Effectiveness of Acupuncture for Low Back Pain: A Systematic Review

Jing Yuan, PhD; Nithima Purepong, MSc; Daniel Paul Kerr, PhD; Jongbae Park, KMD, PhD; Ian Bradbury, PhD; Suzanne McDonough, PhD

Disclosures

Spine. 2008;33(23):E887-E900. 

In This Article

Abstract and Introduction

Abstract

Study Design. A systematic review of randomized controlled trials (RCTs).
Objective. To explore the evidence for the effectiveness of acupuncture for nonspecific low back pain (LBP).
Summary of Background Data. Since the most recent systematic reviews on RCTs on acupuncture for LBP, 6 RCTs have been published, which may impact on the previous conclusions.
Methods. Searches were completed for RCTs on all types of acupuncture for patients with nonspecific LBP published in English. Methodologic quality was scored using the Van Tulder scale. Trials were deemed to be high quality if they scored more than 6/11 on the Van Tulder scale, carried out appropriate statistical analysis, with at least 40 patients per group, and did not exceed 20% and 30% dropouts at short/intermediate and long-term follow-up, respectively. High quality trials were given more weight when conducting the best evidence synthesis. Studies were grouped according to the control interventions, i.e., no treatment, sham intervention, conventional therapy, acupuncture in addition to conventional therapy. Treatment effect size and clinical significance were also determined. The adequacy of acupuncture treatment was judged by comparison of recommendations made in textbooks, surveys, and reviews.
Results. Twenty-three trials (n = 6359) were included and classified into 5 types of comparisons, 6 of which were of high quality. There is moderate evidence that acupuncture is more effective than no treatment, and strong evidence of no significant difference between acupuncture and sham acupuncture, for short-term pain relief. There is strong evidence that acupuncture can be a useful supplement to other forms of conventional therapy for nonspecific LBP, but the effectiveness of acupuncture compared with other forms of conventional therapies still requires further investigation.
Conclusion. Acupuncture versus no treatment, and as an adjunct to conventional care, should be advocated in the European Guidelines for the treatment of chronic LBP.

Introduction

Low back pain (LBP) has a high lifetime prevalence in which nonspecific LBP represents a large majority of cases.[1,2] Although 90% of patients have improved at 1 month,[3] the majority continue to be symptomatic at 1 year, with only 21% to 25% completely recovered in terms of pain and disability.[4,5] Overall, LBP is one of the most costly conditions in the UK, which is in line with findings in other countries, leading to a total cost of £10,668 million (including direct health care cost and indirect cost e.g., informal care, production losses related to LBP).[5] Furthermore, costs caused by recurrence of LBP contribute substantially more, than costs in first episodes, to the total burden of LBP.[6]

The Royal College of General Practitioners (RCGP) recommends that LBP should shift from secondary to primary care, and the aim should be a rapid return to normal function.[7] There is much current debate on how to achieve this return to normal function. Among complementary and alternative medicine (CAM), acupuncture has been demonstrated as a powerful therapy, which is associated with clinically relevant improvements for LBP and is receiving increasing recognition from both the public and professionals.[8,9] Two recent randomized controlled trials (RCTs) evaluating economics, 1 in the UK and the other in Germany, shows that acupuncture is relatively cost effective in terms of quality of life for LBP.[10,11] These endorsements seem to have translated into practice in that a growing number of GP practices in England are providing access to acupuncture for their patients.[12,13] Moreover, the public are increasing their interest in the use of acupuncture, e.g., a recent survey in the United States indicated that most LBP patients would be very likely to try acupuncture if they did not have to pay out of pocket, and their physician thought it was a reasonable treatment option.[14]

Since the most recent systematic reviews on RCTs on acupuncture for LBP,[15,16] 6 RCTs (4 with large sample sizes) have been published,[11,15,16,17,18,19,20,21] which may impact on the conclusions drawn by the previous reviews. Therefore the aim of this review was to investigate the updated evidence on the effectiveness of acupuncture for nonspecific LBP using rigorous rating criteria.

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