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Acupuntura y técnica de aguja seca para el dolor lumbar

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Referencias

Referencias de los estudios incluidos en esta revisión

Araki 2001 {published and unpublished data}

Araki S, Kawamura O, Mataka T, Fujioka H, et al. Randomized controlled trial comparing the effect of manual acupuncture with sham acupuncture for acute low back pain [RCT ni yoru kyusei yotsu‐sho ni taisuru shishin‐gun to gishin‐gun no tiryou koka]. Journal of the Japan Society of Acupuncture and Moxibustion 2001;51(3):382.

Carlsson (even) {published data only}

 

Carlsson (morn) {published data only}

 

Carlsson 2001 {published data only}

Carlsson CP, Sjolund BH. Acupuncture for chronic low back pain: a randomized placebo‐controlled study with long‐term follow‐up. Clin J Pain 2001;17(4):296‐305. [MEDLINE: 915]

Ceccherelli 2002 {published data only}

Ceccherelli F, Rigoni MT, Gagliardi G, Ruzzante L. Comparison of superficial and deep acupuncture in the treatment of lumbar myofascial pain: a double‐blind randomized controlled study. Clin J Pain 2002;18(3):149‐153. [MEDLINE: 1045]

Cherkin 2001 {published data only}

Cherkin DC, Eisenberg D, Sherman KJ, Barlow W, Kaptchuk TJ, Street J, et al. Randomized trial comparing traditional Chinese medical acupuncture, therapeutic massage, and self‐care education for chronic low back pain. Archives of Internal Medicine 2001;161(8):1081‐1088. [MEDLINE: 886]
Kalauokalani D, Cherkin DC, Sherman KJ, Koepsell TD, Deyo RA. Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects. Spine 2001;26(13):1418‐1424.

Cherkin 2001 (mass) {published data only}

 

Cherkin 2001 (sc) {published data only}

 

Coan 1980 {published data only}

Coan RM, Wong G, Ku SL, Chan YC, Wang L, Ozer FT, et al. The acupuncture treatment of low back pain: a randomized controlled study. Am J Chinese Med 1980;8:181‐189.

Ding 1998 {published data only}

Ding YD. Fly‐probing‐acupoint manipulation as a main treatment for lumbago. Shanghai Journal of Acupuncture and Moxibustion 1998;17(5):25‐26. [MEDLINE: 4]

Edelist 1976 {published data only}

Edelist G, Gross AE, Langer F. Treatment of low back pain with acupuncture. Canad Anaesth Soc J 1976;23:303‐306.

Garvey 1989 {published data only}

Garvey TA, Marks MR, Wiesel SW. A prospective, randomized, double‐blind evaluation of trigger‐point injection therapy for low‐back pain. Spine 1989;14:962‐964.

Garvey 1989 (lidoc) {published data only}

 

Garvey 1989 (spray) {published data only}

 

Garvey 1989(steroid) {published data only}

 

Giles 1999 {published data only}

Giles LG, Muller R. Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti‐inflammatory drug, and spinal manipulation. J Manip Physiol Ther 1999;22(6):376‐381. [MEDLINE: 807]

Giles 1999 (manip) {published data only}

 

Giles 1999 (NSAID) {published data only}

 

Giles 2003 {published data only}

Giles LGF, Muller R. Chronic spinal pain. A randomized clinical trial comparing medication, acupuncture and spinal manipulation. Spine 2003;28(14):1490‐1503.

Giles 2003 (manip) {published data only}

 

Giles 2003 (NSAID) {published data only}

 

Grant 1999 {published data only}

Grant DJ, Bishop‐Miller J, Winchester DM, Anderson M, Faulkner S. A randomized comparative trial of acupuncture versus transcutaneous electrical nerve stimulation for chronic back pain in the elderly. Pain 1999;82(1):9‐13. [MEDLINE: 1081]

Gunn 1980 {published data only}

Gunn CC, Milbrandt WE, Little AS, Mason KE. Dry needling of muscle motor points for chronic low‐back pain: a randomized clinical trial with long‐term follow‐up. Spine 1980;5:279‐291.

He 1997 {published data only}

He RY. Clinical Observation on Treatment of Lumbago due to Cold‐Dampness By Warm‐Acupuncture Plus Chinese Medicine. Chinese Acupuncture & Moxibustion 1997;17(5):279‐80. [MEDLINE: 1753]

Inoue 2000 {published and unpublished data}

Inoue M, Kitakouji H, Ikeuchi R, Katayama K, Ochi H, et al. Randomized controlled pilot study comparing acupuncture with sham acupuncture for lumbago [Yotsu ni taisuru gishin wo mochiita randamuka hikaku‐shiken no kokoromi]. Journal of the Japan Society of Acupuncture and Moxibustion 2000;50(2):356. [MEDLINE: 1771]

Inoue 2001 {published and unpublished data}

Inoue M, Kitakouji H, Ikeuchi R, Katayama K, Ochi H, et al. Randomized controlled pilot study comparing manual acupuncture with sham acupuncture for lumbago (2nd report) [Yotsu ni taisuru gishin wo mochiita randamuka hikaku‐shiken no kokoromi]. Journal of The Japan Society of Acupuncture and Moxibustion 2001;51(3):412.

Kerr 2003 {published data only}

Kerr DP, Walsh DM, Baxter D. Acupuncture in the management of chronic low back pain: a blinded randomized controlled trial. The Clinical Journal of Pain 2003;19:364‐370.

Kittang 2001 {published data only}

Kittang G, Melvaer T, Baerheim A. [Acupuncture contra antiphlogistics in acute lumbago]. Tidsskr Nor Laegeforen 2001;121(10):1207‐1210. [MEDLINE: 1101]

Kurosu 1979(a) {published data only}

Kurosu Y. Acupuncture and Moxibustion for Lumbago (II) ‐ Comparative Experiment of the Therapeutic Effectiveness of Acupuncture and Garlic Moxibustion. The Journal of the Japan Acupuncture & Moxibustion Association 1979;28(2):31‐34. [MEDLINE: 1765]

Kurosu 1979(b) {published data only}

 

Lehmann 1986 {published data only}

Lehmann TR, Russell DW, Spratt KF. The impact of patients with nonorganic physical findings on a controlled trial of transcutaneous electrical nerve stimulation and electroacupuncture. Spine 1983;8:625‐634.
Lehmann TR, Russell DW, Spratt KF, Colby H, Liu YK, Fairchild ML, Christensen S. Efficacy of electroacupuncture and TENS in the rehabilitation of chronic low back pain patients. Pain 1986;26:277‐290.

Leibing 2002 {published data only}

Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, et al. Acupuncture treatment of chronic low‐back pain ‐ a randomized, blinded, placebo‐controlled trial with 9‐month follow‐up. Pain 2002;96(1‐2):189‐196. [MEDLINE: 1113]

Li 1997 {published data only}

Li Q, Shang WM. The effect of acupuncture plus cupping on 78 cases with lumbago. Hebei Chinese Traditional Medicine 1997;19(5):28. [MEDLINE: 1754]

Lopacz 1979 {published data only}

Lopacz S, Gralewski Z. A trial of assessment of the results of acupuncture or suggestion in the treatment of low back pain. Neur Neurochir Pol 1979;8:405‐409.

MacDonald 1983 {published data only}

MacDonald AJ, Macrae KD, Master BR, Rubin AP. Superficial acupuncture in the relief of chronic low back pain. Ann Royal Coll Surg Engl 1983;65:44‐46.

Mendelson 1983 {published data only}

Mendelson G, Kidson MA, Loh ST, Scott DF, Selwood TS, Kranz H. Acupuncture analgesia for chronic low back pain. Clin Exp Neurol 1978;15:182‐185.
Mendelson G, Selwood TS, Kranz H, Loh TS, Kidson MA, Scott DS. Acupuncture treatment of chronic back pain.: a double‐blind placebo‐controlled trial. Am J Med 1983;74:49‐55.

Meng 2003 {published data only}

Meng CF, Wang D, Ngeow J, Lao L, Peterson M, Paget S. Acupuncture for chronic low back pain in older patients: a randomized, controlled trial. Rheumatology 2003;42:1‐10.

Molsberger 2002 {published data only}

Molsberger A, Winkler J, Schneider S, Mau J. Acupuncture and conventional orthopedic pain treatment in the management of chronic low back pain ‐ a prospective randomised and controlled clinical trial. ISSLS. 1998:87.
Molsberger AF, Mau J, Pawelec DB, Winkler J. Does acupuncture improve the orthopedic management of chronic low back pain‐‐a randomized, blinded, controlled trial with 3 months follow up. Pain 2002;99(3):579‐587. [MEDLINE: 1760]

Sakai 1998 {published and unpublished data}

Sakai T, Tsukayama H, Amagai H, Kawamoto M, Masuda K, et al. Controlled trial on acupuncture for lumbago [Yotsu ni taisuru hari no hikaku‐taisyo‐shiken]. Journal of the Japan Society of Acupuncture and Moxibustion 1998;48(1):110. [MEDLINE: 1773]

Sakai 2001 {published data only}

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.
Yamashita H. Are the Effects of Electro‐Acupuncture on Low Back Pain Equal to those of TENS?. Focus on Alternative and Complementary Therapies 2001;6(4):254‐255. [MEDLINE: 1752]

Takeda 2001 {published and unpublished data}

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 to kyokusho‐sisin no koka hikaku]. Journal of the Japan Society of Acupuncture and Moxibustion 2001;51(3):411.

Thomas 1994 {published data only}

Thomas M, Lundberg T. Importance of modes of acupuncture in the treatment of chronic nociceptive low back pain. Acta Anaesthesiol Scand 1994;38:63‐69.

Tsukayama 2002 {published data only}

Tsukayama H, Yamashita H, Amagai H, Tanno Y. Randomised controlled trial comparing the effectiveness of electroacupuncture and TENS for low back pain: a preliminary study for a pragmatic trial. Acupuncture in Medicine 2002;20(4):175‐180. [MEDLINE: 1758]

Von Mencke 1988 {published data only}

Von Mencke M, Wieden TE, Hoppe M, Porschke W, Hoffmann O, Herget HF. Akupunktur des Schulter‐Arm‐Syndroms und der Lumbagie/Ischialgie ‐ zwei prosepktive Doppelblind‐Studien* (Teil I). Akupunktur 1988;4:204‐215.
Von Mencke M, Wieden TE, Hoppe M, Porschke W, Hoffmann O, Herget HF. Akupunktur des Schulter‐Arm‐Syndroms und der Lumbagie/Ischialgie ‐ zwei prosepktive Doppelblind‐Studien* (Teil II). Akupunktur 1989;5:5‐13.

Wang 1996 {published data only}

Wang JX. The effect of acupuncture on 492 cases with lumbago. Shanghai Acupuncture Journal 1996;15(5):28. [MEDLINE: 1755]

Wu (b) 1991 {published data only}

 

Wu 1991 {published data only}

Wu YC ea. Acupuncture for 150 cases of acute lumbago. Shanghai Journal of Acupuncture and Moxibustion 1991;10(2):18‐19. [MEDLINE: 3]

Yeung 2003 {published data only}

Yeung CKN, Leung MCP, Chow DHK. The use of electro‐acupuncture in conjunction with exercise for the treatment of chronic low‐back pain. The journal of alternative and complementary medicine 2003;9(4):479‐490.

Referencias de los estudios excluidos de esta revisión

Cai 1996 {published data only}

Cai Gw ZDLL. Clinic research in treatment of acute sciatica by needling YaoYangKuan (DU3) deep. Shangai J of Acupuncture 1996;15(2):8‐9.

Duplan 1983 {published data only}

Duplan B, Cabanel G, Piton JL, Grauer Jl, Phelip X. Acupuncture et lombosciatique a la phase aiguë: etude en double aveugle de trente cas. Sem Hop Paris 1983;59:3109‐3114.

Fox 1976 {published data only}

Fox EJ, Melzack R. Transcutaneous electrical stimulation and acupuncture: comparison of treatment for low‐back pain. Pain 1976;2(2):141‐148.

Franke 2000 {published data only}

Franke A, Gebauer S, Franke K, Brockow T. [Acupuncture massage vs Swedish massage and individual exercise vs group exercise in low back pain sufferers‐‐a randomized controlled clinical trial in a 2 x 2 factorial design]. Forsch Komplementarmed Klass Naturheilkd 2000;7(6):286‐293. [MEDLINE: 958]

Fujinuki 1989 {published data only}

Fujinuki R. Yobu sekityukan kyosakusyo no shinkyu tiryo ni kansuru kenkyu (2). The study of acupuncture & moxibustion for lumbar spinal canal stenosis (2). Journal of the Japan Acupuncture and Moxibustion 1989;48(11):6‐13. [MEDLINE: 1769]

Galacchi 1981 {published data only}

Gallacchi G, Muller W, Plattner GR, Schnorrenberger CC. Acupuncture and laser treatment in cervical and lumbar syndrome [Akupunktur ‐ und Laserstrahlbehandlung beim Zervikal ‐ and Lumbalsyndrom]. Schweiz Med Wschr 1981;111(37):1360‐66.

Gallacchi 1983 {published data only}

Gallacchi G, Muller W. Acupuncture‐‐does it contribute anything?] [Akupunktur ‐ bringt sie etwas?]. Schweiz Rundschau Med Prax 1983;72(22):778‐82.

Ghia 1976 {published data only}

Ghia JN, Mao W, Toomey T, Gregg JM. Acupuncture and chronic pain mechanisms. Pain 1976;2(3):285‐99.

Hackett 1988 {published data only}

Hackett GI, Seddon D, Kaminski D. Electroacupuncture compared with paracetamol for acute low back pain. Practitioner 1988;232:163‐164.

Ishimaru 1993 {published data only}

Ishimaru K, Shinohara S, Kitade T, Yhodo M. Clinical efficacy of electrical heat acupuncture (First report): effect on low‐back pain. American Journal of Acupuncture 1993;21(1):13‐18.

Junnila 1982 {published data only}

Junnila SYT. Acupuncture therapy for chronic pain. American Journal of Acupuncture 1982;10(3):259‐62.

Kinoshita 1965 {published data only}

Kinoshita H. Comparative observation in Goshin‐ho and Hinaishin‐po. The Journal of the Japan Acupuncture & Moxibustion Association 1965;18(2):5‐9. [MEDLINE: 1763]

Kinoshita 1971 {published data only}

Kinoshita H. Consideration of tonification and dispertion based upon clinical experiment.. The Journal of the Japan Acupuncture & Moxibustion Association 1971;20(3):6‐13. [MEDLINE: 1762]

Kinoshita 1981 {published data only}

Kinoshita H, Kinoshita N. Clinical Research in the Use of Paraneural Acupuncture for Sciatica. The Journal of the Japan Acupuncture & Moxibustion Association 1981;30(1):4‐13. [MEDLINE: 1767]

Koike 1975 {published data only}

Koike Y. Quantity of stimulation in the treatment of lumbago. Acupuncture treatment for lumbago.. The Journal of the Japan Acupuncture & Moxibustion Association 1975;24(3):8‐13. [MEDLINE: 1761]

Kuramoto 1977 {published data only}

Kuramoto S. A clinical study of the effects of electrical acupuncture on protrusions of the intervertebral discs. The Journal of the Japan Acupuncture & Moxibustion Association 1977;26(2):45‐48. [MEDLINE: 1764]

Laitinen 1976 {published data only}

Laitinen J. Acupuncture and transcutaneous electric stimulation in the treatment of chronic sacrolumbalgia and ischialgia. American Journal of Chinese Medicine 1976;4(2):169‐175.

Li 1994 {published data only}

Li J, Chenard JR, Marchand S, Charest J, Lavignolle B. Points d'acupuncture et zones‐gachettes: réponse a la presson et résistance cutanée chez des lombalgies chroniques. Rhumatologie 1994;46:11‐19. [MEDLINE: 437]

Megumi 1979 {published data only}

Megumi N. Acupuncture‐moxibustion Therapy for the Lumbago known as Colic. The Journal of the Japan Acupuncture & Moxibustion Association 1979;28(2):35‐44. [MEDLINE: 1766]

Ren 1996 {published data only}

Ren, Tian‐Ming. Needling Taichong (Liv 3) and Mingmen (Du 4 or GV 4) to treat lower back pain. Journal of Clinical Acupuncture 1996;12(5‐6):90.

Shinohara 2000 {published data only}

Shinohara S, Kitade K, Tanzawa S. Effect of acupuncture based on Jingjin (channel sinews) theory for musculoskeletal conditions [Undoki‐kei shojo ni keikin no gainen wo katsuyo‐shita rinsyo‐hoho to sono koka]. Journal of the Japan Society of Acupuncture and Moxibustion 2000;50(2):340. [MEDLINE: 1770]

Sodipo 1981 {published data only}

Sodipo JOA. Transcutaneous electrical nerve stimulation (TENS) and acupuncture: comparison of therapy for low‐back pain. Pain. 1981:S277.

Sugiyama 1984 {published data only}

Sugiyama N, Ito F, Takagi T. The effect of acupuncture and mobilization on lumbago. Journal of the Japan Society of Acupuncture and Moxibustion 1984;33(4):402‐9. [MEDLINE: 1768]

Wang 1997 {published data only}

Wang RY. The effect of acupuncture with moxibustion or acupuncture with cupping on 167 cases with lumbago. Anhui Chinese Traditional Medicine Clinical Journal 1997;9:272‐3. [MEDLINE: 1756]

Wang 2000 {published data only}

Wang RR, Tronnier V. Effect of acupuncture on pain management in patients before and after lumbar disc protrusion surgery ‐ a randomized control study. American Journal of Chinese Medicine 2000;28(1):25‐33.

Wedenberg 2000 {published data only}

Wedenberg K. A prospective randomized study comparing acupuncture with physiotherapy for low‐back and pelvic pain in pregnancy. Acta Obstet Gynecol Scand 2000;79:331‐335.

Xingsheng 1998 {published data only}

Xingsheng C. Comparative study on acupuncture needling methods for sciatica: routine needling vs point‐to‐point penetration and deep puncture. American Journal of Acupuncture 1998;26(1):37‐41.

