Acupuncture is an effective treatment for relief from low back pain, even when compared with other interventions (sham acupuncture, usual care, or no treatment), with stronger effects observed immediately after treatment. Clinically significant reduction in pain is more reliably observed in chronic rather than acute low back pain (strength of recommendation: A, based on systematic review and meta-analysis of randomized controlled trials [RCTs]).
The American College of Physicians issued a clinical practice guideline recommending acupuncture as a first-line therapy for acute and chronic nonradicular low back pain along with other nondrug therapy including stretching, heat application, massage, and manual spinal manipulation.5 The National Institutes of Health’s National Center for Complementary and Integrative Health considers acupuncture to be a safe treatment when done by trained acupuncturists using sterile needles.
Research evidence from systematic reviews
Systematic review and meta-analysis involved in 6656 participants comparing acupuncture with other treatments (sham acupuncture, no treatment, transcutaneous electrical nerve stimulation, medications, usual care) found that acupuncture was clinically superior to sham acupuncture in pain reduction for patients with chronic low back pain (CLBP) immediately after and up to 3 months following treatment. Further, acupuncture provided more pain relief in CLBP compared with no treatment and usual care, which typically consisted of nonacupuncture care like physical therapy, massage, and medication.
Systematic reviews involved in 11 682 participants comparing acupuncture with sham acupuncture, no treatment, or acupuncture plus conventional treatment, which included physical therapy, exercise, and medication, revealed inconsistent evidence of benefit in acute low back pain. Acupuncture was consistently found to provide superior pain relief for CLBP lasting greater than 3 months in the short term.
Systematic reviews involved in 7958 participants analysed acupuncture versus sham acupuncture for chronic low back pain and found that acupuncture significantly reduced pain intensity immediately and 12 weeks after treatment. Compared with medications (nonsteroidal anti-inflammatory drugs, muscle relaxants, or analgesics), acupuncture provided greater pain relief and improved function.
Neuroimaging Studies of Acupuncture on Low Back Pain suggested that improving abnormal structure and functional activities in the brain of the LBP patient is an important mechanism of acupuncture treatment for LBP. The brain regions involved in acupuncture analgesia for LBP were mainly located in the pain matrix, default mode network (DMN), salience network (SN), and descending pain modulatory system (DPMS).
Roselyn Clemente Fuentes et al Can Fam Physician. 2020 Mar; 66(3): 186–187.
Qiao Wen et al Front Neurosci. 2021; 15: 730322.