific LBP in adults. We excluded RCTs that investigated LBP with a specific etiology. We included trials comparing acupuncture with sham intervention, no treatment, and usual care. The primary outcomes were pain, back-specific functional status, and quality of life; the secondary outcomes were pain-related disability, global assessment, or adverse events.

Data collection and analysis: Two review authors independently screened the studies, assessed the risk of bias and extracted the data. We meta-analyzed data that were clinically homogeneous using a random-effects model in Review Manager 5.3. Otherwise, we reported the data qualitatively. We used the GRADE approach to assess the certainty of the evidence.

Main results: We included 33 studies (37 articles) with 8270 participants. The majority of studies were carried out in Europe, Asia, North and South America. Seven studies (5572 participants) conducted in Germany accounted for 67% of the participants. Sixteen trials compared acupuncture with sham intervention, usual care, or no treatment. Most studies had high risk of performance bias due to lack of blinding of the acupuncturist. A few studies were found to have high risk of detection, attrition, reporting or selection bias. We found low-certainty evidence (seven trials, 1403 participants) that acupuncture may relieve pain in the immediate term (up to seven days) compared to sham intervention (mean difference (MD) -9.22, 95% confidence interval (CI) -13.82 to -4.61, visual analogue scale (VAS) 0-100). The difference did not meet the clinically important threshold of 15 points or 30% relative change. Very low-certainty evidence from five trials (1481 participants) showed that acupuncture was not more effective than sham in improving back-specific function in the immediate term (standardized mean difference (SMD) -0.16, 95% CI -0.38 to 0.06; corresponding to the Hannover Function Ability Questionnaire (HFAQ, 0 to 100, higher values better) change (MD 3.33 points; 95% CI -1.25 to 7.90)). Three trials (1068 participants) yielded low-certainty evidence that acupuncture seemed not to be more effective clinically in the short term for quality of life (SMD 0.24, 95% CI 0.03 to 0.45; corresponding to the physical 12-item Short Form Health Survey (SF-12, 0-100, higher values better) change (MD 2.33 points; 95% CI 0.29 to 4.37)). The reasons for downgrading the certainty of the evidence to either low to very low were risk of bias, inconsistency, and imprecision. We found moderate-certainty evidence that acupuncture produced greater and clinically important pain relief (MD -20.32, 95% CI -24.50 to -16.14; four trials, 366 participants; (VAS, 0 to 100), and improved back function (SMD -0.53, 95% CI -0.73 to -0.34; five trials, 2960 participants; corresponding to the HFAQ change (MD 11.50 points; 95% CI 7.38 to 15.84)) in the immediate term compared to no treatment. The evidence was downgraded to moderate certainty due to risk of bias. No studies reported on quality of life in the short term or adverse events. Low-certainty evidence (five trials, 1054 participants) suggested that acupuncture may reduce pain (MD -10.26, 95% CI -17.11 to -3.40; not clinically important on 0 to 100 VAS), and improve back-specific function immediately after treatment (SMD: -0.47; 95% CI: -0.77 to -0.17; five trials, 1381 participants; corresponding to the HFAQ change (MD 9.78 points, 95% CI 3.54 to 16.02)) compared to usual care. Moderate-certainty evidence from one trial (731 participants) found that acupuncture was more effective in improving physical quality of life (MD 4.20, 95% CI 2.82 to 5.58) but not mental quality of life in the short term (MD 1.90, 95% CI 0.25 to 3.55). The certainty of evidence was downgraded to moderate to low because of risk of bias, inconsistency, and imprecision. Low-certainty evidence suggested a similar incidence of adverse events immediately after treatment in the acupuncture and sham intervention groups (four trials, 465 participants) (RR 0.68 95% CI 0.46 to 1.01), and the acupuncture and usual care groups (one trial, 74 participants) (RR 3.34, 95% CI 0.36 to 30.68). The certainty of the evidence was downgraded due to risk of bias and imprecision. No trial reported adverse events for acupuncture when compared to no treatment. The most commonly reported adverse events in the acupuncture groups were insertion point pain, bruising, hematoma, bleeding, worsening of LBP, and pain other than LBP (pain in leg and shoulder).

Authors' conclusions: We found that acupuncture may not play a more clinically meaningful role than sham in relieving pain immediately after treatment or in improving quality of life in the short term, and acupuncture possibly did not improve back function compared to sham in the immediate term. However, acupuncture was more effective than no treatment in improving pain and function in the immediate term. Trials with usual care as the control showed acupuncture may not reduce pain clinically, but the therapy may improve function immediately after sessions as well as physical but not mental quality of life in the short term. The evidence was downgraded to moderate to very low-certainty considering most of studies had high risk of bias, inconsistency, and small sample size introducing imprecision. The decision to use acupuncture to treat chronic low back pain might depend on the availability, cost and patient's preferences.