Xu 1996 {published data only}

Xu L, Zhi‐xiang Z, Xian‐ming L, Guang‐zhan L, Cheng‐xuan Q. Acupuncture plus massage versus massage alone in treating acute lumbar sprain. International Journal of Clinical Acupuncture 1996;7(3):365‐67.

Yue 1978 {published data only}

Yue SJ. Acupuncture for chronic back and neck pain. Acupuncture & Electro‐Therapeut Res Int J 1978;3:323‐24.

Zhang 1995 {published data only}

Zhang ZT, Zhang QZ. The effect of acupuncture plus chiropractic on 57 cases with waist protrusion of the intervertebral disk. Neck pain and Lumbago Journal 1995;16(2):97‐8. [MEDLINE: 1757]

Zhang 1996 {published data only}

Zhang HP, Du SP, u LJ. [Observation on therapeutic effects of 110 cases with sciatica treated by electro‐acupuncture deeply at Yaoyangguan]. Chinese Acupuncture & Moxibustion 1996;16(8):19‐20. [MEDLINE: 2]

Zhi 1995 {published data only}

Zhi L, Jing S. Clinical comparison between scalp acupuncture combined with a single body acupoint and body acupuncture alone for the treatment of sciatica. American Journal of Acupuncture 1995;23(4):305‐7.

Referencias de los estudios en curso

Cherkin {unpublished data only}

Efficacy of Acupuncture for Chronic Low Back Pain. Ongoing study Funding: National Center for Complementary and Alternative Medicine (NCCAM).

GerAc {unpublished data only}

German Acupuncture Trials. Ongoing study Starting date of trial not provided. Contact author for more information.

Harvard Med School {unpublished data only}

Physical CAM Therapies for Chronic Low Back Pain. Ongoing study Funding: NIH.

Kong {unpublished data only}

Ongoing study Starting date of trial not provided. Contact author for more information.

Munglani {unpublished data only}

Randomised controlled single‐blinded trial of deep intra‐muscular stimulation in the treatment of chronic mechanical low back pain.. Ongoing study Starting date of trial not provided. Contact author for more information.

Thomas {unpublished data only}

Longer term clinical and economic benefits of offering acupuncture to patients with chronic low back pain.. Ongoing study Funding: NHS.

Cherkin 2003

Cherkin DC, Sherman KJ, Deyo RA, Shekelle PG. A review of the evidence for the effectiveness, safety and costs of acupuncture, massage therapy and spinal manipulation for back pain. Ann Int Med 2003;138:898‐906.

Chu 1979

Chu LSW, Yeh SDJ, Wood DD. Acupuncture manual: a western approach. New York: Marcel Dekker Inc, 1979.

Chung 2003

Chung A, Bui L, Mills E. Adverse effects of acupuncture. Which are clinically significant?. Canadian Family Physician 2003;49:985‐89.

Ernst 2003

Ernst G, Strzyz H, Hagmeister H. Incidence of adverse effects during acupuncture therapy‐ a multicentre survey. Complementary Therapies in Medicine 2003;11:93‐97.

Gerwin 2001

Gerwin RD. Classification, epidemiology, and natural history of myofascial pain syndrome. Current Pain and Headache Reports 2001;5(5):412‐20.

Lao 1996

Lao L. Acupuncture techniques and devices. J Alternative Complementary Med 1996;2:23‐5.

MacPherson 2001

MacPherson H, Thomas K, Walters S, Fitter M. The York acupuncture safety study: prospective survey of 34 000 treatments by traditional acupuncturists. BMJ 2001;323(7311):486‐7.

MacPherson 2002

MacPherson H, White A, Cummings M, Jobst KA, Rose K, Niemtzow RC, STRICTA Group. Standards for Reporting Interventions in Controlled Trials of Acupuncture: the STRICTA recommendations. J Altern Complement Med 2002;8(1):85‐9.

Melchart 2004

Melchart D, Weidenhammer W, Streng A, Reitmayr S, Hoppe A, Ernst E, et al. Prospective investigation of adverse effects of acupuncture in 97,733 patients. Arch Intern Med 2004;164:104‐5.

Odsberg 2001

Odsberg A, Schill U, Haker E. Acupuncture treatment: side effects and complications reported by Swedish physiotherapists. Comp Ther Med 2001;9:17‐20.

Pengel 2003

Pengel LHM, Herbert RD, Maher CG, Refshauge KM. Acute low‐back pain: systematic review of its prognosis. BMJ 2003;327(7410):323‐327.

Shekelle 1994

Shekelle PG, Andersson G, Bombardier C, et al. A brief introduction to the critical reading of the clinical literature. Spine 1994;19:2028S‐31S.

Stux 2003

Stux G, Berman B, Pomeranz B. Basics of acupuncture. 5th Edition. Berlin Heidelberg: Springer‐Verlag, 2003.

Sutton 2000

Sutton AJ, Duval SJ, Tweedie RL, Abrams KR, Jones DR. Empirical assessment of effect of publication bias on meta‐analyses. BMJ 2000 June 10;320(7249):1574‐7.

Travell 1983

Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Williams & Wilkins, 1983.

van Tulder 1995

van Tulder MW, Koes BW, Bouter LM. A cost‐of‐illness study of back pain in the Netherlands. Pain 1995;62:233‐40.

van Tulder 1997

van Tulder MW, Koes BW, Bouter LM. Conservative treatment of acute and chronic nonspecific low back pain. A systematic review of randomized controlled trials of the most common interventions. Spine 1997;22(18):2128‐56.

van Tulder 1999 (a)

van Tulder MW, Cherkin D, Berman B, Lao L, Koes BW. Acupuncture for low back pain. Cochrane Database of Systematic Reviews 1999, Issue 2. [Art. No.: CD001351. DOI: 10.1002/14651858.CD001351]

van Tulder 1999 (b)

van Tulder MW, Cherkin DC, Berman B, Lao L, Koes BW. The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 1999;24(11):1113‐23.

van Tulder 2003

van Tulder M, Furlan A, Bombardier C, Bouter L, The Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine 2003;28(12):1290‐9.

Waddell 1987

Waddell G. A new clinical model for the treatment of low back pain. Spine 1987;12:632‐644.

White 2001

White A, Hayhoe S, Hart A, Ernst E. Adverse events following acupuncture: prospective survey of 32 000 consultations with doctors and physiotherapists. BMJ 2001;323:485‐6.

Yamashita 1999

Yamashita H, Tsukayama H, Tanno Y, Nishijo K. Adverse events in acupuncture and moxibustion treatment: a six‐year survey at a national clinic in Japan. J Altern Complement Med 1999;5(3):229‐36.

Yamashita 2000

Yamashita H, Tsukayama H, Hori N, Kimura T, Tanno Y. Incidence of adverse reactions associated with acupuncture. J Altern Complement Med 2000;6(4):345‐50.

Yamashita 2001

Yamashita H, Tsukayama H, White AR, Tanno Y, Sugishita C, Ernst E. Systematic review of adverse events following acupuncture: the Japanese literature. Comp Ther Med 2001;9:98‐104.

Characteristics of studies

Characteristics of included studies [ordered by study ID]

Araki 2001

Methods

‐Randomized (draw lots). Used sealed opaque envelopes by the acupuncturist.
‐Patients and outcome assessors were blinded.
‐Funding: not reported
‐Setting: private clinic in Osaka, Japan.
‐Informed consent obtained orally from patients.
‐Ethics approval: not described
‐All patients were followed.
‐Analysis: Mean difference between before and after. Repeated measure ANOVA for responses.

Participants

40 patients with acute low‐back pain (less than three days) and no sciatica.

Diagnoses: lumbar disc herniation, discopathy and lumbago.

Mean age: 44 years old

28 males and 7 females.

Working status:?
Previous treatments:?
Co‐morbidity:?

Interventions

1) The needles were inserted into SI3 (bilaterally) with Teh Chi sensation, in supine position, and then patients were made to perform back exercise. Needles were left in situ during the back exercise. Insertion depth was 2.5 cm with stainless steel needles (50 mm length, 0.20 mm diameter). Acupuncture treatment was performed once only.
Randomized to this group: 20
Acupuncturists' experience: three and six years.

2) Sham needling was performed to SI3 (bilaterally) point in supine position. Acupuncturist mimicked needle insertion: tapped head of needle guide tube and then patients were made to perform back exercise. Gesture of needling was performed during the back exercise. Sham treatment was performed once only.
Randomized to this group: 20

Outcomes

1) Pain: Visual Analog Scale (VAS) from 0 to 100 mm;
2) Function: Japan Orthopedic Association (JOA) score, ranges from 0 to 14 (higher is better). Used only the category of restriction of daily activities.
3) Flexion: Finger‐to‐floor distance

All three outcomes were taken before and immediately after the single session.

Costs: not reported

Complications: not reported

Notes

The original study was published in abstract only. We obtained additional information from the authors.

Language: Japanese

For results, see the comparisons:
1.6
1.2
1.3
1.4
1.5
1.6

Conclusion: "There is no difference between the effect of acupuncture and that of sham acupuncture"

Carlsson (even)

Methods

see Carlsson 2001

Participants

Interventions

Outcomes

Notes

Carlsson (morn)

Methods

see Carlsson 2001

Participants

Interventions

Outcomes

Notes

Carlsson 2001

Methods

‐ Randomized by computer generated list. A secretarial assistant who was not involved in the study performed the assignments.
‐ Patients and outcome assessors were blinded.
‐ Funding: One author is supported by Swedish Medical Research Council.
‐ Setting: Pain clinic (outpatients) in Malmo General Hospital affiliated with University in Sweden.
‐ Informed consent: yes
‐ Ethics approval: yes
‐ Follow‐up: 100% at one month, 62% at three months, and 53% at six months.
‐ Analysis: used "last observation carried forward" for missing values.
Baseline differences in pain (VAS) were resolved by analysing percent changes at follow‐ups. However, for this analysis they used the non‐parametric Mann‐Whitney test.
There is no information about which test they used to analyse the global assessments. But, when we replicate the analysis using RevMan, we get different results from the authors if we use relative risks, but not if we use odds ratios.
For sick leave they used Wilcoxon signed ranks test.

Participants

51 patients with low back pain for six months or longer (mean 9.5 years) without radiation below the knee and normal neurological examination.

Diagnoses: 39 muscular origin, 11 severe structural changes on X‐rays.

Excluded: trauma, systemic disease, pregnancy and history of acupuncture treatment.

Mean age: 50 years

17 males and 33 females.

Working status: 20 on sick leave, 17 retired, 12 full time, one unemployed.

Previous treatments: corsets, nerve blocks, analgesics, TENS, physiotherapy. Two had undergone surgery.

Interventions

1) Manual acupuncture: local points (BL24, BL25, BL26, Ex Jiaji) and distal points (LI11, LI4, BL40, BL57 and BL60). "Teh‐Chi" feeling was sought in all instances, mostly at a needle‐tip depth of 2 to 3 cm. The needles were stimulated three times during the 20‐minute treatment sessions to restore Teh Chi feelings. The needles were disposable, stainless steel, with a diameter between 0.3 and 0.32 mm and a length between 30 and 70 mm.
Frequency: once per week for eight weeks; two further treatments were given during the follow‐up assessments period of six months or longer.
Randomized to this group:16
Acupuncturist' experience: board certified anaesthesiologist with more than 10,000 acupuncture treatments.

2) In addition to the needles as in the manual acupuncture group, they performed electrical stimulation of four needles (one pair per side in the low back). Frequency: 2 Hz every 2.5 seconds, interrupted by a 15 Hz train for 2.5 seconds.
Randomized to this group: 18

3) Mock transcutaneous electrical nerve stimulation (TENS) given by an impressive, stationary, but disconnected GRASS (gradient‐recalled acquisition in a steady state) stimulator attached to two large TENS electrodes. The electrodes were placed on the skin over the most intensely painful area in the low back. During stimulation, flashing lamps were displayed and visible to the patient. This group was seen once per week for 8 weeks.
Randomized to this group: 16

Outcomes

1) Pain: Visual Analog Scale (VAS) from 0 to 100 mm; measured in the morning and in the evening. Not clear how many patients filled all pain diaries everyday.
2) Global assessment by physician. Subjective. Improvement is not defined
3) Present work status: number of people on sick leave.
4) Intake of analgesics recorded daily
5) Sleep quality recorded daily

Outcomes were taken at 1 month, 3 months and 6 months or longer after the end of the 8 sessions.

The results of these outcomes at baseline are not reported, except for pain which is slightly different between acupuncture and placebo.

Costs: not reported

Complications: no complications occurred during treatment or follow‐up period

Notes

Language: English

Publication: full paper

Additional information from authors: no

The authors pooled groups 1 and 2 and compared with group 3.

The results for pain are similar in the morning and evening measurements.

For results, see the comparisons:
5.1
5.2
5.6
5.8
5.9 (other data table)
5.10 (other data table)
7.2

Conclusion: "The authors demonstrated a long‐term pain‐relieving effect of needle acupuncture compared with true placebo in some patients with low‐back pain"

Ceccherelli 2002

Methods

‐Randomized (table of random numbers). No description of allocation concealment.
‐Outcome assessors were blinded.
‐Funding: AIRAS (Associazone Italiana per la Ricerca e l'Aggiornamento Scientifico)
‐Setting: Pain clinic, University of Padova, Italy.
‐Informed consent and ethics approval not reported
‐All patients were followed
‐Analysis: Between groups were initially compared by repeated measurements two‐way ANOVA. Post hoc comparison was done by the Bonferroni correction of the unpaired t‐test.

Participants

42 patients with continuous pain for more than 3 months. Normal neurologic exam. No signs of radicular compression.

Diagnoses: chronic lumbosacral myofascial pain.

Excluded: spinal cord injury, osteoporosis, rheumatic diseases, disk herniation, fibromyalgia, organic diseases, hypertension or obesity.

Age: between 30‐50 years old. Mean 42 years old.

30 males and 12 females

Working status: ?

Previous treatments: none had been treated with acupuncture

Co‐morbidity: ?

Interventions

1) Deep acupuncture: 1.5 cm in the muscle or in the trigger point. Needles: disposable Sedatelec 300um diameter of 3 different lengths: 10 mm, 29 mm and 49 mm. Points: Extra 19, VG6. The following were inserted bilaterally: GB34, UB54, UB62. Plus four trigger points or as second choice in the four most painful muscular tender points found in the lumbar area. Total of eight sessions (total 6 weeks), each session lasted for 20 minutes.
All needles were stimulated for 1 minute immediately after the insertion and for 20 s. every 5 min at 5, 10 and 15 minutes. The frequency of alternate right and left rotation of the needles was 2 Hz.
Randomized to this group: not described
Acupuncturist's experience: not described

2) Same as described for acupuncture, but the depth of insertion was only 2 mm in the skin.
Randomized to this group: not described

Outcomes

1) Pain: verbally using the McGill Pain Questionnaire. They used the number of words chosen and the pain rating index. The pain rating index is the sum of numerical values that has been assigned to each word used to describe the pain.

Measured immediately after the end of the sessions and after 3 months.

Costs: not reported

Complications: not reported

Notes

Language: English

Publication: full paper

Additional information from authors: we contacted authors, but no response was received.

For results, see the comparisons:
7.1

Conclusions: "Clinical results show that deep stimulation has a better analgesic effect when compared with superficial stimulation"

Cherkin 2001

Methods

‐Randomized (computer‐generated random sequence). A research assistant confirmed eligibility, collected baseline data and randomised the eligible ones.
‐Outcome assessors were blinded.
‐Funding: Group Health Cooperative, The Group Health Foundation (Seattle), Wash and the John E. Fetzer Institute (Kalamazoo) and Agency for Health Care Research and Quality, Rockville.
‐Setting. Health Maintenance Organization in Washington State, USA
‐Informed consent: yes
‐Ethics approval: yes
‐Follow‐up: 95% at 4 weeks, 95% at 10 weeks and 95% at 52 weeks.
‐Analysis: Intention‐to‐treat. ANCOVA for continuous variables and Logistic regression for dichotomous variables. Adjustments for baseline values: Roland score, baseline symptom bothersomeness scale score, pain below the knee, more than 90 days of back pain, satisfaction with previous back care, sex and age.

Participants

262 patients who visited a primary care physician for low‐back pain who had persistent pain for at least 6 weeks.

Diagnoses: Non‐specific low‐back pain.

Excluded: sciatica, acupuncture or massage for back pain, back care from a specialist or CAM provider, clotting disorders or anticoagulant therapy, cardiac pacemakers, systemic or visceral disease, pregnancy, litigation or compensation, inability to speak English, severe or progressive neurologic deficits, previous lumbar surgery, recent vertebral fracture, serious comorbid conditions and bothersomeness of back pain less than 4 (on a 0 to10 scale).

Mean age: 44.9 years old

42% males and 58% females

Working status: 84% employed or self‐employed

Treatments being received at the time of entry in the study: medications (68%), massage (16%), acupuncture (3%), narcotics (10%)

Co‐morbidity: see exclusion criteria

Interventions

1) Acupuncture: Traditional Chinese Medical acupuncture by licensed acupuncturists with at least 3 years of experience; Basic TCM needling techniques, electrical stimulation and manual manipulation of the needles, indirect moxibustion, infrared heat, cupping, and exercise recommendation.
Proscribed: massage including acupressure, herbs and treatments not considered common TCM (Japanese meridian therapy). Number and location of needles were left to the provider. They were allowed up to 10 visits over 10 weeks for each patient. All patients were needled and "teh chi" was reported for 89%. Mean of 12 needles (range 5‐16) were inserted in each visit. Acupuncturists recommended exercise for about half of their patients, usually stretching, walking or swimming.
Randomized to this group: 94 (88 received acupuncture as randomised).

2) Massage by a licensed therapist with at least 3 years of experience. Manipulation of soft tissue: Swedish (71%), movement reeducation (70%), deep‐tissue (65%), neuromuscular (45%), and trigger and pressure point (48%), moist heat or cold (51%). Prohibited: energy techniques (Reiki, therapeutic touch), meridian therapies (acupressure and shiatsu) and approaches deemed too specialized (craniosacral and Rolfing). Massage therapists recommended exercise. They were allowed up to 10 visits over 10 weeks per patient.
Randomized to this group: 78 (74 received massage as randomised).

