Effectiveness of Acupuncture for Low Back Pain

School of Health Sciences, University of Ulster, Co Antrim, Northern Ireland.
Spine (Impact Factor: 2.3). 12/2008; 33(23):E887-900. DOI: 10.1097/BRS.0b013e318186b276
Source: PubMed


A systematic review of randomized controlled trials (RCTs).
To explore the evidence for the effectiveness of acupuncture for nonspecific low back pain (LBP).
Since the most recent systematic reviews on RCTs on acupuncture for LBP, 6 RCTs have been published, which may impact on the previous conclusions.
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.
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.
Acupuncture versus no treatment, and as an adjunct to conventional care, should be advocated in the European Guidelines for the treatment of chronic LBP.

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    • "massage, SMTspinal manipulative therapy). Two systematic reviews [17] [24] reported relatively positive findings: Xu et al. [17] conducted Table 1 Summary of 17 included reviews. "
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    ABSTRACT: Introduction: Chronic nonspecific low back pain (cnLBP), which cannot be attributed to a specific pathology is very common. As a result acupuncture is frequently used by patients as a treatment option.This overview aimed to summarize and evaluate the available systematic reviews on the clinical effectiveness and cost-effectiveness of acupuncture for the management of cnLBP, and to identify the safety of acupuncture for the management of cnLBP. Methods: Systematic reviews of acupuncture and cnLBP were sourced from five databases. Publications between January 2003 and May 2014 were included for analysis. Quality appraisal of included systematic reviews was assessed by the Overview Quality Assessment Questionnaire. Results: Seventeen systematic reviews were included. Five found that acupuncture was more effective when compared with a no treatment/waiting list control, as there were eight systematic reviews and meta-analysis providing positive and consistent findings. Seven systematic reviews providing positive findings of the comparison of acupuncture to sham acupuncture/passive modality treatment. Three systematic reviews of multiple RCTs also indicated positive and consistent findings of the comparison of acupuncture plus an intervention vs an intervention alone. Overall, findings on the effectiveness of acupuncture for cnLBP were consistent. Conclusions: As there is a range of diverse acupuncture styles used for patients with cnLBP, future trials are needed to establish the standardization of acupuncture in terms of the length of treatment sessions, frequency of sessions, number of needles needed per treatment, placement of needle insertion, depth of needle insertion, and whether needle stimulation achieves De Qi.
    European Journal of Integrative Medicine 04/2015; 7(2). DOI:10.1016/j.eujim.2014.11.001 · 0.78 Impact Factor
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    • "The methodological qualities of the original (RCT) studies were then extracted, and quality levels were recorded as " Low " or " High, " based on the judgments made by the authors of the respective systematic reviews. As recommended, for systematic reviews using the Jadad scale [36], a score of two points or less (out of a maximum of five) represented poor quality; for systematic reviews using the PEDro scale [37], score of three points (out of a maximum of ten) was considered the cut-off for low quality [38] [39]; for systematic reviews which used criteria list from Method Guidelines for Systematic Reviews in the Cochrane Back Review Group [40– 42], low quality was defined as a score less than 5/10, 6/11, and 6/12 for the versions of 1997, 2003, and 2009, respectively; two systematic reviews used additional requirements to judge the quality; the related information was extracted: one review [16] emphasized the necessity of adequate randomization and/or allocation concealment of RCTs to be of high quality and another review [25] weighted the importance of low drop-out at follow-up, between group statistical tests, and adequate power. When no clear judgment was available from the authors, we (Lizhou Liu and Leon Mabire) made determinations in accordance with the guidelines for each scale; the included RCTs were judged as " Low " quality if over 50% of these were of high risk. "