Copyright © 2020 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Conflict of interest statement

JLM has no conflicts of interest. JLM is funded by the Foundation of Direction of Nangfang Hospital (2018B008) and National Natural Science Foundation (81902009) from China. JLM was funded by Post‐doctoral Fellow (PDF) Research Assistant Professor (RAP) Scheme of the University of Hong Kong when she started the research work. The relevant overseas travel grant for the 27th European Society of Intensive Care Medicine (ESICM) Congress was offered by the Chinese University of Hong Kong.

ADF has no conflicts of interest

WYL has no conflicts of interest

MH has no conflicts of interest

ZPN has no conflicts of interest

LXL has no conflicts of interest. LXL was funded by USA NIH grant: Number R24 AT001293. LXL was partially funded by Grant Number R24 AT001293 from the National Center for Complementary and Alternative Medicine (NCCAM) of the US National Institutes of Health.

Figures

1

1

Flowchart of studies' screening

2

2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study

3

3

Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies

1.1

1.1. Analysis

Comparison 1: Acupuncture vs sham intervention, Outcome 1: Pain intensity (VAS)

1.2

1.2. Analysis

Comparison 1: Acupuncture vs sham intervention, Outcome 2: Back‐specific function

1.3

1.3. Analysis

Comparison 1: Acupuncture vs sham intervention, Outcome 3: Quality of life

1.4

1.4. Analysis

Comparison 1: Acupuncture vs sham intervention, Outcome 4: Quality of life

1.5

1.5. Analysis

Comparison 1: Acupuncture vs sham intervention, Outcome 5: Pain‐related disability (PDI)

1.6

1.6. Analysis

Comparison 1: Acupuncture vs sham intervention, Outcome 6: Global assessment of therapy effectiveness (6‐point scale)

1.7

1.7. Analysis

Comparison 1: Acupuncture vs sham intervention, Outcome 7: Global assessment of therapy effectiveness (effective number)

1.8

1.8. Analysis

Comparison 1: Acupuncture vs sham intervention, Outcome 8: Adverse events

2.1

2.1. Analysis

Comparison 2: Acupuncture vs no treatment, Outcome 1: Pain intensity (VAS)

2.2

2.2. Analysis

Comparison 2: Acupuncture vs no treatment, Outcome 2: Back‐specific function

2.3

2.3. Analysis

Comparison 2: Acupuncture vs no treatment, Outcome 3: Quality of life

2.4

2.4. Analysis

Comparison 2: Acupuncture vs no treatment, Outcome 4: Pain‐related disability (PDI, PRS)

3.1

3.1. Analysis

Comparison 3: Acupuncture vs usual care, Outcome 1: Pain intensity (VAS)

3.2

3.2. Analysis

Comparison 3: Acupuncture vs usual care, Outcome 2: Back‐specific function

3.3

3.3. Analysis

Comparison 3: Acupuncture vs usual care, Outcome 3: Back‐specific function

3.4

3.4. Analysis

Comparison 3: Acupuncture vs usual care, Outcome 4: Quality of life

3.5

3.5. Analysis

Comparison 3: Acupuncture vs usual care, Outcome 5: Pain‐related disability (PDI)

3.6

3.6. Analysis

Comparison 3: Acupuncture vs usual care, Outcome 6: Global assessment of therapy effectiveness (6‐point scale)

3.7

3.7. Analysis

Comparison 3: Acupuncture vs usual care, Outcome 7: Global assessment of therapy effectiveness (effective number)

3.8

3.8. Analysis

Comparison 3: Acupuncture vs usual care, Outcome 8: Adverse events

4.1

4.1. Analysis

Comparison 4: Acupuncture vs another intervention, Outcome 1: Acupuncture vs TENS

4.2

4.2. Analysis

Comparison 4: Acupuncture vs another intervention, Outcome 2: Acupuncture vs TENS

4.3

4.3. Analysis

Comparison 4: Acupuncture vs another intervention, Outcome 3: Acupuncture vs TENS

4.4

4.4. Analysis

Comparison 4: Acupuncture vs another intervention, Outcome 4: Acupuncture vs baclofen

4.5

4.5. Analysis

Comparison 4: Acupuncture vs another intervention, Outcome 5: Acupuncture vs pulsed radiofrequency therapy (PRT)