3) Self‐care education: high‐quality and inexpensive educational material designed for persons with chronic back pain: a book and 2 professionally produced videotapes.
Randomized to this group: 90

Outcomes

1) Pain: bothersomeness of back pain (0 to10), leg pain (0 to10) or numbness or tingling (0 to10). The higher score was used.
2) Function: Roland Disability Scale
3) Disability: National Health Interview Survey
4) Utilization: provider visits, X‐rays, operations, hospitalizations, medication use, visits to other massage therapists or acupuncturists
5) Costs
6) Satisfaction
7) SF‐12 Mental and Physical Health summary scales
8) Number of days of exercise

Outcomes were measured at baseline, 4, 10 and 52 weeks after randomisation

Complications: no serious adverse effects were reported by any study participant

Notes

Language: English

Publication: full paper

For results, see the comparisons:
6.1
6.2
6.4

However, the results shown in the table of comparisons are the unadjusted analysis. We based our conclusions on the authors analyses.
Therefore, the results are presented in the other data table:
6.5

Conclusions: "Massage is an effective short‐term treatment for chronic low‐back pain, with benefits that persist for at least one year. Self‐care educational materials had little early effect, but by one year were almost as effective as massage. If acupuncture has a positive effect, it seems to be concentrated during the first four weeks because there was little improvement thereafter".

Cherkin 2001 (mass)

Methods

See Cherkin 2001

Participants

Interventions

Outcomes

Notes

Cherkin 2001 (sc)

Methods

See Cherkin 2001

Participants

Interventions

Outcomes

Notes

Coan 1980

Methods

‐Randomization was carried out by having prepared in advance a small box with 50 identically‐sized pieces of paper, folded so that they could not be read. 25 had A and 25 had B written on them. The box was shaken and one of the pieces of paper was removed from the box blindly.
‐Nobody was blinded
‐Funding: National Health and Medical Research Council of Australia
‐Setting: Acupuncture Center in Maryland, USA
‐Informed consent: ?
‐Ethics approval:?
‐All patients were followed
‐Analysis: Adherers (or "per protocol analysis").

Participants

50 patients recruited via newspapers with low‐back pain for at least 6 months.

Diagnoses: Abnormal X‐ray (38/43), Sciatica (27/49), Muscle spasm (36/46)

Inclusion criteria: no previous acupuncture treatments, no history of diabetes, infection or cancer, and not more than 2 back surgeries.

Mean age: 47 years old (range 18 to 67)

23 males and 27 females

Working status:?

Previous treatments: back surgery (4)

Interventions

1) Acupuncture: Classical Oriental meridian theory. Electrical acupuncture in some patients. Selection of acupuncture loci varied. 'Acknowledged acupuncturists'. 10 or more sessions, approximately 10 weeks. Teh chi unclear.
Randomized to this group: 25

2) Waiting list, no treatment for 15 weeks. Then they received the same acupuncture treatment as above.
Randomized to this group: 25

Outcomes

1) Pain: Mean pain scores (0=no pain and 10=worst pain)
2) Function: Mean limitation of activity (0=none and 3=severe)
3) Mean pain pills per week
4) Global improvement (improved, same, worse)

Results after 10 weeks in acupuncture and after 15 weeks in waiting list group

Costs: not reported

Complications: not reported

Notes

The authors reported a per protocol analysis. However, because there is individual patient data reported in the article, we were able to recalculate using the intention‐to‐treat principle.

Language: English

Publication: full paper

Additional information from authors: no

For results, see the comparisons:
4.1
4.2
4.4
4.5

Conclusions: "This study demonstrated that acupuncture was a superior form of treatment for these people with low‐back pain, even though they had the condition for an average of 9 years".

Ding 1998

Methods

‐ Randomized (method not described). No mention of concealment of allocation.
‐Patients blinded
‐Funding: not reported
‐Setting: University in GuangZhou, China
‐Informed consent: Not reported
‐Ethics approval: Not reported
‐All patients were followed
‐Analysis: chi‐squares between groups

Participants

54 patients with chronic low‐back pain, frequent recurrence, worse during work and relief with rest.

Diagnosis: chronic low‐back pain.

Excluded: specific pathological entities using lab tests and x‐rays.

Mean age: 45 years old in the ancient needling technique and 42 in regular needling technique group (range 19‐68)

40 males and 14 females

Working status: ?

Previous treatments: ?

Interventions

1) Ancient needling technique "The turtle exploring the holes". Major points: GV3, Ashi point(s). Supplement points: BL40. Needles 0.38 mm X 75 mm were used for deeper insertion and to different direction in 45 degree angle. Strong Teh chi sensation was obtained. The needles were retained for 40 to 50 minutes. Treatments were given daily up to 10 treatments.
Randomized to this group: 35

2) Regular needling technique. Needles 0.38 mm X 75 mm were used for deeper perpendicular insertion with twirling or rotating technique was used until strong Teh Chi sensation was acquired. Needle retaining was 20 minutes with 3 to 4 times twirling or rotating stimulation in between. Treatments were given daily for up to 10 days.
Randomized to this group: 19

Outcomes

1. Pain on a 4‐point scale: "cure": no pain for 2 months;
"marked effective": pain markedly improved;
"improved": pain is somewhat relieved; and "no change".

Measured immediately after and 2 months after the end of the sessions.

Costs: Not reported

Complications: Not reported

Notes

Language: Chinese

Publication: full paper

No additional information from authors

For results, see the other data table:
7.3

Conclusions: "An ancient needling technique is better than the regular needling technique in treating chronic low back pain".

Edelist 1976

Methods

‐ Randomized (method not described). No mention of concealment of allocation.
‐Outcome assessors blinded
‐Funding: not reported
‐Setting: University Hospital in Toronto. Canada
‐Informed consent: yes
‐Ethics approval: yes
‐Not sure if follow‐up is complete
‐Analysis: not reported

Participants

30 patients with low‐back pain with no improvement after conventional therapy, including bed rest, analgesics, heat and physiotherapy. Patients were felt to have disc disease, which could not be surgically improved.

Interventions

1) Acupuncture: Manual insertion of 4 sterile needles into traditional acupuncture points (BL 60 and BL 25 bilaterally) until reaching Teh Chi, then electroacupuncture at 3‐10 Hz. 30 minutes, 3 treatments in maximum 2 weeks. Training & experience of acupuncturists unknown.
Randomized to this group: not reported

2) Sham acupuncture, 4 needles placed in areas devoid of classic acupuncture points, no Teh Chi.
Randomized to this group: not reported

Outcomes

1) Global assessment: subjective improvement of back/leg pain
2) Global assessment: objective improvement as measured by increased range of spinal movement, improvement in tests for nerve root tension and objective improvement in neurological signs.

Costs: not reported

Complications: not reported

Notes

Number of patients randomised unknown. We only know that 30 were analysed.

We classified the patients into "chronic low‐back pain".

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
5.2
5.5

Conclusions: "There seemed to be no difference in either the subjective or objective changes between the two effects and suggest that much of the improvement in pain syndromes associated with acupuncture may be on the basis of placebo effect".

Garvey 1989

Methods

‐Randomized (computer generated four‐tier list). No mention of concealment of allocation.
‐Patients and outcome assessors blinded. Therapists were blinded for content of injections (groups 2 and 3)
‐Funding: not reported
‐Setting: Outpatient clinic in a hospital. USA
‐Informed consent: not reported
‐Ethics approval: not reported
‐Follow‐up: 51 of 63 randomised (81%)
‐Analysis: Adherers and intention‐to‐treat (with worst case scenario). Continuity chi squared, adjusted test.

Participants

63 patients with acute non radiating low‐back pain, normal neurological examination, absence of tension signs, normal x‐ray, persistent pain despite initial treatment of 4 weeks, being able to localize a point of maximum tenderness (trigger point).

Age: mean 38 years old

Gender: 41 men and 22 women

Working status: not reported

Previous treatment: non‐steroidal anti‐inflammatory drugs, hot showers, avoidance of activities that aggravate the pain. No exercise program had been started.

Interventions

1) Dry‐needling stick with a 21‐gauge needle after an isopropyl alcohol wipe. 1 session. Training & experience of therapists unknown
Randomized to this group: 20

2) injection with 1.5 ml of 1% lidocaine using a 1.5 inch, 21‐gauge needle after an isopropyl alcohol wipe.
Randomized to this group: 13

3) injection with 0.75 ml of 1% lidocaine and 0.75 ml of Aristospan (Triamcinolone Hexacetonide) using a 1.5 inch, 21‐gauge needle after an isopropyl alcohol wipe.
Randomized to this group: 14

4) 10‐second ethyl chloride spray from 6 inches away, followed by 20 second acupressure using the plastic needle guard after an isopropyl alcohol wipe.
Randomized to this group: 16

Outcomes

1) global improvement: percentage of not improved or improved.

This outcome was measured at 2 weeks after the interventions.

Costs: Not reported

Complications:
Group 1) 1 case of "fever, chills and systemic upset"; 2 cases of increased pain due to intramuscular hematoma.
Group 3) "increased pain"

Notes

Intervention is "dry‐needling"

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
8.1
8.2

Conclusions: "The injected substance apparently is not the critical factor, since direct mechanical stimulus to the trigger‐point seems to give symptomatic relief equal to that of treatment with various types of injected medication".

Garvey 1989 (lidoc)

Methods

see Garvey 1989

Participants

Interventions

Outcomes

Notes

Garvey 1989 (spray)

Methods

see Garvey 1989

Participants

Interventions

Outcomes

Notes

Garvey 1989(steroid)

Methods

see Garvey 1989

Participants

Interventions

Outcomes

Notes

Giles 1999

Methods

‐Randomized (method not described). Person drew an envelope out of a box with 150 well‐shuffled envelopes, each containing one of three colour codes (50 envelopes per intervention)
‐Outcome assessor and data analyst blinded
‐Funding: Green Projects Donation fund Limited via the Royal Melbourne Institute of Technology and partly supported by Townsville General Hospital and James Cook University
‐Setting: Outpatient pain clinic in a hospital setting. Townsville Australia.
‐Informed written consent was obtained.
‐Ethical approval by the Northern Regional Health Authority's Townsville General Hospital
‐Follow up: 77 of 130 randomised (59%)
‐Analysis: Based on "adherers only principle", i.e.. discarded those who did not comply with the treatment assigned. Checked for possible confounders and interactions by multiple regression and logistic regression.

Participants

77 patients with spinal pain for at least 13 weeks (median 6 years).

Diagnoses: 82% lower back pain; 42% neck pain and 34% upper back pain.

Excluded: nerve root involvement, spinal anomalities, pathology other than mild to moderate osteoarthrosis, previous spinal surgery and leg inequality > 9mm.

Median age: 42 years old

30 males and 47 females

Working status: 56% blue collar, 26% white collar, 13% academic, 5% retired

Previous treatments: 77% drugs, 42% manipulation, 40% physiotherapy and 6% acupuncture

Co‐morbidity: not described

Interventions

1) The treating clinician decided which form of acupuncture to use.
One of four experienced medical acupuncturists using sterile HWATO Chinese disposable acupuncture guide tube needles 50 mm long with a gauge of 0.25 mm for 20 minutes. An average number of 8 to 10 needles were placed in local tender points and in distant acupuncture points according to the "near and far" technique, depending on the condition being treated. Once patients could satisfactorily tolerate the needles for 20 minutes, low‐volt electrical stimulation was applied to the needles. Six treatments were applied in a 3 to to 4‐week.
Randomized to this group: 46
Drop‐outs: 26 (52%). Reasons: unrelated to the outcome

2) Spinal manipulation was performed as judged to be safe and appropriate by the treating chiropractor for the spinal level of involvement only. A high‐velocity, low‐amplitude spinal manipulation was performed. Six treatments applied in a 3 to to 4‐week period.
Randomized to this group: 49
Drop‐outs: 13 (26%). Reasons: same as in the acupuncture group

3) Medication: tenoxican (20 mg/d) and ranitidine (50 mg x 2/ day). Medication was given to the patients for the defined 3 to 4‐week treatment period. Treatment times were standardized by arranging 15 to 20‐minute appointments for all visits to eliminate a potential placebo effect originating from different lengths of exposure to the clinician
Randomized to this group: 31
Drop‐outs: 10 (33%). Reasons: same as in the acupuncture group.

Outcomes

1) Pain: Visual Analog Scale (VAS) from 0 to 10 cm
2) Pain frequency on 5‐ordered categories: 1/month, 1/week, 1/day, frequent and constant.
3) Function: Oswestry Disability Index
4) Cross over to another intervention after the study period

All outcomes were measured immediately after the end of the treatment period

Costs: Not reported

Complications: No side effects occurred for acupuncture or manipulation. Three medically treated subjects had gastric symptoms

Notes

The results of this study are not used in this review because of the high drop‐out rate in the acupuncture group (52%) that might invalidate the results of this trial.

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
6.1
6.2
6.4

Study conclusions: "the manipulation group displayed the most substantial improvements that were uniformly found to be significant. In the other intervention groups, not a single significant improvement could be found in any of the outcome measures".

Giles 1999 (manip)

Methods

See Giles 1999

Participants

Interventions

Outcomes

Notes

Giles 1999 (NSAID)

Methods

See Giles 1999

Participants

Interventions

Outcomes

Notes

Giles 2003

Methods

‐Randomized (method not described). Person drew an envelope out of a box with 150 well‐shuffled envelopes, each containing one of three colour codes (50 envelopes per intervention)
‐Data analyst blinded
‐Funding: Queensland State Government. Partly supported by Townsville General Hospital.
‐Setting: Outpatient pain clinic in a hospital setting. Townsville Australia.
‐Informed written consent was obtained.
‐Ethical approval by the Northern Regional Health Authority's Townsville General Hospital
‐Follow up: 115 were randomised. Six dropped out before treatment for reasons not related to outcomes. 69/109 (63.3%) were followed.
‐Analysis: Based on "intention‐to‐treat analysis". Checked for possible confounders and interactions by multiple regression and logistic regression.

Participants

109 patients with uncomplicated spinal pain for a minimum of 13 weeks (average duration was 6.4 years)

Diagnosis: mechanical spinal pain

Excluded: nerve root involvement, spinal anomalies, pathology other than mild to moderate osteoarthrosis, spondylolisthesis exceeding grade 1, previous spinal surgery and leg length inequality >9 mm.

Median age: 39 years old

60 males and 49 females

Working status: 29% skilled trade, 20% pensioner or unemployed, 20% manager, clerk or sales, 12% professional, 18% other.

Previous treatments: not described

Co‐morbidity: not described

Interventions

1) The clinician determined the form of acupuncture technique. The Near and Far technique consists of: needling the trigger point and distal analgesia producing sympatholytic acupuncture points below the elbow or knee.
Acupuncture was performed by one of two experienced acupuncturists using sterile disposable acupuncture guide tube needles (length 50 mm, gauge 0.25 mm) during 20‐minute appointments.
For each patient, 8 to 10 needles were placed in local paraspinal intramuscular maximum pain areas and approximately 5 needles were placed in distal acupuncture point meridians depending on the spinal pain syndrome being treated. Once patients could tolerate the needles, needle agitation was performed by turning or "flicking" the needles at approximately 5‐minute intervals for 20 minutes. The needles were inserted to a length of 20 to 50 mm, in the maximum pain area, and up to approximately 5 mm in the distal points.
Two treatments per week up to the defined maximum of 9 weeks of treatment.
Randomized to this group: 36. Two were lost before treatment, 2 during treatment and 10 changed treatment because of no effect.

2) Spinal manipulation. 20‐minute appointment. High‐velocity, low‐amplitude thrust spinal manipulation to a joint was performed as judged to be safe and usual treatment by the treating chiropractor for the spinal level of involvement to mobilize the spinal joints. Two treatments per week up to a maximum of 9 weeks.
Randomized to this group: 36. One was lost before treatment, 1 during treatment and 8 changed treatments because of "no effect".

3) A medication could be selected that had not already been tried by a patient randomised into the mediation arm of the study. The patients normally were given Celecoxib (200 to 400 mg/day) unless it had previously been tried. The next drug of choice was Rofecoxib (12.5 to 25 mg/day) followed by paracetamol (up to 4 g/day). Doses, left to the sports physician's discretion, were related particularly to the patient's weight, with the severity of symptoms playing a minor role. The treating sports physician also was allocated 20 minutes for follow‐up visits.
Randomized to this group: 43. Three were lost before treatment and 18 changed treatment (11 for "no effect" and 8 for "side effects")

Outcomes

1) Pain: Visual Analog Scale (VAS) from 0 to 10 cm
2) Pain frequency on 5‐ordered categories: 1/month, 1/week, 1/day, frequent and constant.
3) Function: Oswestry Disability Index
4) Cross over to another intervention after the study period
5) SF‐36 Health Survey Questionnaire

All outcomes were measured immediately after the end of the treatment period

Costs: Not reported

Complications: Not reported

Notes

Not sure about proportion of patients with lower back pain.

The results might be biased by the high and differential drop out rates.

Results are presented as medians and 25th and 75th percentiles and were transformed to means and standard deviations.

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
6.1
6.2

Study results: "Manipulation yielded the best results over all the main outcome measures except the Neck Disability Index, for which acupuncture achieved a better result than manipulation". "All three therapies showed positive response according to the SF‐36 general health status questionnaire"

Conclusions: "In patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short‐term improvement than acupuncture or medication".

Giles 2003 (manip)

Methods

See Giles 2003

Participants

Interventions

Outcomes

Notes

Giles 2003 (NSAID)

Methods

See Giles 2003

Participants

Interventions

Outcomes

Notes

Grant 1999

Methods

‐ Random numbers were used (method not described) to generate a sequence of sealed envelopes containing the treatment code, the next available envelope being opened on the patient's entry into the trial.
‐Outcome assessors were blinded.
‐Funding: Grant from the Trustees of the Liberton Hospital Endowment Funds
‐Setting: Outpatients clinic in the United Kingdom
‐Informed consent: not reported
‐The study was approved by the Lothian Research Ethics Committee
‐Follow‐up: 57 out of 60 randomised
‐Analysis: No intention‐to‐treat. Mann‐Whitney U‐tests for between group differences.

Participants

60 patients aged 60 years or over, with a complaint of pain of at least 6 months duration.

Diagnoses: chronic low‐back pain.

