Key Finding
Needling therapies for chronic primary low back pain showed modest improvements in pain and functional limitations compared to no intervention and usual care, though overall evidence certainty was low to very low.
Researchers conducted a comprehensive review of 37 clinical trials to evaluate whether acupuncture and other needling therapies help adults with chronic primary low back pain. This review was conducted to inform World Health Organization treatment guidelines. The studies compared needling therapies to sham treatments, usual care, or no treatment at all.
The researchers found some benefits, though the quality of evidence was limited. When compared to sham (placebo) acupuncture, needling therapies showed small improvements in physical quality of life after 6 months. When compared to no treatment, patients experienced reduced pain at both 2 weeks and 3 months, and improved physical function at these same time points. Older adults specifically showed improvements in physical function at 2 weeks and 3 months. When compared to usual medical care, needling therapies reduced both pain and functional limitations at 3 months.
However, it's important to understand that the evidence quality was rated as low to very low across all outcomes, meaning we can't be completely certain about these results. For many other measures examined, there was little to no difference between needling therapies and comparison treatments.
What this means for you: If you have chronic low back pain, needling therapies like acupuncture may provide some relief for pain and help improve your ability to function in daily activities, particularly when compared to doing nothing or continuing with usual care alone. The benefits appear modest but may be meaningful for some individuals. To try acupuncture safely, seek treatment from a licensed or certified acupuncturist in your area.
This systematic review analyzed 37 RCTs (from 1831 screened citations) evaluating needling therapies for chronic primary low back pain in adults to inform WHO clinical practice guidelines. Overall certainty of evidence was low to very low across outcomes. Compared to sham, NT demonstrated improved physical HRQoL at 6 months (2 RCTs; SMD=0.20, 95%CI 0.07-0.32). Compared to no intervention, NT reduced pain at 2 weeks (21 RCTs; MD=-1.21, 95%CI -1.50 to -0.92) and 3 months (9 RCTs; MD=-1.56), with corresponding reductions in functional limitations (2 weeks: 19 RCTs, SMD=-1.39; 3 months: 8 RCTs, SMD=-0.57). In older adults, functional improvements were observed at both time points. Compared to usual care, NT reduced pain (MD=-1.35) and functional limitations (MD=-2.55) at 3 months. Clinical takeaway: NT may provide modest benefits for pain and function in CPLBP, though evidence certainty remains limited and benefits were inconsistent across comparisons.
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