5.1

5.1. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 1: Acupuncture vs dry needling on trigger points

5.2

5.2. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 2: Acupuncture vs dry needling on trigger points

5.3

5.3. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 3: Acupuncture vs dry needling on trigger points

5.4

5.4. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 4: Standard acupuncture vs individualized acupuncture

5.5

5.5. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 5: Standard acupuncture vs individualized acupuncture

5.6

5.6. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 6: Standard acupuncture vs individualized acupuncture

5.7

5.7. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 7: High‐frequency acupuncture vs low‐frequency acupuncture

5.8

5.8. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 8: High‐frequency acupuncture vs low‐frequency acupuncture

5.9

5.9. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 9: Acupuncture (local acupoints) vs acupuncture (local + distant acupoints)

5.10

5.10. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 10: Acupuncture (local acupoints) vs acupuncture (local + distant acupoints)

5.11

5.11. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 11: Acupuncture (rotation) vs acupuncture (fast‐in & fast‐out)

5.12

5.12. Analysis

Comparison 5: Acupuncture vs another acupuncture technique, Outcome 12: Acupuncture (0.25 mm diameter) vs. acupuncture (0.9 mm diameter)

6.1

6.1. Analysis

Comparison 6: Acupuncture plus intervention vs intervention alone, Outcome 1: Acupuncture + standard therapy vs standard therapy

6.2

6.2. Analysis

Comparison 6: Acupuncture plus intervention vs intervention alone, Outcome 2: Acupuncture + standard therapy vs standard therapy

6.3

6.3. Analysis

Comparison 6: Acupuncture plus intervention vs intervention alone, Outcome 3: Acupuncture + standard therapy vs standard therapy

6.4

6.4. Analysis

Comparison 6: Acupuncture plus intervention vs intervention alone, Outcome 4: Acupuncture + exercise vs exercise

6.5

6.5. Analysis

Comparison 6: Acupuncture plus intervention vs intervention alone, Outcome 5: Acupuncture + exercise vs exercise

6.6

6.6. Analysis

Comparison 6: Acupuncture plus intervention vs intervention alone, Outcome 6: Acupuncture + botulinum toxin type A vs botulinum toxin type A