Excluded: treatment with anticoagulants, systemic corticosteroids, dementia, previous treatments with acupuncture or TENS, cardiac pacemaker, other severe concomitant disease, inability of patient or therapist to apply TENS machine.

Mean age: 73.6 years old

6 males and 54 females

Previous treatments: not reported

Interventions

1) Two sessions of manual acupuncture weekly for 4 weeks, i.e. eight sessions in total. The needles were of a standard size (32 gauge, 1.5 inch length with guide tube). Points were chosen for the individual patient as in routine clinical practice, only using points in the back. Six needles were used on average at each treatment with a minimum of two and a maximum of eight. Treatment sessions lasted for 20 minutes.
Randomized to this group: 32. Two dropped out during the study. Reasons: influenza and dental problem.

2) TENS: Standard machine (TPN 200, Physio‐Med‐Services) using 50 Hz stimulation with the intensity adjusted to suit the patient, again as a routine clinical practice. The patient was given her/his own machine to use at home, and instructed to use it during the day as required for up to 30 minutes per session to a maximum of 6 hours per day. She/he was also seen for 20 minutes, twice weekly, by the physiotherapist, ensuring the same contact with him. At each visit, symptoms were reviewed, treatment discussed and the optimum use of the TENS machine ensured.
Randomized to this group: 28. One dropped out due to acute depression.

Co‐interventions: The patients were advised to continue existing medication but not to commence any new analgesics or any additional physical treatments for the duration of the trial.

Outcomes

1) Pain: visual Analog scale (0 to 200 mm).
2) Pain subscale of the 38‐item Nottingham Health Profile part 1.
3) Analgesics consumption
4) Spinal flexion

These outcomes were taken at baseline, 4 days and 3 months after last treatment session.

Costs: not reported

Complications: 3 acupuncture patients reported dizziness and 3 TENS patients developed skin reactions. (Comparison 07.08)

Notes

The two groups appear different at baseline with respect to the four outcome measures. Patients in the acupuncture group have higher VAS and NHP pain scores, reduced spinal flexion and lower tablet consumption compared to the TENS group.

Because the authors had not adjusted for baseline values, no conclusions can be made based on this study.

We could try to obtain raw data from authors and run ANCOVA, but the data is also skewed and transformation is not appropriate.

Results:
6.1
6.4

Language: English

Publication: full paper

No additional information from authors

Conclusions: "A 4‐week course of either acupuncture or TENS had demonstrable benefits on subjective measures of pain (VAS and NHP score) and allowed them to reduce their consumption of analgesic tablets. The benefits of both treatments remained significant 3 months after completion, with a trend towards further improvement in the acupuncture patients."

Gunn 1980

Methods

‐Randomized (randomised blocks, blocks defined by age and operation status; the first subject from each block was assigned to the acupuncture treatment.)
‐No information about concealment of allocation
‐Nobody was blinded
‐Funding: Workers' Compensation board of British Columbia
‐Setting: Pain Clinic in Richmond, British Columbia, Canada
‐Informed consent: Yes
‐Ethics approval: not reported
‐Follow‐up: 56 (100%) at discharge, 53 (95%) at 12 weeks and 44 (78%) at time of writing.
‐Analysis: Analysis of covariance. No intention‐to‐treat.

Participants

56 males with chronic low‐back pain of at least 12 weeks duration, who had 8 weeks of a standard clinic regimen.

Diagnoses: disc diseases, low‐back strain, spondylitis, spondylolisthesis, radiculopathy, low‐back contusion, pseudoarthrosis, disc protrusion, prolapsed disc, lumbar disc syndrome, post‐laminectomy syndrome, neuropathy, sciatica, nerve root compression, facet sprain, musculo‐ligamentous strain, compression fracture, interspinous ligament strain,

Excluded: Psychosomatic backache. Females.

Mean age: 40.6 years old (range 20 to 62 years)

Working status: all off work.

Previous treatments: some had surgery.

Interventions

1) Dry‐needling: Standard therapy (physiotherapy, remedial exercises, occupational therapy, industrial assessment) plus dry‐needling on muscle motor points (non‐meridian), 3 to 5 cm needles, direction of the needle perpendicular to the skin, mechanical stimulation by pecking and twirling, low voltage (9V) electrical stimulation interrupted direct current or phasic current.
Maximum of 15 treatments (average 8), once or twice a week. Training & experience unknown.
Randomized to this group: 29

2) Standard therapy only (physiotherapy, remedial exercises, occupational therapy, industrial assessment).
Randomized to this group: 27

Outcomes

1) Global improvement:
0: no improvement. Still disabled. Unable to return to any form of employment
+: Some improvement. Some subjective discomfort. Able to return to lighter employment.
++: Good improvement. Slight subjective discomfort but able to return to work and function at pre‐accident employment (or equivalent).
+++: Total improvement. No subjective discomfort. Returned to previous (or equivalent) employment.

The above was measured after discharge, 12 weeks after discharge and at the time of writing of the paper. (all these varied)

Costs: not reported

Complications: not reported

Notes

Intervention is dry‐needling.

We dichotomized at 0 versus +/++/+++.

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
8.1

Conclusion: "The group that had been treated with needling was found to be clearly and significantly better than the control group with regard to status at discharge, at 12 weeks, and at final follow‐up".

He 1997

Methods

‐Randomized (method not reported). No information about concealment of allocation
‐Patients were blinded
‐Funding: Not reported
‐Setting: outpatient clinic in a hospital. University Centre in Sichuan Province, China
‐Informed consent: Not reported
‐Ethics approval: Not reported
‐Follow‐up: All 100 patients were followed.
‐Analysis: Not reported

Participants

100 patients with low‐back pain (5 days to 6 months duration), with limited range of motion, and symptoms worse in cold and rainy weather.

Excluded: kidney or bone disease confirmed by urine test and X‐ray.

Age range: 22 to 79 years old

44 males and 56 females

Working status: not reported

Previous treatments: not reported

Interventions

1) Manual acupuncture with moxibustion plus Chinese herbal medicine. Two groups of points: 1) GV 4, BL 22 , Ashi‐points. 2) BL23, GV 3 and Extra 9 (L3‐L4). Moxibustion was used 2 to 3 times on the handle of the needles and needles were retained for 30 minutes. Treatments were given daily up to 10 treatments. Teh Chi sensation was obtained. Herbal formula was given daily.
Randomized to this group: 50
Experience: unknown

2) Chinese herbal treatment alone.
Randomized to this group: 50

Outcomes

1) Overall assessment that includes pain, physical function, sensitivity to weather change and return to work.
According to this measure, patients are classified into:
a) cured: no pain, return to normal life and work, remains normal at one‐year follow‐up;
b) marked effective: pain is generally gone, but still feels uncomfortable in cold and damp weather;
c) improved: pain is markedly relieved, still feels uncomfortable in cold and damp weather, but better than pre‐treatment
d) no changes: no significant change.

The overall assessment was measured one year after the end of the sessions.

Costs: not reported

Complications: not reported

Notes

We classified the duration as acute/subacute.

We dichotomized at a/b/c versus d.

Language: Chinese

Publication: full paper

No additional information from authors

For results, see the comparisons:
2.2

Conclusion: "Manual acupuncture with moxibustion plus Chinese herbal medicine is better (p<0.01) than Chinese herbal medicine alone for treating low‐back pain with cold and dampness, based on TCM diagnosis".

Inoue 2000

Methods

‐Randomized (computer generated numbers). Allocation was done by a centralized office using the Internet.
‐Patients and outcome assessors were blinded.
‐Funding: Not reported
‐Setting: University hospital in Kyoto, Japan.
‐Written informed consent was taken from patients
‐The Ethics Committee approved this study.
‐Follow‐up: All 27 patients were followed (100%)
‐Analysis: Mann‐Whitney's U test was used for between group analysis.

Participants

27 patients with low back pain of unknown duration who attended the outpatient acupuncture clinic.

Excluded: (1) neurological findings, pain or numbness in lower extremity; (2) malignancy, (3) infection or inflammatory disease; (4) fracture; (5) lumbago due to urological problem, gynaecological problem, digestive problem or cardio‐vascular problem; (6) patients who cannot stop other conflicting or ongoing treatments; (7) problem of general condition; (8) dementia; (9) pregnancy.

Mean age: 59.6 years old

Gender: no information

Working status: no information

Previous treatments: no information.

Interventions

1) Real acupuncture: Two needling points were chosen bilaterally from lumbar area (i.e. 4 points in total): BL52 and extra point (yao‐yan: EX‐B7). Needles were inserted to a depth of 20 mm, manipulated by sparrow pecking method for 20 seconds, and then removed. One treatment session was performed.
Randomized to this group: 15
Acupuncturist had more than 10 years of experience.

2) Sham acupuncture: The same two points were chosen. Acupuncturist mimicked needle insertions: tapped head of needle guide tube, then gesture of needling was performed for 20 seconds. One session.
Randomized to this group: 12

Outcomes

1) Pain: visual analog scale (VAS) at the most restricted action immediately after the single session.

Costs: not reported

Complications: not reported

Notes

Language: Japanese

Publication: abstract

We obtained additional information from authors.

For results, see the comparisons:
9.1

Conclusion: "There was no difference between real needling and sham needling".

Inoue 2001

Methods

‐Randomized (computer generated numbers). Allocation was done by a centralized office using the Internet.
‐Patients and outcome assessors were blinded.
‐Funding: Not reported
‐Setting: University hospital in Kyoto, Japan.
‐Written informed consent was obtained.
‐The Ethics Committee approved this study.
‐Follow‐up: All 21 patients were followed (100%)
‐Analysis: Mann‐Whitney's U test was used for between group analysis.

Participants

21 patients with low‐back pain of unknown duration who attended the outpatient acupuncture clinic were included.

Excluded: (1) neurological findings, pain or numbness in lower extremity; (2) malignancy, (3) infection or inflammatory disease; (4) fracture; (5) lumbago due to urological problem, gynaecological problem, digestive problem or cardio‐vascular problem; (6) patients who can not stop other conflicting or ongoing treatments; (7) problem of general condition; (8) dementia; (9) pregnancy.

Mean age: 55.1 years old

Gender: no information

Working status: no information

Previous treatments: no information.

Interventions

1) Real acupuncture: One needling point was chosen from lumbar area: most painful locus was detected. Needles were inserted and sparrow‐picking technique was performed for 20 seconds. One session.
Randomized to this group: 10
Experience: not reported

2) Sham acupuncture: One needling point was chosen from lumbar area: most painful locus was detected, same as real acupuncture group. Acupuncturist mimicked needle insertion: tapped head of needle guide tube, then gesture of needling was performed for 20 seconds. One session.
Randomized to this group: 11

Outcomes

1) Pain: visual analog scale (VAS) at the most restricted action immediately after the single session.

Costs: not reported

Complications: not reported

Notes

Language: Japanese

Publication: abstract

We obtained additional information from authors.

For results, see the comparisons:
9.1

Conclusion: "Real needling is superior to sham needling".

Kerr 2003

Methods

‐Randomized (computer generated numbers). No information about who performed allocation of patients.
‐Patients and outcome assessors were blinded
‐Funding: Department of Health and Social Services for Northern Ireland
‐Setting: outpatient clinic in a hospital
‐Signed a consent form and were verbally advised as to the nature of the intervention. Patients were informed that they would receive one of 2 different forms of treatment being investigated
‐Ethics permission was obtained from the University of Ulster's Research Ethical Committee
‐46 of 60 randomised patients (76%) finished the trial period and 40/60 (66.7%) were followed at 6 months.
‐Analysis: Only those who completed the study (46/60). T‐tests for paired and independent samples.

Participants

60 patients with chronic low‐back pain (> 6 months) with or without leg pain and with no neurologic deficits. Mean duration of pain was 75.8 months.

Excluded: age < 18 years old, pregnancy, underlying systemic disorder, rheumatoid arthritis, osteoarthritis of the spine or cancer.

Mean age: 41 years old

28 males and 32 females

Working status: not reported

Previous treatments: not reported

Interventions

1) Same set of acupoints for everyone, regardless of the distribution of their symptoms: Bl23, Bl25, GB 30, Bl40, Ki3 (all bilateral) and GV4. Eleven needles were used in each session (Seirin acupuncture needles N8, 0.30 x 50 mm, c‐type needle). The needles were inserted until Teh Chi was produced. Position: prone. Duration: 30 minutes. Needles were manually rotated to produce Teh Chi initially and at 10 to 20 minute intervals. Sessions: 6 sessions, over a 6‐week period.
Patients were also given a leaflet regarding their low‐back pain that included standardized advice and exercises.
A Chartered Physiotherapist trained in acupuncture carried out all treatments.
Randomized to this group: 30

2) Placebo‐TENS: Patients were advised that the treatment was relatively novel and that they should not feel any discomfort with the procedure and, in fact, should not be aware of any sensation at all. They were advised that the treatment had an effect on the nerve‐endings and that it should relieve their symptoms. Patient lying in the prone position for 30 minutes. A non‐functioning TENS machine was attached to 4 electrodes placed over the lumbar spine and the unit was placed in a position to make it difficult to interfere with the apparatus. The investigator monitored the patient's condition after 10 and 20 minutes. Sessions: 6 over a 6‐week period.
Patients were also given the advice and exercise leaflet and the same principal investigator carried out all treatments.
Randomized to this group: 30

Outcomes

1) Pain (VAS)
2) SF‐36
3) Physical examination: finger‐floor distance.
All these outcomes were measured immediately after the end of the 6th session.

4) Global improvement measured at 6 months: "Did you experience pain relief? "Yes" or "No". But only 40 (66.7%) patients were followed up to 6 months

Costs: not reported

Complications: In the acupuncture group there were 2/23 patients who reported side effects and 2/17 in the placebo group.

Notes

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
5.1
5.2
5.4
5.7

Conclusions: "Although acupuncture showed highly significant differences in all the outcome measures between pre and post‐treatment, the differences between the two groups were not statistically significant".

Kittang 2001

Methods

‐ Randomization in blocks of four patients (method not described). No description of who performed the allocation of patients
‐Outcome assessor was blinded
‐Funding: Three governmental, medical association and science council funding sources as well as funding from two pharmaceutical companies
‐Setting: Private clinic in Flora and Kinn, Norway
‐Consent not described, ethics approval obtained
‐57/60 patients were followed
‐Analysis: t‐test & Fishers exact test

Participants

60 patients with acute low‐back pain (lasting less than 10 days).

Excluded: Neurologic outcomes, rheumatic illness, malign disease, systemic use of anti‐inflammatory drugs or steroids before inclusion and use of medicine that may interact with anti‐inflammatory drugs.

Between 18 and 67 years of age

Gender: both sexes

Working status: 2/3 on sick leave at time of inclusion

Interventions

1) First treatment was needling in "lumbago 1 and 3" with medial lumbago, and in "upper lip" with more lateral pain. Later treatments were 5 needles across at level L2, at "Ashi points" (local pain points) and in both ankles. Analgesia was allowed and sick leave provided when necessary. Four treatments within two weeks.
Patients in both groups were given general advise and encouraged to daily physical activity.
Randomized to this group: 30

2) Naproxen 500 mg twice daily for ten days
Randomized to this group: 30

Outcomes

1) Pain (VAS) measured at baseline, 1 and 2 weeks and 3 and 6 months
2) Use of other analgesics measured at 1 and 2 weeks
3) Number of back pain episodes at 6 and 18 months
4) Side effects at 1 and 2 weeks
5) Stiffness measured at baseline, 1 and 2 weeks and 3 and 6 months
6) Lateral flexion measured at baseline, 1 and 2 weeks and 3 and 6 months

Costs: not reported

Notes

Language: Norwegian

Publication: full paper

Asked authors for additional information: no response.

For results, see the comparisons:
2.1
2.3
2.4

Conclusions: "No difference in reduction of pain or stiffness over a six‐month evaluation"

Kurosu 1979(a)

Methods

‐Randomized (method not described). No information about concealment of allocation
‐No information about blinding
‐Funding: Not reported
‐Setting: Private clinic in Tokyo, Japan
‐There is no description about informed consent or ethics approval.
‐Follow‐up: 20 of 20 (100%)
‐Analysis: Intention‐to‐treat, used t‐test for between group analyses

Participants

20 patients with lumbar or sacral region pain.

Most of patients were between 40 and 50 years old.

10 males and 10 females

Working status: Not reported

Previous treatments: Not reported

Interventions

1) Acupuncture: the needles were inserted, and left in situ for 10 minutes, and then removed. Insertion depth was 2 to 4 cm, depending on one's figure. Acupuncture needles used were stainless steel needles (50 mm length, 0.25 mm diameter). Six to eight points in lumbar part were chosen from BL23, 24, 25, 26, 27, 31, 52 and 3 extra channel points by palpation. Abdominal needling was added: needles were inserted to a depth of 1 to 1.5 cm at CV4,13 and ST25 (bilaterally). Acupuncture treatment was performed more than 4 times.
Randomized to this group: 10
Experience: well‐known and well‐experienced acupuncturist.

2) Garlic moxibustion in lumbar region: Moxa is placed on top of a slice of garlic. Six to eight points in lumbar area were chosen from BL23, 25, 27, 52 and the other points by palpation.
Randomized to this group: 10

Outcomes

1) Pain: 10‐item questionnaire about the specific actions that caused pain. Possible range of this questionnaire is ‐10 to 20 (if patient feels pain at all actions) and higher scores are better. It was measured immediately before second and fourth session

Costs: not reported

Complications: not reported

Notes

Language: Japanese

Publication: full paper

No additional information from authors.

For results, see the comparisons:
10.2

Conclusions: "There is no difference between needle retention technique and garlic moxibustion for low‐back pain".

Kurosu 1979(b)

Methods

‐Randomized (method not described). No information about concealment of allocation
‐No information about blinding
‐Funding: Not reported
‐Setting: Private clinic in Tokyo, Japan
‐There is no description about informed consent or ethics approval.
‐Follow‐up: 20 out of 20 (100%)
‐Analysis: Intention‐to‐treat, used t‐test for between group analyses

Participants

20 patients with lumbar or sacral region pain.

Most of patients were between 40 and 50 years old.