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    ABSTRACT: Objective. As evidence of the effectiveness of acupuncture for low back pain (LBP) is inconsistent, we aimed to critically appraise the evidence from relevant systematic reviews. Methods. Systematic reviews of randomized controlled trials (RCTs) concerning acupuncture and LBP were searched in seven databases. Internal validity and external validity of systematic reviews were assessed. Systematic reviews were categorized and high quality reviews assigned greater weightings. Conclusions were generated from a narrative synthesis of the outcomes of subgroup comparisons. Results. Sixteen systematic reviews were appraised. Overall, the methodological quality was low and external validity weak. For acute LBP, evidence that acupuncture has a more favorable effect than sham acupuncture in relieving pain was inconsistent; it had a similar effect on improving function. For chronic LBP, evidence consistently demonstrated that acupuncture provides short-term clinically relevant benefits for pain relief and functional improvement compared with no treatment or acupuncture plus another conventional intervention. Conclusion. Systematic reviews of variable quality showed that acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBP. More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this area.
    Evidence-based Complementary and Alternative Medicine 03/2015; 2015:328196. DOI:10.1155/2015/328196 · 1.88 Impact Factor
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    • "Although the optimum dosage50,51,83,85,124 (frequency of treatment sessions per week or month), duration (length of time the needles should remain in situ), and intensity (the number of needles used and degree of manual manipulation or electrical stimulation) has yet to be determined23,24,50,51,83,85,114,135,174 for many neuromusculoskeletal conditions, the vast majority of ‘dry’ needling randomized controlled trials attempt to elicit a deqi response.175,176 Deqi has been defined as a dull ache, heaviness, distension, numbness, tingling, cramping, pressure, fullness, spreading, warmth, or coolness.175,176 "
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    ABSTRACT: Background: Wet needling uses hollow-bore needles to deliver corticosteroids, anesthetics, sclerosants, botulinum toxins, or other agents. In contrast, dry needling requires the insertion of thin monofilament needles, as used in the practice of acupuncture, without the use of injectate into muscles, ligaments, tendons, subcutaneous fascia, and scar tissue. Dry needles may also be inserted in the vicinity of peripheral nerves and/or neurovascular bundles in order to manage a variety of neuromusculoskeletal pain syndromes. Nevertheless, some position statements by several US State Boards of Physical Therapy have narrowly defined dry needling as an ‘intramuscular’ procedure involving the isolated treatment of ‘myofascial trigger points’ (MTrPs). Objectives: To operationalize an appropriate definition for dry needling based on the existing literature and to further investigate the optimal frequency, duration, and intensity of dry needling for both spinal and extremity neuromusculoskeletal conditions. Major findings: According to recent findings in the literature, the needle tip touches, taps, or pricks tiny nerve endings or neural tissue (i.e. ‘sensitive loci’ or ‘nociceptors’) when it is inserted into a MTrP. To date, there is a paucity of high-quality evidence to underpin the use of direct dry needling into MTrPs for the purpose of short and long-term pain and disability reduction in patients with musculoskeletal pain syndromes. Furthermore, there is a lack of robust evidence validating the clinical diagnostic criteria for trigger point identification or diagnosis. High-quality studies have also demonstrated that manual examination for the identification and localization of a trigger point is neither valid nor reliable between-examiners. Conclusions: Several studies have demonstrated immediate or short-term improvements in pain and/or disability by targeting trigger points (TrPs) using in-and-out techniques such as ‘pistoning’ or ‘sparrow pecking’; however, to date, no high-quality, long-term trials supporting in-and-out needling techniques at exclusively muscular TrPs exist, and the practice should therefore be questioned. The insertion of dry needles into asymptomatic body areas proximal and/or distal to the primary source of pain is supported by the myofascial pain syndrome literature. Physical therapists should not ignore the findings of the Western or biomedical ‘acupuncture’ literature that have used the very same ‘dry needles’ to treat patients with a variety of neuromusculoskeletal conditions in numerous, large scale randomized controlled trials. Although the optimal frequency, duration, and intensity of dry needling has yet to be determined for many neuromusculoskeletal conditions, the vast majority of dry needling randomized controlled trials have manually stimulated the needles and left them in situ for between 10 and 30 minute durations. Position statements and clinical practice guidelines for dry needling should be based on the best available literature, not a single paradigm or school of thought; therefore, physical therapy associations and state boards of physical therapy should consider broadening the definition of dry needling to encompass the stimulation of neural, muscular, and connective tissues, not just ‘TrPs’.
    Physical Therapy Reviews 08/2014; 19(4):252-265. DOI:10.1179/108331913X13844245102034
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