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References

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Inoue 2000 {published data only}
    1. Inoue M, Kitakouji H, Ikeuchi R, Katayama K, Ochi H, Imakei. Randomized controlled pilot study comparing acupuncture with sham acupuncture for lumbago [Yotsu ni taisuru gishin womochiita randamuka hikaku–shiken no kokoromi]. Journal of the Japan Society of Acupuncture and Moxibustion 2000;50(2):356. [MEDLINE: ]
Inoue 2001 {published data only}
    1. Inoue M, Kitakouji H, Ikeuchi R, Katayama K, Ochi H, Nakanishi H. Randomized controlled pilot study comparing manual acupuncture with sham acupuncture for lumbago (2nd report) [Yotsu ni taisuru gishin wo mochiita randamuka hikaku–shiken nokokoromi]. Journal of The Japan Society of Acupuncture and Moxibustion 2001;51(3):412.
Inoue 2006 {published data only}
    1. Inoue M, Kitakoji H, Ishizaki N, Tawa M, Yano T, Katsumi Y, et al. Relief of low back pain immediately after acupuncture treatment - a randomised, placebo controlled trial. Acupuncture in Medicine 2006;24(3):103-8. [PMID: ] - PubMed
Inoue 2008 {published data only}
    1. Inoue M, Nakajima M, Itoi M, Ohashi S, Yano T. The comparison of the effectiveness between acupuncture treatment and local injection for low back pain - a randomized controlled trial. Journal of the Japanese Society of Balneology, Climatology and Physical Medicine 2008;71(4):211-20.
Inoue 2009 {published data only}
    1. Inoue M, Hojo T, Nakajima M, Kitakoji H, Itoi M. Comparison of the effectiveness of acupuncture treatment and local anaesthetic injection for low back pain: a randomised controlled clinical trial. Acupuncture in Medicine 2009;27(4):174-7. [PMID: ] - PubMed
Itoh 2004 {published data only}
    1. Itoh K, Katsumi Y, Kitakoji H. Trigger point acupuncture treatment of chronic low back pain in elderly patients - a blinded RCT. Acupuncture in Medicine 2004;22(4):170-7. [PMID: ] - PubMed
Itoh 2005 {published data only}
    1. Itoh K, Katsumi Y. Effect of acupuncture treatment on chronic low back pain with leg pain in aged patients. Journal of the Japan Society of Acupuncture and Moxibustion 2005;55(4):530-7.
Itoh 2006 {published data only}
    1. Itoh K, Katsumi Y, Hirota S, Kitakoji H. Effects of trigger point acupuncture on chronic low back pain in elderly patients - a sham-controlled randomised trial. Acupuncture in Medicine 2006;24(1):5-12. [PMID: ] - PubMed
Jing 2011 {published data only}
    1. Jing HT, Peng YY, Chen M, Huang YS. Clinical observation of lumbar spinal stenosis treated with deep puncture at Jiaji (EX-B2). Chinese Acupuncture & Moxibustion 2011;31(9):791-4. [PMID: ] - PubMed
Kawase 2006 {published data only}
    1. Kawase Y, Ishigami T, Nakamura H, Hattori T, Minagawa M, Kouda H, et al. Acupuncture treatment for lower back pain: multi-center randomized controlled trial using sham acupuncture as a control. Journal of the Japan Scoiety of Acupuncture and Moxibustion 2006;56(2):140-9.
Kim 2009 {published data only}
    1. Kim SM, Kim HJ, Lee MJ, Shin YJ. Effects of local and Sa-am acupuncture on hypoadrenia and chronic low back pain. Journal of Korean Oriental Medicine, 2009;30(2):104-16.
Kittang 2001 {published data only}
    1. Kittang G, Melvaer T, Baerheim A. Acupuncture contra antiphlogistics in acute lumbago [Akupunktur kontra antiflogistika ved akutt lumbago]. Tidsskrift for den Norske Laegeforening: Tidsskrift for Praktisk Medicin, ny Raekke 2001;121(10):1207-10. [PMID: ] - PubMed
Kumnerddee 2009 {published data only}
    1. Kumnerddee, W. Effectiveness comparison between Thai traditional massage and Chinese acupuncture for myofascial back pain in Thai military personnel: a preliminary report. Journal of the Medical Association of Thailand 2009.;92(Suppl 1):S117-23. [PMID: ] - PubMed
Kurosu 1979 {published data only}
    1. Kurosu Y. Acupuncture and moxibustion for lumbago (II) - comparative experiment of the therapeutic effectiveness of acupuncture and garlic moxibustion. Journal of the Japan Acupuncture & Moxibustion Association 1979;28(2):31-4. [MEDLINE: ]
Lee 2011 {published data only}
    1. Lee JB, Im JG, Lee HG, Kim JU, Yook TH, Song BY. The comparison of effectiveness between acupuncture and its cotreatment with wan-gwa acupuncture on the treatment of low back pain. Journal of Korean Acupuncture & Moxibustion Society 2011;28(2):43-7.
Lee 2018 {published data only}
    1. Lee HJ, Choi BI, Jun S, Park MS, Oh SJ, Lee JH, et al. Efficacy and safety of thread embedding acupuncture for chronic low back pain: a randomised controlled pilot trial. Trials 2019;10(1):680. - PMC - PubMed
Lehmann 1983 {published data only}
    1. Lehmann TR, Russell DW, Spratt KF, Colby H, Liu YK, Fairchild ML, et al. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients. Pain 1986;26(3):277-90. [PMID: ] - PubMed
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Li 1997 {published data only}