11 males and 9 females

Working status: Not reported

Previous treatments: Not reported

Interventions

1) Acupuncture: the needles were left in situ for 10 minutes, and then removed. Depth was 2 to 4 cm, depending on one's figure. Stainless steel needles (50 mm length, 0.25 mm diameter). Six to eight points in lumbar part were chosen from BL23, 24, 25, 26, 27, 31, 52 and 3 extra channel points by palpation; abdominal needling was added: needles were inserted to a depth of 1 to 1.5 cm at CV4,12 and ST25 (bilaterally). Acupuncture treatment was performed more than 4 times.
Experience: well‐known and well‐experienced acupuncturist.
Randomized to this group: 10

2) Other acupuncture technique: needles were removed immediately after insertion. Insertion depth was 2 to 4 cm, depending on one's figure. Stainless steel needles (50 mm length, 0.25 mm diameter). Six to eight points in lumbar part were chosen from BL23, 24, 25, 26, 27, 31, 52 and 3 extra channel points by palpation. Abdominal needling was added: needles were inserted to a depth of 1 to 1.5 cm at CV4,12 and ST25 (bilaterally); needles were left in situ for 10 minutes, and then removed. Acupuncture treatment was performed 3 times.
Randomized to this group: 10

Outcomes

1) Pain: 10‐item questionnaire about the specific actions that caused pain. Possible range of this questionnaire is ‐10 to 20 (if patient feels pain at all actions) and higher scores are better. It was measured immediately after the fourth session

Costs: not reported

Complications: not reported

Notes

Language: Japanese

Publication: full paper

No additional information from authors.

For results, see the comparisons:
11.2

Conclusions: "Results of needle retention technique is superior to that of simple insertion technique for low‐back pain".

Lehmann 1986

Methods

‐Block randomisation, blocks defined by prior lumbar surgery (method not reported). No information about concealment of allocation.
‐Therapists were blinded between real TENS and sham TENS, but not between acupuncture and TENS
‐Funding: NIHR Grant
‐Setting: Multidisciplinary inpatient clinic in a University of Iowa Hospital, USA.
‐Informed consent and ethics approval were not reported
‐Follow‐up: 39 of 54 randomised patients (72%)
‐Analysis: Multivariate analysis of covariance (adjustments for baseline scores and for non‐organic signs). No intention‐to‐treat analysis.

Participants

54 patients screened at orthopaedic clinic with chronic (>3 months) disabling low‐back pain.

Excluded: candidates for lumbar surgery, pain less than 3 months, pregnancy, osteomyelitis of the spine, discitis, tumour, ankylosing spondylitis, vertebral fractures and structural scoliosis.

Diagnoses: chronic disabling (not working) low‐back pain. Duration of low‐back pain: 48% more than 18 months.

Mean age: 39 years old (ranged from 20 to 59)

Gender: 33% females.

93% married.

Working status: 1/54 was working. 51 were receiving compensation. 33% were involved with litigation.

Previous treatments: some had surgery.

Interventions

1) Electroacupuncture with needles, biphasic wave at 2 to 4 Hz, inner and outer bladder meridian for paravertebral pain. Gall bladder meridian for lateral (sciatic) pain. LI4 points and additional points were stimulated according to the patient's pattern of pain; certified and experienced acupuncturist; twice weekly for 3 weeks. Teh Chi not reported.
Randomized to this group: 18

2) Real TENS, pulse width of 250/second at 60 Hz, 15 treatments in 3 weeks, sub‐threshold intensity, points of stimulation over the center of pain, experienced physiotherapist.
Randomized to this group: 18

3) Sham TENS, same as TENS but dead battery.
Randomized to this group: 18

Outcomes

1) Peak pain and average pain (VAS)
2) Activities of daily living: 15 items (yes/no)
3) Physician's perception of improvement
4) Range of motion
All these outcomes were measured at baseline, at discharge and between 3 to 6 months after discharge

5) Return to Work after 6 months (from no disability=10 points, to not able to work at all=0 points);

Costs: not reported

Complications: there were no complications.

Notes

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
5.6
5.8
5.11 (other data table)
6.3
6.4
6.6 (other data table)

Conclusions: "There were no significant differences between treatment groups with respect to their overall rehabilitation". "The electroacupuncture group demonstrated slightly better results than the other groups."

Leibing 2002

Methods

‐Computer‐based randomisation method.
‐Patients and outcome assessors were blinded. (Patients were blinded only between two types of acupuncture)
‐Funding: Ministry of Education, Science, Research and Technology, Federal Republic of Germany.
‐Setting: Outpatient clinic. Department of Orthopaedics, University Goettingen, Germany
‐Informed consent and ethics approval were obtained.
‐Follow‐up: 150 patients were randomised. 131 initiated treatment. 114 (76%) were followed at the end of the treatment and 94 (63%) at 9 months.
‐Analysis: ANOVA with post‐hoc comparisons using Tukey studentized range tests when significant overall effects observed. No intention‐to‐treat analysis, but used last observation carried forward from the 131 patients that initiated treatment.

Participants

150 patients with chronic (> 6 months) non‐radiating low‐back pain.

Excluded: Abnormal neurological status, concomitant severe disease, psychiatric illness, current psychotherapy, pathological lumbosacral anterior‐posterior and lateral X‐rays (except for minor degenerative changes), rheumatic inflammatory disease, planned hospitalisation and refusal of participation.

Mean age: 48.1 years old

Gender: 58% female

76% married

Mean BMI: 26.3

Working status: 82% employed

Current treatments: 8.4% surgery. 50% analgesics

Interventions

1) All patients received standardized active physiotherapy of 26 sessions (each 30 minutes) over 12 weeks. It was performed by trained physiotherapists according to the Bruegger‐concept. In addition, 20 sessions (each 30 minutes) by an experienced Taiwanese physician over 12 weeks. In the first 2 weeks, acupuncture was done 5/week, and in the next 10 weeks, 1/week.
Combined traditional body and ear acupuncture. Twenty fixed body acupoints (9 bilateral, two single points) and six on the ear (alternately on one ear) were selected according to their function in TCM and were needled in every patient. No diagnostic procedure was done to determine individual acupoints.
Body points were manually stimulated until Teh Chi and left in place for 30 minutes: GV3, GV4, BL23, BL25, BL31, BL32, BL40, BL60, GB34, SP6, Yautungdien (extra meridian, at the back of the hand).
Ear points (left in for one week): 38, 51, 52, 54, 55, 95
Randomized to this group: 50, but only 40 initiated treatment. Ten were lost before first session. Reasons: withdrew consent=3; exclusion criteria appeared prior to treatment=5; relocated=2.

2) No additional treatment. Only active physiotherapy (as described above)
Randomized to this group: 50, but only 46 started treatment. Four were lost before first treatment. Reasons: withdrew consent=2; exclusion criteria=2.

3) Sham acupuncture plus physiotherapy. Sham acupuncture received 20 sessions (each 30 minutes) of minimal acupuncture by the same physician over 12 weeks. Sham acupuncture was done following the standards of minimal acupuncture. Needles were inserted superficially, 10 to 20 mm distant to the verum‐acupoints, outside the meridians, and were not stimulated (no Teh Chi).
Randomized to this group: 50, but only 45 started treatment. Reasons: withdrew consent=1; exclusion criteria=4.

Outcomes

1) Pain intensity: 10 cm VAS
2) Pain disability: total score consists of 7 areas of activity (min 0, max 70) O=no disability, and 70=total disability.
3) Psychological distress: Hospital Anxiety and Depression Scale, 14‐item instrument for use in non‐psychiatric medical patients. Total score (0 to 42) is a measure of psychological distress.
4) Spine flexion, fingertip‐to‐floor distance (min = 0 cm)

Costs: not reported

Complications: minor, not serious adverse events occurred in three patients in the acupuncture group.

Notes

The use of last observation carried forward usually attenuates the differences between groups.

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
5.1 5.3
5.8 5.12
5.13 5.15
12.1 12.2
12.3 12.5
12.8 12.9

Conclusions: "Acupuncture plus physiotherapy was superior to physiotherapy alone regarding pain intensity, disability and psychological distress at the end of the treatment. Compared to sham acupuncture plus physiotherapy, acupuncture (plus physiotherapy) reduced psychological distress only. At 9 months, the superiority of acupuncture plus physiotherapy compared to physiotherapy alone became less and acupuncture plus physiotherapy was not different from sham plus physiotherapy".

Li 1997

Methods

‐Randomized (method not reported).
No mention of concealment of allocation.
‐Patients were blinded. Comment: since both groups were given active treatments, all the patients should know that they were treated by "real" acupuncture. However, they probably couldn't tell which active treatment group they were in.
‐Funding: not reported
‐Setting: Outpatient clinic in a hospital. Hebei Province, China.
‐Informed consent and ethics approval were not mentioned
‐Follow‐up: all 156 patients were followed.
‐Analysis: U‐test: between groups

Participants

156 patients with low‐back pain of varying duration (between 2 days and 8 years)

Diagnoses: not reported

Excluded: not reported

Age between 20 and 71 years old

80 males and 76 females

Working status: not reported

Previous treatments: not reported

Interventions

1) Manual acupuncture plus cupping. Teh Chi sensation was obtained and needles were retained for 20 minutes. Major points: BL23, 40. GV 2, 26, LU5. Supplement points: for coldness and dampness: GV3, BL31, 34. For blood stasis: BL17, 18. For kidney deficiency: GV4 and KI 3. Treatment was given every other day (except for acute back pain, which was treated daily) up to 10 treatments.
Randomized to this group: 78
Experience: adequate

2) Manual acupuncture alone. Major points: BL23, 40 and GV2. Supplement points: same as treatment group.
Randomized to this group: 78

Outcomes

1) Overall assessment (see description in He 1997). Measured immediately after the end of the sessions.

Costs: not reported

Complications: not reported

Notes

Language: Chinese

Publication: full paper

No additional information from authors

For results, see the comparisons:
11.6 (other data table)

Conclusions: "Manual acupuncture plus cupping technique is better than manual acupuncture alone for treating low‐back pain"

Lopacz 1979

Methods

‐ Randomization procedure not described.
‐ Nobody was blinded.

Participants

34 male patients from a neurology department.
Inclusion criteria: low‐back pain for 1 month or more.

Age: mean 42 years old (ranged from 25 to 52).

Interventions

1) Acupuncture: 4 needles close to spine, 10 minutes, 4 treatments, 8 days, plus pharmacotherapy. Teh Chi unclear. Training & experience of acupuncturists unknown.
Randomized to this group: 18

2) Placebo, suggestion, new Swedish method for pain relief, same 4 points echo‐encephalography, 10 minutes, 4 treatments, 8 days, plus pharmacotherapy.
Randomized to this group: 16

Outcomes

1) Global improvement (5‐point scale): very good, good, doubtful, unchanged and worsening.

Measured after first treatment and after 4 treatments

Costs: not reported

Complications: not reported

Notes

Very short term follow‐up only. Small sample size.

Authors dichotomized at very good + good versus others.

We classified the patients as chronic low‐back pain.

Language: Polish

Publication: full paper

No additional information from authors

For results, see the comparisons:
5.2

Conclusions: "The therapeutic results were better, both immediately and after a series of acupuncture. The difference in the results of treatment was statistically significant in the patients with longest duration of pains (>3 months)".

MacDonald 1983

Methods

‐A stratified random process to divide the sexes as equally as possible between the two groups.
‐Patients and observers were blinded.
‐Funding: North West Thames Regional Health Authority
‐Setting: London
‐Informed consent and ethics approval not reported
‐Follow‐up: not reported
‐Analysis: Wilcoxon rank sum test.

Participants

17 patients referred from orthopaedic or rheumatological departments.
Inclusion criteria: chronic LBP for at least one year, no relief from conventional treatments.

Diagnoses: spondylitis, ankylosing spondylitis, degenerative disc lesion, idiopathic, non‐articular rheumatism, osteoarthritis, prolapsed intervertebral disc, arachnoiditis, ligamentous strain and Scheuermann's osteochondritis.

Exclusion criteria: not reported

Demographics: not reported. But it says "the two groups were comparable in terms of age, duration of pain, mood scores, number of physical signs and severity of pain.

Interventions

1) Superficial needling: subcutaneous (4 mm) 30‐gauge needle insertion at trigger points. (Number of trigger points unknown). 5 to 20 minutes, maximum of 10 treatments in 10 weeks. Electrical impulses 700µs at 2 Hz if manual stimulation failed. Randomized to this group: 8
Experience: unknown

2) Placebo transcutaneous electrical stimulation: electrodes connected to dummy apparatus, maximum 10 treatments in 10 weeks.
Randomized to this group: 9

Outcomes

1) Pain relief:
‐ worse (‐1)
‐ no change (0)
‐ minimal improvement (1% to 24%) (1)
‐ moderate improvement (25% to 49%) (2)
‐ good (50% to 74%) (3)
‐ excellent (75% to 99%) (4)
‐ complete resolution (100%) (5)
2) Pain score reduction
3) Activity pain score reduction
4) Physical signs reduction
5) Severity and pain area reduction

Costs: not reported

Complications: not reported

Notes

Intervention is dry‐needling.

Very small sample size, number of treatments unknown, and follow‐up time unknown.

Language: English

Publication: full paper

No additional information from authors

Results:
1) Pain relief: dry‐needling: 77.36, placebo: 30.14 (p<0.01);
2) Pain score: dry‐needling: 57.15, placebo 22.71 (p:NS);
3) Activity: dry‐needling 52.04, placebo 5.83 (p<0.05);
4) Physical signs: dry‐needling: 96.78, placebo: 29.17 (p<0.01);
5) Severity and pain area: dry‐needling: 73.75, placebo: 18.89 (p<0.01);

Conclusions: "Needling achieved better responses than the placebo in all five measures. Four of the five inter‐group differences were statistically significant."

Mendelson 1983

Methods

‐Randomized (method not described). Unclear about concealment of allocation. Cross‐over study.
‐Patients and outcome assessors were blinded.
‐Funding: National Health and Medical research Council of Australia.
‐Setting: Prince Henry's and Alfred Hospitals, Melbourne, Australia.
‐Informed written consent was obtained. Ethics approval by the Ethics Review Committee.
‐Follow‐up: 77 of the 95 patients randomised (81%).
‐Analysis: T‐tests. No intention to treat analysis.

Participants

95 volunteers with chronic low‐back pain, no compensation or litigation pending, no overt psychiatric disease.

Diagnoses: Osteoarthritis, traumatic spondylopathy, disc lesion, sacroiliac joint disorder and backache not specified.

Mean age: 54 years old

Gender: 37 males and 40 females.

Pain duration: 12 years.

Interventions

1) Traditional Chinese acupuncture by a surgeon trained in Peking; points: B23, 25, 36, 40 and 60. If sciatica: GB 30, 34 and 39. Average 8 needles, manual stimulation until reaching Teh Chi, 30 minutes with no further stimulation, twice weekly, 4 weeks.
Randomized to this group: don't know. 36 completed the study.

2) Sham acupuncture, intradermal injection of 2% lidocaine at non‐acupuncture, non‐tender sites, then acupuncture needles superficially into the infiltrated areas for 30 minutes without stimulation, twice weekly, 4 weeks.
Randomized to this group: don't know. 41 completed the study.

Outcomes

1) Pain (VAS) 100‐mm scale.
2) Pain relief
3) McGill Pain Questionnaire
4) Disability (method not described)

Costs: not reported

Complications: not reported

Notes

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
5.1
5.2

Conclusions: "Patients receiving acupuncture had a greater but not significantly different reduction in pain rating scores compared with those receiving placebo. Similarly, no significant difference was found between the two groups based on self‐assessment of disability".

Meng 2003

Methods

‐Randomized (computer generated random allocation sequence). Serially numbered, sealed, opaque envelopes
‐No blinding
‐Funding: New York Chapter of the Arthritis Foundation
‐Setting: Private surgeries clinics of the Hospital for Special Surgery at the New York Presbyterian Hospital. USA
‐Written informed consent; approval by Institutional Review Board
‐Follow‐up: 47 of 55 randomised patients (85%)
‐Analysis: ANOVA for between group differences. Both intention‐to‐treat and completers only analysis

Participants

55 patients with chronic nonspecific low back pain (>12 weeks) and older than 60 years.

Excluded: specific cause for low‐back pain, prior use of acupuncture, use of corticosteroids, muscle relaxants, narcotics, anticoagulants.

Mean age: 71 years old

Gender: 22 male and 33 female

Previous treatments: 27 NSAID, 10 analgesics, 1 muscle relaxant and 2 aspirin.

Ethnicity: 47 Caucasian, 5 African‐American and 3 Hispanic.

Charlson Comorbidity Index: 1.7 (+/‐ 2.0)

Interventions

1) Acupuncture plus standard therapy: Acupuncture twice a week for 5 weeks. Total 10 sessions. 30‐gauge needles with electrical stimulation (4 to 6 Hz) with a pulse duration of 0.5 ms. Teh Chi response at all points were verified. Between 10 and 14 needles were used per session. Needle retention was 20 minutes. Fixed acupoints: UB23, 24, 25, 28 (bilateral). Du3 and 4. Supplementary acupoints: maximum 4 additional needles: UB36, 54, 37, 40, GB 30, 31.
Two anaesthetists certified in acupuncture.
Randomized to this group: 31. Received acupuncture: 28. Completed follow‐up: 24.

2) Standard therapy: Primary physician for 5‐week intervention period: NSAID, aspirin, non‐narcotic analgesic. Continue back exercise (physical therapy) or home exercise regimen. Prohibited: narcotics, muscle relaxants, TENS, epidural steroid injections and trigger point injections.
Randomized to this group: 24. Received standard therapy: 23. Completed follow‐up: 23.

Outcomes

1) Back specific functional status (modified Roland Disability Questionnaire)
2) Pain (VAS)

These outcomes were measured at 0, 2, 6 and 9 weeks during the trial period, but we only used the measures at 6 weeks (at the end of all sessions) and 9 weeks (3 to 4 weeks after the end of the sessions) .

Costs: not reported

Complications: no difference in adverse effects.