    1. Li Q, Shang WM. The effect of acupuncture plus cupping on 78 cases with lumbago. Hebei Chinese Traditional Medicine 1997;19(5):28. [MEDLINE: ]
Li 2005 {published data only}
    1. Li N, Wu B, Wang CW. Comparison of acupuncture-moxibustion and physiotherapy in treating chronic non-specific low back pain. Chinese Journal of Clinical Rehabilitation 2005;9(2):186-7.
Li 2012 {published data only}
    1. Li L, Feng WW, Lu HF, Li C. Comparing the effect between acupuncture and combined acupuncture with local muscle exercise for chronic non-specific low back pain treatment. Chinese Journal of Rehabilitation Medicine 2012;27(5):475-6.
Li 2013 {published data only}
    1. Li CZ, Shu GJ, Chen Y, Tao HX, Xiang Y, Li J, et al. Effect of acupuncture and massage and Thera-Band physical exercise for chronic non-specific low back pain. Chinese Journal of Rehabilitation Medicine 2013;28(1):51-3.
Li 2013a {published data only}
    1. Li QT. Treatment of chronic lumbar muscle strain with acupuncture and bloodletting therapy. Modern Journal of Integrated Traditional Chinese and Western Medicine 2013;22(1):64-5.
Li 2016 {published data only}
    1. Li RQ, Wei NR, Sun LX, Xin HY, Zhang YL, Liu YS. The effectiveness of acupoint catgut embedding therapy and electroacupuncture treatment on chronic low back pain. Hainan Medical Journal 2016;27(1):125-8.
Li 2016a {published data only}
    1. Li WS, Yue XY, Xu JH, Wu DZ, Zhou YH, Sun SY, et al. Comparison of effect of electroacupuncture with warm needling for treatment of low back pain. Shanghai Journal of Acupuncture and Moxibustion 2016;35(7):866-9.
Li 2018 {published data only}
    1. Li HL, Zhang JS. The treatment of electroacupuncture for nonspecific low back pain.. Journal of New Chinese Medicine 2018;50(8):170-2.
Lian 2005 {published data only}
    1. Lian N, Liu JB, Francisco T, Yan QM, Edwin G. Improvement of dermal needle and body acupuncture on pain due to lumbar strain and hyperplastic spondylitis. Chinese Journal of Clinical Rehabilitation 2005;9(42):161-3.
Liu 2015 {published data only}
    1. Liu HJ, Zhu SG, Qiu YF, Dong L, Qin T, Fu YL. Effects of lumbar muscle exercise combined with electroacupuncture for chronic non-specific low back pain. Chinese Journal of Rehabilitation 2015;30(4):296-7.
Liu 2017 {published data only}
    1. Liu L, Skinner MA, McDonough SM, Baxter GD. Acupuncture for chronic low back pain: a randomised controlled feasibility trial comparing treatment session numbers. Clinical Rehabilitation 2017;31(12):1592-1603. - PubMed
Lopacz 1979 {published data only}
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Macdonald 1983 {published data only}
    1. Macdonald AJ, Macrae KD, Master BR, Rubin AP. Superficial acupuncture in the relief of chronic low back pain. Annals of The Royal College of Surgeons of England 1983;65(1):44-6. - PMC - PubMed
Marignan Michel 2014 {published data only}
    1. Marignan M. Auriculotherapy treatment protocol for low-back pain: a randomized trial. Medical Acupuncture 2014;26(3):154-60.
McKee 2012 {published data only}
    1. McKee MD, Kligler B, Blank AE, Fletcher J, Jeffres A, Casalaina W, et al. The ADDOPT study (Acupuncture to Decrease Disparities in Outcomes of Pain Treatment): feasibility of offering acupuncture in the community health centre setting. Journal of Alternative and Complementary Medicine (New York) 2012;18(9):839-43. [PMID: ] - PMC - PubMed
Mendelson 1983 {published data only}
    1. Mendelson G, Kidson MA, Loh ST, Scott DF, Selwood TS, Kranz H. Acupuncture analgesia for chronic low back pain. Clinical Experimental Neurology 1978;15:182–5. - PubMed
    1. Mendelson G, Selwood TS, Kranz H, Loh TS, Kidson MA, Scott DS. Acupuncture treatment of chronic back pain.: a double-blind placebo-controlled trial. American Journal of Medicine 1983;74:49–55. - PubMed
Meng 2019 {published data only}
    1. Meng Q, Wang Y, Yu C, Liu C. The clinical study of internal heat needling versus TCM acupuncture in the treatment of nonspecific low back pain (NLBP). Advances in Integrative Medicine 2019;6:S51.
Miyazaki 2009 {published data only}
    1. Miyazaki S, Hagihara A, Kanda R, Mukaino Y, Nobutomo K. Applicability of press needles to a double-blind trial: a randomized, double-blind, placebo-controlled trial. Clinical Journal of Pain 2009;25(5):438-44. [PMID: ] - PubMed
Moura 2019 {published data only}
    1. Moura CC, Chaves ECL, Chianca TCM, Ruginsk SG, Nogueira DA, Souza VHS, et al. Contribution of Chinese and French ear acupuncture for the management of chronic back pain: a randomised controlled trial. Journal of Clinical Nursing 2019;28(21-22):3796-806. [PMID: ] - PubMed
Muller 2005 {published data only}
    1. Muller R, Giles LG. Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. Journal of Manipulative and Physiological Therapeutics 2005;28(1):3-11. [PMID: ] - PubMed
Pan 2018 {published data only}
    1. Pan XA, Wu XM, Chan J, Li P. Curative effect observation on acupuncture combined with you gui capsules for chronic low back pain with kidney-yang deficiency. Journal of New Chinese Medicine 2018;50(12):218-20.
Puetz 2019 {published data only}
    1. Puetz CL, Kong JT. Electro-acupuncture for the treatment of chronic low back pain: effectiveness and prediction. Pain Medicine 2019;20(3):642.
Sakai 1998 {published data only}
    1. Yamashita H, Kiichiro T, Tsukayama H, Nakamura T, Ikeuchi T, Kawamoto M. Are the effects of electro-acupuncture on low back pain equal to those of TENS? Focus on Alternative and Complementary Therapies 2001;6(4):254-5. [MEDLINE: ]
Sakai 2001 {published data only}
    1. Sakai T, Tsutani K, Tsukayama H, Nakamura T, Ikeuchi T, Kawamoto M, et al. Multi-center randomized controlled trial of acupuncture with electric stimulation and acupuncture-like transcutaneous electrical nerve stimulation for lumbago. Journal of the Japan Society of Acupuncture and Moxibustion 2001;51:175-84.
Sator‐Katzenschlager 2004 {published data only}
    1. Sator-Katzenschlager SM, Scharbert G, Kozek-Langenecker SA, Szeles JC, Finster G, Schiesser AW, et al. The short- and long-term benefit in chronic low back pain through adjuvant electrical versus manual auricular acupuncture. Anesthesia and Analgesia 2004;98(5):1359-64. [PMID: ] - PubMed
Sha 2018 {published data only}
    1. Sha SY, Zhang M, Meng QL. Clinical study on curative effects of nonspecific low back pain based on back-shu and front-mumatching acupoints method of acupuncture combined with rehabilitation treatment. World Chinese Medicine 2018;13(11):2847-50.
Song 2014 {published data only}
    1. Song WL, Zhang J, Qin YX, Wang DZ. The compound intervention of moxibustion box and floating acupuncture for chronic low back pain treatment. Journal of Guiyang College of Traditional Chinese Medicine 2014;36(1):91-2.
Sun 2010 {published data only}
    1. Sun YZ, Li DY. Observation on lower back myofascitis treated with penetration needling on yang meridians of the back and electroacupuncture as compared with Western medication. Zhongguo Zhen Jiu 2010;30(10):816-8. [PMID: ] - PubMed
Sundberg 2009 {published data only}
    1. Sundberg T, Petzold M, Wandell P, Ryden A, Falkenberg T. Exploring integrative medicine for back and neck pain - a pragmatic randomised clinical pilot trial. BMC Complementary and Alternative Medicine 2009;9:33. [PMID: ] - PMC - PubMed
Takeda 2001 {published data only}
    1. Takeda H, Nabeta T. Randomized controlled trial comparing the effect of distal point needling with local point needling for low back pain [RCT ni yoru yotsu–sho ni taisuru enkakubu–sisin tokyokusho–sisin no koka hikaku]. Journal of the Japan Society of Acupuncture and Moxibustion 2001;51(3):411.
Tellez‐Garcia 2015 {published data only}
    1. Téllez-García M, De-la-Llave-Rincón AI, Salom-Moreno J, Palacios-Ceña M, Ortega-Santiago R, Fernández-de-Las-Peñas C. Neuroscience education in addition to trigger point dry needling for the management of patients with mechanical chronic low back pain: a preliminary clinical trial. Journal of Bodywork and Movement Therapies 2015;19(3):464-72. [PMID: ] - PubMed
Thomas 1994 {published data only}
    1. Thomas M, Lundberg T. Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Acta Anaesthesiologica Scandinavica 1994;38(1):63-9. [PMID: ] - PubMed
Thomas 2005 {published data only}
    1. Thomas KJ, MacPherson H, Ratcliffe J, Thorpe L, Brazier J, Campbell M, et al. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technology Assessment (Winchester, England) 2005;9(32):iii-iv, ix-x, 1-109. [PMID: ] - PubMed
Thomas 2006 {published data only}
    1. Thomas KJ, MacPherson H, Thorpe L, Brazier J, Fitter M, Campbell MJ, et al. Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. BMJ (Clinical Research Ed) 2006;333(7569):623. [PMID: ] - PMC - PubMed
Tian 2016 {published data only}
    1. Tian M, Zhong ZG. Intensive silver needle acupuncture therapy for treatment of chronic low back pain. Asia-Pacific Traditional Medicine 2016;12(8):93-4.
Tonev 2010 {published data only}
    1. Tonev D, Radeva S, Toncheva A. Non-pharmacological treatment of subacute and chronic low back pain without radiculopathy: acupuncture versus physiotherapy. Revmatologiia 2010;18(2):46-50.
Toroski 2018 {published data only}
    1. Toroski M, Nikfar S, Mojahedian MM, Ayati MH. Comparison of the cost-utility analysis of electroacupuncture and nonsteroidal antiinflammatory drugs in the treatment of chronic low back pain. Journal of Acupuncture and Meridian Studies 2018;11(2):62-6. - PubMed
Tsui 2004 {published data only}
    1. Tsui ML, Cheing GL. The effectiveness of electroacupuncture versus electrical heat acupuncture in the management of chronic low-back pain. Journal of Alternative and Complementary Medicine (New York) 2004;10(5):803-9. [PMID: ] - PubMed