Notes

Language: English

Publication: full paper

For results, see the comparisons:
12.1
12.2
12.5
12.7

Conclusions: "Our data indicate that acupuncture plus standard therapy does decrease back pain and disability in older patients compared with standard therapy alone in a clinically and statistically significant manner"

Molsberger 2002

Methods

‐Randomized (computer generated) stratified according to pain duration. Central telephone randomisation.
‐Patients and outcome assessors were blinded.
‐Funding: Grant from the German Ministry of Education, Science and Research
‐Setting: Inpatients in the Hospital. Dusseldorf, Germany.
‐All patients were informed about the trial and written consent was obtained.
‐Follow‐up: 124 of 186 patients randomised (66%)
‐Analysis: Approximate chi‐square or exact Fisher test, non‐parametric Mann‐Whitney‐Wilcoxon rank test. Per protocol analysis (n=174) and intention‐to‐treat analysis (n=186). Main analysis is adjusted for multiple testing.

Participants

186 patients with low‐back pain lasting longer than 6 weeks, with average pain scores greater than 50 mm (max 100 mm) during the last week. Aged between 20 and 60 years old, and speak German.

Excluded: sciatica, neurological disorder, disc or spine surgery, bone or joint disorder, previous treatment with acupuncture, psychiatric illness, pregnancy, regular intake of analgesics, off work longer than 6 months, no litigation.

Mean age: 50 years old

Gender: 97 males and 89 females.

Mean duration of pain: 9.9 years.

Working status: not reported

Previous treatments: not reported

Interventions

1) Verum acupuncture plus conventional orthopedic therapy. Acupuncture: standard points: BL23, 25, 40 and 60 and GB30 and 34. In addition, up to four points of maximum pain "Ah shi points", which were often close but not necessarily identical to BL 54, 31, 32 were needled. Needle insertion ranged from 1 to 10 cm and needle manipulation was mild to strong. A Teh Chi feeling was always achieved. During the acupuncture treatment, no additional treatment was administered. All patients received 12 verum acupuncture treatments, 3/week, each lasting for 30 minutes.
Acupuncture was carried out by an experienced medical doctor, who had studied in China (Beijing).
Randomized to this group: 65. Drop‐outs during treatment: 7. Lost to follow‐up: 11.

2) Sham acupuncture plus conventional orthopedic therapy. Sham acupuncture received 12 sham acupuncture treatments, 3/week, each lasting 30 minutes. Sham acupuncture was standardized to ten needles applied superficially (depth of needle insertion was less than 1 cm) at defined non‐acupuncture points of the lumbar region, and five needles on either side of the back.
Randomized to this group: 61. Drop‐outs during treatment: 3. Lost to follow‐up: 17

3) The conventional orthopedic therapy consisted of: daily physiotherapy, physical exercises, back school, mud packs, infrared heat therapy. On demand they received 50 mg diclofenac up to three times a day. Injections or cortisone application of any kind were not allowed.
Randomized to this group: 60. Drop‐outs during treatment: 2. Lost to follow‐up: 22

Outcomes

1) Pain intensity (VAS) during the last 7 days.
2) At least 50% reduction in pain intensity
3) Effectiveness of treatment: excellent, good, satisfactory and failed. Dichotomized at exc+good versus satisfactory+failed.
4) Schober and finger‐to‐floor distance.

All outcomes were taken at the end of the treatment period and 3 months later.

Costs: not reported

Complications: no side effects or complications occurred in any treatment group

Notes

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
5.1
5.2
5.14
12.1
12.4
12.6

Conclusions: "Together with conservative orthopedic standard therapy, acupuncture helps to decrease pain intensity directly after treatment, and patients' rating of the acupuncture treatment is significantly better than that of the standard therapy alone. The therapeutic effect lasts for at least 3 months after the end of treatment"

Sakai 1998

Methods

‐Randomized (method not described). Sealed envelopes.
‐Not blinded.
‐Funding: Grant from the Foundation for Training and Licensure Examination in Anma‐Massage‐Acupressure, Acupuncture and Moxibustion.
‐Setting: Outpatients in a University Hospital. Tokyo, Japan.
‐Informed consent was taken orally. No description of ethics approval.
‐Follow‐up: no information
‐Analysis: No statistical test.

Participants

26 patients with non‐specific low‐back pain of variable duration

Excluded: (1) osteoarthritis of lumbar spine, osteoporosis, scoliosis, spondylolysis, spondylolisthesis, herniation of lumbar disc, spinal stenosis or fracture; (2) radiculopathy or neuropathy in the lower extremity; (3) urological problem, gynaecological problem, neurological problem, collagen, diabetes or malignancy; (4) increase of CRP or ESR; (5) medication of corticosteroid, immunosuppressant agent, NSAID or muscle relaxant; (6) problem of general condition; (7) dementia; (8) pregnancy; (9) elderly patient; (10) those who were judged to be inappropriate for the trial by the authors.

Mean age: 51 years old

Gender: 7 males and 19 females

Working status: not reported

Previous treatments: not reported

Interventions

1) Needling points in lumbar area were chosen from BL23, 25, 32, 52 and 2 extra channel points near the spinous process of L4 and L5, and that in lower extremity were chosen from BL37, 40, 57, ST36, GB34 by palpation. Manual acupuncture technique such as needle retention and sparrow pecking technique were performed. Electro‐acupuncture was applied in some cases. Other details in technique not reported. Patients were treated twice a week for two weeks, i.e. four sessions in total.
Randomized to this group: 14
Experience: unknown

2) Oral medication, which includes NSAID and/or kampo medicine (Chinese herbs).
Randomized to this group: 12

Outcomes

1) Pain relief (VAS) on average on the pervious day, rated by the patient. Higher values are better.
2) JOA (Japan Orthopaedic Association) Score rated by the physician. Subjective symptoms of back pain and restriction of daily activities. Maximum 17 points. Higher values are better.

Outcomes were measured Immediately at the end of all sessions.

Costs: not reported

Complications: not reported

Notes

This study reports on two distinct trials, but we used only the data from one trial, which was randomised. The other trial allocated patients using alternation, therefore it was not randomised.

Language: Japanese

Publication: abstract (and unpublished report).

We obtained additional information from authors

For results, see the comparisons:
10.1
10.4

Conclusions: "Results of acupuncture are the same as those of medication for low‐back pain"

Sakai 2001

Methods

‐Multicentric study.
‐An independent controller in central office prepared an allocation table and sealed envelopes. A computer‐generated randomised allocation table was used to make a sequence of sealed opaque envelopes containing the code of intervention. The assigned envelope was opened by acupuncturist at the patient's entry into the trial
‐Outcome assessor was blinded.
‐Funding: Grant from the Foundation for Training and Licensure Examination in Anma‐Massage‐Acupressure, Acupuncture and Moxibustion.
‐Setting: Outpatients in a University Hospital. Tokyo, Osaka, Kyoto and Tsukuba, Japan.
‐Written informed consent was taken from patients. At two of the four centres, judgement of ethics committee was asked and the committees approved the protocol. The other two centres did not have ethics committees.
‐Follow‐up: 64 of 68 randomised (94%)
‐Analysis: 95%CI and repeated measures ANOVA.

Participants

68 patients with low‐back pain (at least 2 weeks) and age 20 years or older.

Diagnoses: lumbago (22), lumbar spondylosis (15), discopathy (9), acute low‐back pain (3), spondylolysis (3) , spondylolisthesis (1), sacroiliitis (1) and unclassified (10).

Excluded: (1) neurological findings, pain or numbness in lower extremity; (2) malignancy, (3) infection or inflammatory disease; (4) fracture; (5) lumbago due to urological problem, gynaecological problem, digestive problem or cardio‐vascular problem; (6) patients who can not stop other conflicting or ongoing treatments; (7) problem of general condition; (8) dementia; (9) pregnancy; (10) other patients who were judged to be inappropriate for participating in the trial.

Mean age: 37 years old

Gender: 35 females and 29 males.

Working status: not reported

Previous treatments: not reported

Interventions

1) Needling points were chosen by palpation from the part of quadratus lumborum (around BL52) and/or erector spinae (around BL23 and BL26) in the lumbar area. Two points were used bilaterally ‐ in total four points ‐ for each treatment. Patients were treated twice a week for two weeks.
Two types of disposable stainless steel needles were used according to patient's stature and fat: 0.20 mm in diameter and 50 mm in length, and 0.24 mm in diameter and 60 mm in length. Needles were inserted into the muscles. Electro‐stimulation at frequency of 1 Hz was applied for 15 minutes. The intensity was adjusted to make muscle contraction without pain.
Randomized to this group: 32. Drop‐outs during treatment: 1. Lost to follow‐up: 0
Experience: unknown

2) TENS: Same points as above. Two points were used bilaterally ‐ in total four points ‐ for each treatment. Patients were treated twice a week for two weeks, i.e. four sessions in total.
Gel type disposable electrodes of 20 x 30 mm in size were used. Stimulation with the frequency of 1 Hz was applied for 15 minutes
Randomized to this group: 36. Drop‐outs during treatment: 2. Lost to follow‐up: 1

Outcomes

1) JOA (Japan Orthopaedic Association) Score rated by the physician. Subjective symptoms of back pain and restriction of daily activities. Maximum 20 points. Higher values are better.
2) Pain relief (VAS) on average on the pervious day, rated by the patient. Higher values are better.

These outcomes were taken after the end of the 4 sessions.

Costs: not reported

Complications: no adverse event was reported in the electroacupuncture group. In the TENS group: 1 itching and 1 dullness after session.

Notes

Duration of low‐back pain mixed.

Language: English and Japanese

Publication: full paper

We obtained additional information from the authors.

For results, see the comparisons:
10.1
10.3
10.4
10.5

Conclusions: "There was no significant difference between groups in any parameter"

Takeda 2001

Methods

‐Randomized (using draws). Stratified by pain duration and gender. Using sealed and numbered envelopes, but the person doing the randomisation was not independent.
‐Patients blinded.
‐Funding: no funding was received.
‐Setting: Acupuncture College in Osaka, Japan.
‐Informed consent was obtained from participants and there was no description of ethics approval.
‐Follow‐up: 18 of 20 patients randomised (90%)
‐Analysis: Mann‐Whitney U test for between group differences. No intention‐to‐treat analysis.

Participants

20 students of acupuncture college who were suffering from lumbago.

Excluded: sciatica

Duration of pain: Mean 40.4 months in distal group and 81.0 months in local group.

Mean age: 26.4 years old in distal group and 35.8 years in local group.

Gender: 17 males and 3 females

Working status: all students.

Previous treatments: not described

Interventions

1) Distal point technique: At the acupuncture points in lumber area: BL23, 26 and Yao‐yan (extra‐point: EX‐B7), acupuncturist mimicked needle insertion: tapped head of needle guide tube, then gesture of needling was performed. Acupuncture points in lower extremity: BL37, 40 and 58, were needled by real acupuncture needle (40 mm in length and 0.2 mm in diameter). Insertion depth was 1 to 2 cm. Sparrow‐picking technique was performed 5 times, then needles were removed. Participants were treated once a week for 3 weeks.
Experience: unknown
Randomized to this group: 10. Drop‐outs during study: 1.

2) Local points technique: Acupuncture points in lumber area: BL23, 26 and Yo‐gan (extra‐point: EX‐B7), were needled by real acupuncture needle (40 mm in length and 0.2 mm in diameter). Insertion depth was 1 to 2 cm. Sparrow‐picking technique was performed 5 times, then needles were removed. At the acupoints in lower extremity: BL37, 40 and 58, acupuncturist mimicked needle insertion: tapped head of needle guide tube, then gesture of needling was performed. Participants were treated once a week for 3 weeks.
Experience: unknown
Randomized to this group: 10. Drop‐out during treatment: 1.

Outcomes

1) Pain (VAS)
2) Function: activity of daily living score. 8 questions about difficulty of specific actions. Maximum 16 points. Higher values are better.
3) Finger‐to‐floor distance.

All these outcomes were measured immediately before and after the treatment.

Costs: not reported

Complications: not reported

Notes

Language: Japanese

Publication: abstract only

We obtained additional information from authors.

For results, see the comparisons:
11.1
11.4
11.5

Conclusions: "There is no difference between the effects of lumbar area needling and that of distal point needling"

Thomas 1994

Methods

‐ Randomized (method not described). No description of concealment of allocation.
‐ Outcome assessors were independent and not involved in the treatment.
‐ Funding: Karolinksa Institute Foundation, King Gustav Vth 80 year anniversary Fund, Tore Nilssons Foundation for Medical Research, Torsten and Ragnar Soderbergs Foundation and The Swedish Medical Research Council.
‐ Setting: Outpatient clinic at the Karolinska Hospital. Stockholm, Sweden.
‐ Oral informed consent was obtained. No description of ethics approval:
‐ Follow‐up: 40 of 43 randomised patients (93%)
‐ Analysis: Student t‐test for independent samples and multiple comparisons ANOVA. No intention‐to‐treat analysis.

Participants

43 patients from 2 clinics with nociceptive LBP for 6 months or more, restriction of trunk or hip movement due to pain, restriction of ADL, muscle spasm.

Excluded: previous surgery, claudication, depression, neurosis, clinical examination not nociceptive.

Diagnoses: Osteoarthritis, sacroiliac joint, sciatica, intervertebral disc degeneration, disc prolapse, lumbar strain, osteoporosis

Demographics and patients characteristics: not reported, but they say there were no significant differences between the groups.

Interventions

1) Acupuncture: three different modes of acupuncture: a) manual stimulation, b) low frequency (2 Hz) and c) high frequency (80 Hz) electrical stimulation of needles. Six local points (3 pairs of paraspinal points: UB 23, 25, 26 or 32) and 3 to 4 distal points (SI 6, UB40 or 60, GB 30 or 34 or St36). Insertion 1 to 5 cm, rotation producing Teh Chi, 10 sessions of 30 minutes; 2 registered physiotherapists trained in acupuncture.
Randomized to this group: 33

2) Waiting list controls, no treatment.
Randomized to this group: 10

Outcomes

1) Pain: number of words from chart of 83 words describing pain intensity
2) Global improvement: 3‐point scale (improved, no change, worse)
3) Functional status: VAS on 12 ADL . Results are presented as number of activities that cause less than 50% pain.
4) Mobility: goniometry of the lumbar spine

Outcomes were measured after 6 weeks and 6 months.

Costs: not reported

Complications: not reported

Notes

Randomization only for comparison acupuncture versus WLC, not for different modes of acupuncture.

Language: English

Publication: full paper

No additional information from authors

Results see comparisons:
4.1
4.3
4.5
The results for global improvement could not be entered in the graphs.

The authors found significant differences for pain outcomes, however, when we entered this data in RevMan (comparison 05.01) this was not significant. Because we did this based on the data extracted from the figure, we decided to follow the author's conclusions.

Functional outcomes had to be transformed to effect sizes (comparison 05.07 to be combined with another trial)

Conclusions: "After 6 weeks, patients receiving acupuncture were statistically significantly better than the control group on measures of pain, global improvement and mobility. The same results were observed at 6 months, but only for the group that received low frequency electroacupuncture".

Tsukayama 2002

Methods

‐Randomized. Computer‐generated random number were used to make a sequence of sealed envelopes. An independent person prepared an allocation table and sealed envelopes.
‐Outcome assessors were blinded.
‐Funding: Grant from the Foundation for Training and Licensure Examination in Anma‐Massage‐Acupressure, Acupuncture and Moxibustion" and the Tsukuba College of Technology.
‐Setting: Private clinic in Tsukuba, Japan.
‐The study was approved by the Ethics Committee of TCT Clinic. Informed consent was taken from patients according to the ICH/GCP.
‐Follow‐up: 19 of 20 patients (95%)
‐Analysis: Repeated measures ANOVA. No intention‐to‐treat analysis.

Participants

20 patients with low‐back pain of at least 2 weeks and over 20 years old.

Excluded: radiculopathy or neuropathy, fracture, tumour, infection or internal disease, other general heath problem and conflicting or ongoing treatments.

Duration of low back pain: acupuncture group=2900 days (+/‐ 1983) and TENS group=3120 days (+/‐ 3306).

Mean age: 45 years old

Gender: 3 males and 16 females.

Working status: not described

Previous treatments: acupuncture (4)

Interventions

1) Acupuncture: Points selected by tenderness and palpable muscle bands detected on the lower back and the buttock. Four points bilaterally (8 in total) were used for each treatment. Points most frequently used were BL23 and BL26. Two types of disposable stainless steel needles were used, depending on stature and fat: 0.20 mm in diameter and 50 mm in length and 0.24 mm in diameter and 60 mm in length. Needles were inserted into the muscles. The average insertion depth was approximately 20 mm. Electrostimulation was applied to the inserted needles with an electronic stimulator with a frequency of 1 Hz for 15 minutes. Press tack needles were inserted after EA at four of the 8 chosen points and left in situ for several days, they are 1.3 mm long projecting from the sticky side of a small round adhesive dressing.
Patients were treated twice a week for 2 weeks, for 4 sessions in total.
Randomized to this group: 10. Drop‐outs: 1
Experience: unknown

2) TENS: Gel type disposable electrodes of 20x30 mm were used for 8 points. Electro‐stimulation was applied in the same manner as in the acupuncture group. The intensity was adjusted to the maximum comfortable level, and muscle contraction was observed. After each session, a poultice containing methyl salicylic acid, menthol and antihistamine was prescribed to be applied to the low‐back region, at home, in‐between treatments.
Patients were treated twice a week for two weeks, in total 4 sessions.
Randomized to this group: 10. No drop‐outs.

Outcomes

1) Pain (VAS): average pain level on the previous day.
2) JOA score. See description in Sakai 2001

These outcomes were measured 3 days after the last session.

Costs: not reported

Complications: no adverse events reported by the evaluator. The therapists reported transient aggravation of symptoms in the acupuncture group (1), discomfort due to tack needles (1), pain on needle insertion (1) and small subcutaneous bleeding (1). In the TENS group: transient aggravation (1), transient fatigue (1) and itching (1).

Notes

Language: English

Publication: full paper

For results, see the comparisons:
6.4 (other data table)
6.5
6.7

Conclusions: "The results of the present trial showed a significant between‐group difference in pain relief in favour of acupuncture"

Von Mencke 1988

Methods

‐Randomization procedure not described.
‐Patient and outcome assessors blinded.
‐Setting: Secondary care.

Participants

65 patients from an orthopedic clinic with lumbago and/or ischias, no relief after conventional treatment.

Diagnoses: Lombociatalgia (30), low‐back pain (20), LWS Syndrome (10) and Ischialgia (5).

Exclusion criteria: neurological problems, scoliosis, concurrent treatment, acute disc prolapse or protrusion, chronic degenerative disorders, infection.

Age and gender: not described.

Heterogeneous population regarding type, location and duration of disorder.

Interventions

1) Manual acupuncture, traditional meridian acupuncture or trigger points, rotation, insertion 0.2 to 3 cm, 6 to 12 needles 5 to 20 minutes, 8 treatments. Training & experience of acupuncturists unknown.
Points:
‐ Posterior: GV20, BL26, 31,33, 35, 48, 50, 54, 57, 58, 60.
‐ Lateral: GV20, GB 26, 28, 30, 32, 34, 37, 38, 40. BL 26, 31, 33, 48, 60
‐ Anterior: GV 20, ST 36, 40. BL 31, 33, 48, 60.
Randomized to this group: 35

2) Sham acupuncture, no traditional acupuncture nor trigger points.
Randomized to this group: 30

Outcomes

1) Pain (VAS)
2) Global improvement
3) Schober's test
4) Lasegue's test

Notes

Language: German

Publication: full paper

No additional information from authors

Results:
1) Improvement in pain at short‐term follow‐up: acupuncture=55%; sham acupuncture=37%. Long‐term: 44% versus 30%.
2) Global improvement: acupuncture=94%, sham acupuncture=50% (Table 10.02).
3) Increase in Shober test: short‐term: acupuncture=6.4, sham acupuncture=2.7. Long‐term: 7.8 versus ‐0.9
4) Lasegue: short‐term: acupuncture=6.0, sham acupuncture=2.2. Long‐term, acupuncture=6.7, sham acupuncture=0.6

Conclusions: "The difference in improvement between typically and atypically treated patients was highly significant (p<0.0001)."

Wang 1996

Methods

‐Randomized (method not reported). No description of concealment of allocation.
‐Patients were blinded.
‐Funding: not reported
‐Setting: Not reported. Vanuatu, Southwest Pacific Ocean.
‐Informed consent and ethics approval: Not mentioned
‐Follow‐up: not described but it seems 100%.
‐Analysis: U‐test. No intention‐to‐treat analysis

Participants

492 patients with low‐back pain of unknown duration.

Diagnoses: back pain

Exclusion criteria not reported.
Mean age: 48% were older than 40 years old.

Gender: 231 males and 261 females.

Working status: not reported

Previous treatments: not reported

Interventions

1) Local treatment plus cupping. Teh Chi sensation was obtained and needles were retained for 20 minutes. Points: BL23, 25 and 32. Treatments were given daily up to 10 treatments.
Randomized to this group: 246
Experience: unknown

2) Distal treatment plus electrical stimulation. Points: ST36, GB 39, BL60 and LI4.
Randomized to this group: 246
Experience: unknown

Outcomes

1) Overall assessment: a) cure: no pain and normal range of motion, no tenderness upon palpation, and normal life and work status. b) effective: pain is markedly improved, normal lumbar movement, no obvious tenderness upon palpation, and life and work is not affected c) no significant change.

Measured 3 months after the sessions.

Costs: not reported

Complications: not reported

Notes

The authors dichotomized at : Cure+effective versus no change.

Language: Chinese

Publication: full paper

No additional information from authors

For results, see the comparisons:
11.3

Conclusions: "Local acupuncture treatment plus cupping is more effective (p<0.05) than the distal treatment plus electrical stimulation."

Wu (b) 1991

Methods

See Wu 1991

Participants

Interventions

Outcomes

Notes

Wu 1991

Methods

‐Randomized (based on odd or even number of the date of patient admission). No mention of concealment of allocation
‐Patients were blinded.
‐Funding: Not reported
‐Setting: Outpatients in a hospital. Morocco.
‐Informed consent and ethics approval not mentioned.
‐Follow‐up: 100% (single session of acupuncture)
‐Analysis: Not reported

Participants

150 patients with acute low‐back pain.

Exclusion criteria not described

Age between 20 and 55 years old

Gender: 105 males and 45 females

Working status: not described

Previous treatments: not described

Interventions

1) SI3 point treatment
Randomized to this group: 75

2) Extra 29 (EX‐UE7) treatment
Randomized to this group: 75

Manual acupuncture technique (no electro‐stimulation) was used. Strong Teh Chi sensation was obtained combined with lumbar spine movement until symptom relieved. No mention of the duration of the treatment.

Outcomes

1) Global assessment (pain and range of motion).
‐ cure: no pain and normal range of motion
‐ marked effective: pain is generally gone and ROM marked improved
‐ effective: pain is relieved and ROM is somewhat improved.
‐ no change

Costs: not reported

Complications: not reported

Notes

The authors dichotomized at:
a) cure+marked effective+effective versus no change
and
b) cure+marked effective versus effective+no change

Language: Chinese

Publication: full paper

No additional information from authors

For results, see the comparisons:
Dichotomization a) 3.1
Dichotomization b) 3.1

Conclusions: "Acupuncture point SI 3 is more effective than the point Yaotongxue."

Yeung 2003

Methods

‐Randomized in blocks (method not described). Randomization was blinded.
‐Outcome assessors blinded.
‐Funding: The Hong Kong Development Fund and Tung Wah Board Fund
‐Setting: Outpatient clinic in a hospital. Hong Kong.
‐The aims and procedures of the study were explained before written consent was obtained.
Ethical approval from the Ethics Committee of the Hong Kong Hospital Authority and the Human Subject Ethics Subcommittee of the Hong Kong Polytechnic University was obtained prior to the start of the study.
‐Follow‐up: 49 of 52 patients randomised (94%)
‐Analysis: 2‐factor mixed repeated measures ANOVA. Intention‐to‐treat analysis. Dropping patients for reasons other than the treatment were given baseline values. Dropping patients for reasons related to the treatments were given worst score.

Participants

52 patients with chronic low‐back pain (>6 months) with or without radiation. Age between 18 and 75 years.

Diagnoses: non‐specific low‐back pain.

Excluded: 1. Structural deformity (ankylosing spondylitis, scoliosis) 2. Lower limb fracture 3. Tumours 4. Spinal infection 5. Cauda equina syndrome 6. Pregnancy 7. Spinal cord compression 8. Subjects who were unable to keep the appointments 9. Receiving acupuncture treatment within the past 6 months 10. Receiving physiotherapy treatment within the past 3 months

Mean age: 53 years old

Gender: 9 males and 43 females

Working status: not described

Previous treatments: tui na, massage, chiropractor, bone setter or corset.

Interventions

1) Electro‐acupuncture: 3/week for 4 weeks by a physiotherapist certificated in acupuncture. Points were chosen according to the literature: BL23, BL25, BL40 and SP6. Acupuncture was applied to the side on which patients reported pain. If the reported pain was bilateral, EA was applied to the more painful side. Sterilised disposable needles, number 30 (0.3 mm) 40‐mm long needles were inserted and manipulated until Teh Chi was obtained. Electrical stimulation on needles at a frequency of 2 Hz for 30 minutes. The intensity of the stimulation was set at the level that the patient could tolerate and often with evoked visible muscle contractions. The current had biphasic waveform to the four selected acupoints in two pairs. In addition, all patients also received exercise therapy, the same as in the control group.
Randomized to this group: 26. Lost to follow‐up: 1

2) Standard group exercise program led by the same physiotherapist.
The program consisted of an hourly session each week for 4 consecutive weeks, and comprised back strengthening and stretching exercises
In addition, patients were advised on spinal anatomy and body mechanics, back care and postural correction, lifting and ergonomic advice, and behavioural modification, as well as a series of home exercises (15 min/day).
Randomized to this group: 26. Lost to follow‐up: 2

Outcomes

1) Pain: Numerical rating scale for "average" and for "worst" pain intensity during the last week, by asking the patient to rate perceived level of pain on a scale from 0 to 10, where 0 represents no pain and 10 represents pain as bad as it could be.
2) Disability: The Aberdeen LBP scale (19‐item) was used to measure low‐back pain disability, because it is the only LBP‐specific functional disability scale validated for Chinese subjects. Responses to the questions were summed and converted to a score percentage between 0 and 100, with 0 representing the least disabled and 100 the most severely disabled.

These outcomes were measured immediately after, 1 month and 3 months after.

Costs: not reported

Complications: no adverse reaction or complication.

Notes

Language: English

Publication: full paper

No additional information from authors

For results, see the comparisons:
12.1
12.7
12.9

Conclusions: "Significantly better scores in the NRS and Aberdeen LBP scale were found in the exercise plus EA group immediately after treatment, at 1‐month follow‐up and at 3‐month follow‐up"

Key:
CAM = complementary and alternative medicine
ADL = activities of daily living
WLC = waiting list control

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Cai 1996

Sciatica

Duplan 1983

Acute sciatica of disc origin.

Fox 1976

Not randomised

Franke 2000

Acupuncture treatment did not involve needling.

Fujinuki 1989

Lumbar spinal canal stenosis

Galacchi 1981

Percentage of low‐back pain unknown

Gallacchi 1983

Percentage of low‐back pain unknown

Ghia 1976

Specific causes of low‐back pain

Hackett 1988

Acupuncture treatment did not involve needling.

Ishimaru 1993

Not randomised

Junnila 1982

No back pain

Kinoshita 1965

Sciatica

Kinoshita 1971

Sciatica

Kinoshita 1981

Sciatica

Koike 1975

Not randomised

Kuramoto 1977

Lumbar disc herniation

Laitinen 1976

Sciatica

Li 1994

Acupuncture treatment did not involve needling.

Megumi 1979

Not randomised

Ren 1996

Not randomised

Shinohara 2000

No mention of low‐back pain, only musculoskeletal pain.

Sodipo 1981

Not randomised

Sugiyama 1984

Not randomised

Wang 1997

Not randomised

Wang 2000

Lumbar disc surgery

Wedenberg 2000

Pregnancy

Xingsheng 1998

Sciatica

Xu 1996

Not randomised

Yue 1978

Back (n=15) and neck (n=8) and it is a preliminary report

Zhang 1995

Not randomised

Zhang 1996

Not randomised

Zhi 1995

Not randomised

Characteristics of ongoing studies [ordered by study ID]

Cherkin

Trial name or title

Efficacy of Acupuncture for Chronic Low Back Pain

Methods

Participants

Low Back Pain

Interventions

Acupuncture

Outcomes

Starting date

Funding: National Center for Complementary and Alternative Medicine (NCCAM)

Contact information

Janet Erro, RN [email protected]

Study chairs or principal investigators

Daniel Cherkin, PhD, Study Director, Group Health Cooperative Center for Health Studies
Karen J Sherman, PhD, Principal Investigator, Group Health Cooperative Center for Health Studies
Andy Avins, MD, Principal Investigator, Kaiser Foundation Research Institute, Kaiser Permanente Northern California

Study ID Numbers R01 AT001110‐01 A1
Study Start Date April 2004
Record last reviewed March 2004
NLM Identifier NCT00065585
ClinicalTrials.gov processed this record on 2004‐04‐16

Notes

Source: www.controlled‐trials.com
This is a 4‐arm multi‐site randomised controlled trial to clarify the extent to which various types of acupuncture needling can diminish the effect of chronic low back pain on patient functioning and symptoms. Reviews have noted the poor quality of research in this area and urged that scientifically rigorous studies be conducted. Recent higher quality trials suggest acupuncture is a promising treatment for back pain. This study directly addresses methodological shortcomings that have plagued previous studies. A total of 640 subjects (160 per arm) with low back pain lasting at least 3 months will be recruited from group model HMOs in Seattle, WA and Oakland, CA. They will be randomised to one of three different methods of stimulation of acupuncture or to continue usual medical care. Ten treatments will be provided over 7 weeks. The primary outcomes, dysfunction and bothersomeness of low back pain, will be measured at baseline, and after 8, 26, and 52 weeks by telephone interviewers masked to treatment. Analysis of covariance within an intention‐to‐treat context will be used to analyse the data. Because chronic back pain is a major public health problem and the top reason patients seek acupuncture treatment, a clear, unambiguous assessment is critical for making informed decisions about whether acupuncture should be included as part of conventional care for back pain or covered by insurance. Results of this study will provide the clearest evidence to date about the value of acupuncture needling as a treatment for chronic low back pain.

GerAc

Trial name or title

German Acupuncture Trials

Methods

Participants

Interventions

Outcomes

Starting date

Contact information

http://www.gerac.de/index1.html

Notes

Harvard Med School

Trial name or title

Physical CAM Therapies for Chronic Low Back Pain

Methods

Participants

Chronic Low Back Pain

Interventions

Procedure: massage therapy
Procedure: chiropractic
Procedure: acupuncture

Outcomes

Study Design: Treatment, Randomized, Open Label, Active Control, Parallel Assignment

Starting date

Funding: NIH

Contact information

Expected Total Enrollment: 120
Location Information
Massachusetts
Harvard Vanguard Medical Associates, Boston, Massachusetts, 00000, United States
Harvard medical school, Boston, Massachusetts, 00000, United States

More Information
Study ID Numbers 1 R01 AT00622‐01; EisenbergD
Study Start Date April 2002; Estimated Completion Date December 2002
Record last reviewed August 2003
NLM Identifier NCT00065975
ClinicalTrials.gov processed this record on 2004‐04‐16

Notes

Source: www.controlled‐trials.com
This study compares two approaches to the management of acute low back pain: usual care (standard benefit) vs. the choice of: usual care, chiropractic, acupuncture or massage therapy (expanded benefit). 480 subjects with uncomplicated, acute low back pain will be recruited from a health maintenance organization, and randomised to either usual care (n=160) or choice of expanded benefits (n=320). Patients' preferences for individual therapies and expectations of improvement will be measured at baseline and throughout the study. Subjects randomised to the expanded benefits arm who choose chiropractic, acupuncture or massage will receive up to 10 treatments over a five‐week period. Additional treatments will be available after the fifth week but will require a copayment. Treatments will be provided by licensed providers who have met strict credentialing criteria. Chiropractic, acupuncture or massage treatments will begin within 48 hours. Chiropractic, acupuncture and massage therapy scope of practice guidelines for the treatment of acute low back pain have been developed as have detailed data tracking procedures to be used at each patient visit. Symptom relief, functional status, restricted activity days, use of health care, and patient and provider satisfaction will be assessed at 2, 5,12, 26 and 52 weeks after initiation of treatment. Primary outcomes will include: 1) change in symptoms; 2) change in functional status; 3) patient satisfaction; and 4) total utilization of services associated with care for low back pain. Medical records and the HMO's cost management information system will identify use of services. It is hypothesized that patients offered their choice of expanded benefits will experience a more rapid improvement in symptoms, a faster return to baseline functional status, a decrease in utilization of conventional medical services, and will be more satisfied with their care. The study is a direct examination of the effectiveness of an insurance eligibility intervention, not a test of the efficacy of specific, non‐allopathic treatment regimens. The results of this study will provide valuable information to clinicians, patients and third party payers on the relative benefits and costs of an "expanded benefits" treatment option which incorporates chiropractic, acupuncture and massage services for low back

Kong

Trial name or title

Methods

Participants

Interventions

Outcomes

Starting date

Contact information

Notes

Munglani

Trial name or title

Randomised controlled single‐blinded trial of deep intra‐muscular stimulation in the treatment of chronic mechanical low back pain.

Methods

Participants

Out‐patients between 18 and 65 years old

Interventions

Outcomes

Starting date

Contact information

Dr Rajesh Munglani
Contact details Box No 215
Pain Clinic
Addenbrooke's NHS Trust
CB2 2QQ
Tel: 2346

Notes

Source: www.controlled‐trials.com
Deep Intra‐Muscular Stimulation is a technique that consists of needling the body of contracted or shortened muscles, and it is claimed to relieve muscle spasm more effectively than other treatments, but no randomised controlled trials have been performed, especially to compare its effects with the effects of other needling techniques such as acupuncture or trigger point needling. As the Pain Clinic is at present able to make use of the services of a highly experienced practitioner of this technique, we are planning to conduct a randomised, controlled, single‐blinded trial comparing the benefits of deep Intra‐Muscular stimulation with superficial needling of subcutaneous tissues in patients with chronic mechanical low back pain. We wish to asses if the needling of deep muscles specifically produces pain relief over and above that produced by needling of more superficial structures. We plan to treat two groups of 25 patients each, or a total of 50 patients, administering four treatment episodes to each patient. Patients will be asked to turn up for four treatment episodes, and to fill in two self‐reporting questionnaires (SCL‐90 and Pain VAS) before and at 2, 6 and 26 weeks after treatment.

Thomas

Trial name or title

Longer term clinical and economic benefits of offering acupuncture to patients with chronic low back pain.

Methods

Participants

patients with low back pain. Age 20‐65 years with low back pain or sciatica, greater than 4 weeks and less than 12‐months pain this episode

Interventions

i) traditional Chinese acupuncture, up to 10 treatments ii) standard care offered by GP only

Outcomes

Starting date

Funding: NHS

Contact information

Ms Kate Thomas
Address Medical Care Research Unit
University of Sheffield
ScHARR
Regent Court
30 Regent Street
City/town Sheffield
Zip/Postcode S1 4DA
Country United Kingdom
Tel +44 0114 222 0753
Fax +44 0114 272 4095
Email [email protected]
Sponsor NHS Research and Development Health Technology Assessment Programme (HTA)

Notes

Source: www.controlled‐trials.com

Data and analyses

Open in table viewer
Comparison 1. acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (VAS) (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 1.1

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS) (lower values are better).

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS) (lower values are better).

1.1 Immediately after end of sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 functional status (higher scores are better). Generic instrument Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 1.2

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 2 functional status (higher scores are better). Generic instrument.

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 2 functional status (higher scores are better). Generic instrument.

2.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 physical examination: finger‐floor distance (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 1.3

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination: finger‐floor distance (lower values are better).

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination: finger‐floor distance (lower values are better).

3.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 mean difference in pain (final ‐ initial) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 1.4

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 4 mean difference in pain (final ‐ initial).

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 4 mean difference in pain (final ‐ initial).

4.1 Immediately after end of sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 mean difference in functional status (final ‐ initial) Generic instrument Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 1.5

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 5 mean difference in functional status (final ‐ initial) Generic instrument.