Von Mencke 1988 {published data only}
    1. Von Mencke M, Wieden TE, Hoppe M, Porschke W, Hoffmann O, Herget HF. Akupunktur des schulter-arm-syndroms und de lumbagie/ischialgie - zwei prosepktive doppelblind-studien* (TeilII). Akupunktur 1989;5:5–13.
    1. Von Mencke M, Wieden TE, Hoppe M, Porschke W, HoffmannO, Herget HF. Akupunktur des schulter-arm-syndroms und der lumbagie/ischialgie - zwei prosepktive doppelblind-studien* (TeilI). Akupunktur 1988;4:204–15.
Wang 1996 {published data only}
    1. Wang JX. The effect of acupuncture on 492 cases with lumbago. Shanghai Acupuncture Journal 1996;15(5):8. [MEDLINE: ]
Wang 2013 {published data only}
    1. Wang YN, Zhao ZY. Treatment of thirty-two patients of low back pain with acupuncture on points in abdomen. Zhejing Journal of Traditional Chinese Medicine 2013;48(11):830-1.
Wang 2016 {published data only}
    1. Wang HW. The effect of integrative medicine for treatment of lumbar muscle strain. Journal of Clinical Medical Literature 2016;3(6):1132-4.
Wasan 2010 {published data only}
    1. Wasan AD, Kong J, Pham LD, Kaptchuk TJ, Edwards R, Gollub RL. The impact of placebo, psychopathology, and expectations on the response to acupuncture needling in patients with chronic low back pain. Journal of Pain 2010;11(6):555-63. [PMID: ] - PMC - PubMed
Witt 2006a {published data only}
    1. Witt CM, Brinkhaus B, Willich SN. Acupuncture. Clinical studies on efficacy and effectiveness in patients with chronic pain [Akupunktur: Klinische studien zur wirksamkeit bei patienten mit chronischen schmerzen]. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2006;49(8):736-42. [PMID: ] - PubMed
Wu 1991 {published data only}
    1. Wu YC, Xu GG. Acupuncture for 150 cases of acute lumbago. Shanghai Journal of Acupuncture and Moxibustion 1991;10(2):18-9. [MEDLINE: ]
Wu 2012 {published data only}
    1. Wu CH. Treatment effect of acupuncture and angelica injection for low back pain in the elderly. China Healthcare and Nutrition 2012;9(10):335.
Xian 2018 {published data only}
    1. Xian SS, Jiang GL, Nie DF. Clinical observation of Tong Du spinal rotation massage in observation of 30 patients with backache. Medical & Pharmaceutical Journal of Chinese Peoples Liberation Army 2018;030(002):66-9.
Xiao 2014 {published data only}
    1. Xiao J, Zhu LG, Jin T, Chen JF, Yu J, Feng MS. Comparison of paravertebral soft tissue tension changes in patients with chronic lower back pain treated by sliver needle and traditional Chinese medicine fumigation. China Journal of Orthopaedics and Traumatology 2014;27(6):513-7. - PubMed
Yang 2008 {published data only}
    1. Yang XX, Qiu F, Meng LX. Treatment of low back pain by acupuncture and Mckenzie method. Aerospace Medicine 2008;19(4):238-9.
Yeung 2003 {published data only}
    1. Yeung CK, Leung MC, Chow DH. The use of electro-acupuncture in conjunction with exercise for the treatment of chronic low-back pain. Journal of Alternative and Complementary Medicine (New York) 2003;9(4):479-90. [PMID: ] - PubMed
Yu 2002 {published data only}
    1. Yu LH, Wu NS, Zhang KP. An investigation of treatment with silver acupuncture for pain of chronic soft tissue lesions in low back. Chinese Journal of Clinical Rehabilitation 2002;6(14):2176-7.
Yu 2010 {published data only}
    1. Yu QJ, Liu B. Effects of McKenzie method with electroacupuncture treatment for chronic non-specific low back pain. Chronic Pathematology Journal 2010;12(9):1004.
Yu 2019 {published data only}
    1. Yu C, Jia D, Wan Y, Jiang H, Liu YC, Shang H, et al. The clinical study of Chinese Tuina versus acupuncture in the treatment of chronic nonspecific low back pain (CNLBP). Advances in Integrative Medicine 2019;6:S54-151.
Zeng 2005 {published data only}
    1. Zeng HH, Wu SL, Huang LR, Ma C, Xiao XH. Effect of acupuncture combined with cupping on the pain index in patients with chronic lumbar muscle strain. Chinese Journal of Clinical Rehabilitation 2005;9(26):46-7.
Zeng 2016 {published data only}
    1. Zeng Y. The Immediate Effect of Acupuncture Treatment for Nonspecific Low Back Pain with Qijingtiaoqi Manipulation (thesis). Fujian University of Traditional Chinese Medicine, 2016.
Zhao 2014 {published data only}
    1. Zhao H. Clinical observation on therapeutic effect of cupping combined with acupuncture stimulation at trigger points for lumbar myofascial pain syndrome. Acupuncture Research 2014;39(4):324-8. - PubMed
Zhou 2010 {published data only}
    1. Zhou SM, Zhou XX. Effect of acupuncture for treatment of chronic non-specific low back pain. Journal of Changchun University of Traditional Chinese Medicine 2010;26(1):81-2.
Zhu 2016 {published data only}
    1. Zhu WL, Xu DM, Liu J, Wu WZ. The treatment effect of the combination of electroacupuncture and core-strength exercises for nonspecific low back pain. Chinese Journal of Rehabilitation 2016;31(4):283-5.

References to studies awaiting assessment

Han 2018 {published data only}
    1. Han ZM, Liu Y, Luo YP, Peng XJ, Shen J, Zhan SQ, et al. The comparison of shock wave therapy versus acupuncture for the treatment of chronic nonspecial low back pain. Guide of China Medicine 2018;16(31):169-70.
Leite 2018 {published data only}
    1. Leite PMS, Mendonca ARC, Maciel LYS, Poderoso-Neto ML, Araujo CCA, Gois HCJ, et al. Does electroacupuncture treatment reduce pain and change quantitative sensory testing responses in patients with chronic nonspecific low back pain? A randomized controlled clinical trial. Evidence-Based Complementary and Alternative Medicine 2018;2018:8586746. [PMID: ] - PMC - PubMed
Tu 2019 {published data only}
    1. Tu Y, Ortiz A, Gollub RL, Cao J, Gerber J, Lang C, et al. Multivariate resting-state functional connectivity predicts responses to real and sham acupuncture treatment in chronic low back pain. NeuroImage: Clinical 2019;23:1-9. - PMC - PubMed

References to ongoing studies

ACTRN12615000534583 {unpublished data only}
    1. ACTRN12615000534583. For adults with chronic low back pain, does the number of sessions of traditional Chinese Medicine acupuncture in addition to usual care affect back pain and function outcomes? A randomized controlled feasibility study. apps.who.int/trialsearch/Trial2.aspx?TrialID=ACTRN12615000534583 (first received 27 May 2014).
IRCT20150602022539N9 {unpublished data only}
    1. IRCT20150602022539N9. The effect of electroacupuncture in non specific low back pain patients with gluteus maximus trigger points. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT20150602022539N9 (first received 28 March 2019).
IRCT2017090224149N37 {unpublished data only}
    1. IRCT2017090224149N37. Treatment of chronic low back pain using a method of manual therapy and dry needling. apps.who.int/trialsearch/Trial2.aspx?TrialID=IRCT2017090224149N37 (first received 21 Sep 2017).
NCT02039037 {unpublished data only}
    1. NCT02039037. Efficacy of acupuncture and electroacupuncture in patients with chronic nonspecific low back pain: randomized clinical trial. clinicaltrials.gov/ct2/show/NCT02039037 (first received 30 October 2013).
NCT02468297 {unpublished data only}
    1. NCT02468297. Efficacy of the electronic acupuncture shoes: a clinical trial for chronic low back pain. clinicaltrials.gov/ct2/show/NCT02468297 (first received 6 June 2015).
NCT03794869 {unpublished data only}
    1. NCT03794869. Short-term effects of exercise program versus electropuncture in patients with chronic non-specific low back pain: a randomized clinical trial. clinicaltrials.gov/ct2/show/study/NCT03794869 (first received January 7 2019).

Additional references

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