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 5 mean difference in functional status (final ‐ initial) Generic instrument.

5.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 mean difference in physical examination (final ‐ initial): finger‐floor distance Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 1.6

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 6 mean difference in physical examination (final ‐ initial): finger‐floor distance.

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 6 mean difference in physical examination (final ‐ initial): finger‐floor distance.

6.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 2. acupuncture versus other intervention ((Sub)acute LBP: < 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (VAS): lower values are better Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.1

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS): lower values are better.

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS): lower values are better.

1.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 global measure (higher values are better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 2.2

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 2 global measure (higher values are better).

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 2 global measure (higher values are better).

2.1 Long‐term follow‐up (more than 1 year)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 physical examination (finger floor distance) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 2.3

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination (finger floor distance).

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination (finger floor distance).

3.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Side effects / Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 2.4

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 4 Side effects / Complications.

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 4 Side effects / Complications.

4.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 3. acupuncture versus acupuncture. ((Sub)acute LBP: < 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 global measure Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 3.1

Comparison 3 acupuncture versus acupuncture. ((Sub)acute LBP: < 3 months), Outcome 1 global measure.

Comparison 3 acupuncture versus acupuncture. ((Sub)acute LBP: < 3 months), Outcome 1 global measure.

1.1 Immediately after the end of the sessions

2

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 4. acupuncture versus no treatment. (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (instruments: VAS and number of words) Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

Analysis 4.1

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 1 pain (instruments: VAS and number of words).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 1 pain (instruments: VAS and number of words).

1.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

90

Std. Mean Difference (IV, Random, 95% CI)

‐0.73 [‐1.19, ‐0.28]

1.2 Intermediate‐term follow‐up (3 months to 1 year)

1

40

Std. Mean Difference (IV, Random, 95% CI)

‐0.78 [‐1.52, ‐0.04]

2 global measure (improvement) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 4.2

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 2 global measure (improvement).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 2 global measure (improvement).

2.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 functional status (higher values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 4.3

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 3 functional status (higher values are better).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 3 functional status (higher values are better).

3.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 limitation of activity (higher values are worse) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 4.4

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 4 limitation of activity (higher values are worse).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 4 limitation of activity (higher values are worse).

4.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 functional status (standardized measures) Show forest plot

2

Effect size (Random, 95% CI)

Subtotals only

Analysis 4.5

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 5 functional status (standardized measures).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 5 functional status (standardized measures).

5.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

90

Effect size (Random, 95% CI)

0.63 [0.19, 1.08]

5.2 Intermediate‐term follow‐up (3 months to 1 year)

1

40

Effect size (Random, 95% CI)

0.03 [‐0.70, 0.76]

Open in table viewer
Comparison 5. acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values mean better) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

Analysis 5.1

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).

1.1 Immediately after the end of the sessions

4

314

Mean Difference (IV, Random, 95% CI)

‐10.21 [‐14.99, ‐5.44]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

138

Mean Difference (IV, Random, 95% CI)

‐17.79 [‐25.50, ‐10.07]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

2

96

Mean Difference (IV, Random, 95% CI)

‐5.74 [‐14.72, 3.25]

1.4 Long‐term follow‐up (more than 1 year)

1

27

Mean Difference (IV, Random, 95% CI)

‐12.0 [‐41.83, 17.83]

2 global improvement (higher values are better) Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

Analysis 5.2

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 2 global improvement (higher values are better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 2 global improvement (higher values are better).

2.1 Immediately after the end of the sessions

3

234

Risk Ratio (M‐H, Random, 95% CI)

1.23 [1.04, 1.46]

2.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

3

171

Risk Ratio (M‐H, Random, 95% CI)

1.44 [0.92, 2.24]

2.3 Intermediate‐term follow‐up (3 months to 1 year)

1

40

Risk Ratio (M‐H, Random, 95% CI)

1.19 [0.89, 1.60]

2.4 Long‐term follow‐up (more than 1 year)

1

50

Risk Ratio (M‐H, Random, 95% CI)

3.29 [0.85, 12.80]

3 pain disability index (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 5.3

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).

3.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 physical examination (fingertips‐to‐floor distance).( Lower values are better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 5.4

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 4 physical examination (fingertips‐to‐floor distance).( Lower values are better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 4 physical examination (fingertips‐to‐floor distance).( Lower values are better).

4.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 improvement in physical examination Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 5.5

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 5 improvement in physical examination.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 5 improvement in physical examination.

5.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Sick leave (higher values mean worse) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

Analysis 5.6

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 6 Sick leave (higher values mean worse).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 6 Sick leave (higher values mean worse).

6.1 Intermediate‐term follow‐up (3 months to 1 year)

2

58

Risk Ratio (M‐H, Random, 95% CI)

0.58 [0.22, 1.54]

7 Well being (SF‐36). (Higher values are better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 5.7

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 7 Well being (SF‐36). (Higher values are better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 7 Well being (SF‐36). (Higher values are better).

7.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Side effects / Complications Show forest plot

3

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

Analysis 5.8

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 8 Side effects / Complications.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 8 Side effects / Complications.

8.1 Immediately after the end of the sessions

2

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Intermediate‐term follow‐up (3 months to 1 year)

2

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9 pain (percent of baseline values) Show forest plot

Other data

No numeric data

Analysis 5.9

Study

Group

Follow‐up

Number of patients

Percent of baseline

Standard Deviation

p value

Short‐term follow‐up (up to 3 months after the end of the sessions)

Carlsson (even)

Acupuncture

1 month

34

87%

32

0.003

Carlsson (even)

Placebo

1 month

16

123%

46

Carlsson (morn)

Acupuncture

1 month

34

88%

32

0.000

Carlsson (morn)

Placebo

1 month

16

138%

40

Intermediate‐term follow‐up (3 months to 1 year)

Carlsson (even)

Acupuncture

3 months

23

75%

34

0.007

Carlsson (even)

Placebo

3 months

9

120%

50

Carlsson (morn)

Acupuncture

3 months

23

76%

37

0.001

Carlsson (morn)

Placebo

3 months

9

130%

39

Long‐term follow‐up (more than 1 year)

Carlsson (even)

Acupuncture

6 months or longer

21

69%

31

0.056

Carlsson (even)

Placebo

6 months or longer

6

100%

48

Carlsson (morn)

Acupuncture

6 months or longer

21

76%

33

0.128

Carlsson (morn)

Placebo

6 months or longer

6

133%

76



Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 9 pain (percent of baseline values).

9.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

Other data

No numeric data

9.2 Intermediate‐term follow‐up (3 months to 1 year)

Other data

No numeric data

9.3 Long‐term follow‐up (more than 1 year)

Other data

No numeric data

10 sick leave Show forest plot

Other data

No numeric data

Analysis 5.10

Study

Group

Time

Full time work

Sick leave part‐time

Sick leave full time

p value

Long‐term follow‐up

Carlsson 2001

Acupuncture

Baseline

7

6

8

Carlsson 2001

After 6 months

11

7

3

0.024

Carlsson 2001

Placebo

Baseline

4

2

5

Carlsson 2001

After 6 months

5

1

5

0.655



Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 10 sick leave.

10.1 Long‐term follow‐up

Other data

No numeric data

11 general level of pain (0‐15 points)(more points mean less pain) Show forest plot

Other data

No numeric data

Analysis 5.11

Study

Group

Value

p value

Immediately after the end of the sessions

Lehmann 1986

Acupuncture

10.59

F 2,50 = 1.66 (p<0.2)

Lehmann 1986

TENS

9.16

Lehmann 1986

Sham TENS

9.00

Intermediate‐term follow‐up (3 months to 1 year)

Lehmann 1986

Acupuncture

11.08

F 2,41=3.57
p=0.04 (not adjusted for multiple comparisons).
p=0.1 (adjusted for multiple comparisons)

Lehmann 1986

TENS

8.28

Lehmann 1986

Sham TENS

7.94



Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 11 general level of pain (0‐15 points)(more points mean less pain).

11.1 Immediately after the end of the sessions

Other data

No numeric data

11.2 Intermediate‐term follow‐up (3 months to 1 year)

Other data

No numeric data

12 pain: difference between within group changes Show forest plot

1

differences between (Random, 95% CI)

Totals not selected

Analysis 5.12

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 12 pain: difference between within group changes.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 12 pain: difference between within group changes.

12.1 Immediately after the end of the sessions

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Intermediate‐term follow‐up (3 months to 1 year)

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

13 function: difference between within group changes Show forest plot

1

differences between (Random, 95% CI)

Totals not selected

Analysis 5.13

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 13 function: difference between within group changes.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 13 function: difference between within group changes.

13.1 Immediately after the end of the sessions

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

13.2 Intermediate‐term follow‐up (3 months to 1 year)

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

14 Pain: percentage of patients with >50% pain reduction Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 5.14

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 14 Pain: percentage of patients with >50% pain reduction.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 14 Pain: percentage of patients with >50% pain reduction.

14.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

14.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

15 spine range of motion: difference between within group changes Show forest plot

1

difference between (Random, 95% CI)

Totals not selected

Analysis 5.15

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 15 spine range of motion: difference between within group changes.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 15 spine range of motion: difference between within group changes.

15.1 Immediately after the end of the sessions

1

difference between (Random, 95% CI)

0.0 [0.0, 0.0]

15.2 Intermediate‐term follow‐up (3 months to 1 year)

1

difference between (Random, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 6. acupuncture versus other intervention. (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values are better) Show forest plot

7

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

Analysis 6.1

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).

1.1 Immediately after the end of the sessions

5

284

Std. Mean Difference (IV, Random, 95% CI)

0.48 [0.21, 0.75]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

356

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐2.74, 2.36]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

2

356

Std. Mean Difference (IV, Random, 95% CI)

2.48 [1.02, 3.94]

2 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen Show forest plot

6

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 6.2

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 2 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen.

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 2 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen.

2.1 Immediately after the end of the sessions

4

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Intermediate‐term follow‐up (3 months to 1 year)

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 return to work (higher values mean better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 6.3

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 3 return to work (higher values mean better).

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 3 return to work (higher values mean better).

3.1 Intermediate‐term follow‐up (3 months to 1 year)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Side effects / Complications Show forest plot

7

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

Analysis 6.4

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 4 Side effects / Complications.

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 4 Side effects / Complications.

4.1 Immediately after the end of the sessions

4

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.3 Intermediate‐term follow‐up (3 months to 1 year)

3

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 pain and function (adjusted for baseline values) Show forest plot

Other data

No numeric data

Analysis 6.5

Study

Comparison

Outcome measure

Timing

p value

Immediately after the end of the sessions

Tsukayama 2002

Acupuncture versus TENS

Functional status (JOA): higher scores are better

Immediately after

0.24

Tsukayama 2002

Short‐term follow‐up (up to 3 months after the end of the sessions)

Cherkin 2001 (mass)

Acupuncture versus massage

Pain

9 weeks

0.23

Cherkin 2001 (mass)

Function

9 weeks

0.01 (massage is better)

Cherkin 2001 (sc)

Acupuncture versus self‐care education

Pain

9 weeks

0.55

Cherkin 2001 (sc)

Function

9 weeks

0.75

Intermediate‐term follow‐up (3 months to 1 year)

Cherkin 2001 (mass)

Acupuncture versus massage

Pain

52 weeks

0.002 (massage is better)

Cherkin 2001 (mass)

Function

52 weeks

0.05 (massage is better)

Cherkin 2001 (sc)

Acupuncture versus self‐care education

Pain

52 weeks

0.10

Cherkin 2001 (sc)

Function

52 weeks

0.10



Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 5 pain and function (adjusted for baseline values).

5.1 Immediately after the end of the sessions

Other data

No numeric data

5.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

Other data

No numeric data

5.3 Intermediate‐term follow‐up (3 months to 1 year)

Other data

No numeric data

6 general level of pain (0‐15 points)(more points mean less pain) Show forest plot

Other data

No numeric data

Analysis 6.6

Study

Group

Value

p value

Immediately after the end of the sessions

Lehmann 1986

Acupuncture

10.59

F 2,50 = 1.66 (p<0.2)

Lehmann 1986

TENS

9.16

Lehmann 1986

Sham TENS

9.00

Intermediate‐term follow‐up (3 months to 1 year)

Lehmann 1986

Acupuncture

11.08

F 2,41=3.57
p=0.04 (not adjusted for multiple comparisons).
p=0.1 (adjusted for multiple comparisons)

Lehmann 1986

TENS

8.28

Lehmann 1986

Sham TENS

7.94



Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 6 general level of pain (0‐15 points)(more points mean less pain).

6.1 Immediately after the end of the sessions

Other data

No numeric data

6.2 Intermediate‐term follow‐up (3 months to 1 year)

Other data

No numeric data

7 pain: difference between within group changes Show forest plot

1

differences between (Random, 95% CI)

Totals not selected

Analysis 6.7

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 7 pain: difference between within group changes.

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 7 pain: difference between within group changes.

7.1 Immediately after the end of the sessions

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 7. acupuncture versus acupuncture. (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values mean better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

Analysis 7.1

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).

1.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Improvement (higher values are better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 7.2

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 2 Improvement (higher values are better).

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 2 Improvement (higher values are better).

2.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Intermediate‐term follow‐up (3 months to 1 year)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 improvement Show forest plot

Other data

No numeric data

Analysis 7.3

Study

Improvement

Technique 1: Regular

Technique 2: Ancient

p value

Immediately after the end of the sessions

Ding 1998

Marked effective

4

8

Ding 1998

Improved

6

3

Ding 1998

No change

5

2

Ding 1998

Short‐term follow‐up (up to 3 months after the end of the sessions)

Ding 1998

Cure

4

22

Chi‐square=12.44
p<0.01

Ding 1998

Marked effective

4

8

Ding 1998

Improved

6

3

Ding 1998

No change

5

2



Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 3 improvement.

3.1 Immediately after the end of the sessions

Other data

No numeric data

3.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

Other data

No numeric data

Open in table viewer
Comparison 8. dry‐needling versus other intervention ((Sub)acute LBP < 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 global measure (higher values are better) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 8.1

Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 1 global measure (higher values are better).

Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 1 global measure (higher values are better).

1.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

4

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Side effects / Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 8.2

Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 2 Side effects / Complications.

Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 2 Side effects / Complications.

2.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 9. acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (VAS): lower values are better Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 9.1

Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 1 pain (VAS): lower values are better.

Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 1 pain (VAS): lower values are better.

1.1 Short term (immediately after end of sessions)

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 global measure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 9.2

Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 2 global measure.

Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 2 global measure.

2.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 10. acupuncture versus other intervention (unknown / mixed duration of low back pain)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain score (lower values mean better) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 10.1

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 1 pain score (lower values mean better).

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 1 pain score (lower values mean better).

1.1 Immediately after the end of the sessions

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 pain recovery: higher values are better Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 10.2

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 2 pain recovery: higher values are better.

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 2 pain recovery: higher values are better.

2.1 Immediately after the end of the sessions

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 global measure (higher values are better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 10.3

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).

3.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 back specific functional status (higher scores are better). Ex: Japan Orthopedic Association Score. Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 10.4

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 4 back specific functional status (higher scores are better). Ex: Japan Orthopedic Association Score..

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 4 back specific functional status (higher scores are better). Ex: Japan Orthopedic Association Score..

4.1 Immediately after the end of the sessions

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Side effects / Complications Show forest plot

1

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

Analysis 10.5

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 5 Side effects / Complications.

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 5 Side effects / Complications.

5.1 Immediately after the end of the sessions

1

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Open in table viewer
Comparison 11. acupuncture versus acupuncture. (unknown / mixed duration of low back pain)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 11.1

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 1 pain (lower values are better).

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 1 pain (lower values are better).

1.1 Short term (immediately after end of sessions)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 pain recovery (higher values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 11.2

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 2 pain recovery (higher values are better).

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 2 pain recovery (higher values are better).

2.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 global measure (higher values are better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 11.3

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).

3.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 functional status (higher values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 11.4

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 4 functional status (higher values are better).

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 4 functional status (higher values are better).

4.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 physical examination (finger‐floor distance) Higher values are better. Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 11.5

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 5 physical examination (finger‐floor distance) Higher values are better..

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 5 physical examination (finger‐floor distance) Higher values are better..

5.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 improvement Show forest plot

Other data

No numeric data

Analysis 11.6

Study

Improvement

Technique 1: Ac+cupp

Technique 2: Acup

p value

Long‐term follow‐up (more than 1 year)

Li 1997

Cure

33

22

<0.01

Li 1997

Marked effective

32

28

Li 1997

Improved

13

26

Li 1997

No change

0

2



Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 6 improvement.

6.1 Long‐term follow‐up (more than 1 year)

Other data

No numeric data

Open in table viewer
Comparison 12. acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values are better) Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

Analysis 12.1

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).

1.1 Immediately after the end of the sessions

4

289

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.02, ‐0.50]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

3

182

Std. Mean Difference (IV, Random, 95% CI)

‐1.10 [‐1.62, ‐0.58]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

2

115

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.14, ‐0.38]

2 pain: difference between within group changes Show forest plot

2

differences between (Random, 95% CI)

Subtotals only

Analysis 12.2

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 2 pain: difference between within group changes.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 2 pain: difference between within group changes.

2.1 Immediately after the end of the sessions

2

differences between (Random, 95% CI)

‐1.07 [‐2.14, ‐0.00]

2.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

differences between (Random, 95% CI)

‐0.7 [‐1.33, ‐0.07]

2.3 Intermediate‐term follow‐up (3 months to 1 year)

1

differences between (Random, 95% CI)

‐0.8 [‐1.80, 0.20]

3 pain disability index (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

Analysis 12.3

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).

3.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Pain: percentage of patients with >50% pain reduction Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 12.4

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 4 Pain: percentage of patients with >50% pain reduction.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 4 Pain: percentage of patients with >50% pain reduction.

4.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 function: difference between within group changes Show forest plot

2

differences between (Random, 95% CI)

Subtotals only

Analysis 12.5

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 5 function: difference between within group changes.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 5 function: difference between within group changes.

5.1 Immediately after the end of the sessions

2

differences between (Random, 95% CI)

‐6.51 [‐14.99, 1.98]

5.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

differences between (Random, 95% CI)

‐3.1 [‐5.26, ‐0.94]

5.3 Intermediate‐term follow‐up (3 months to 1 year)

1

differences between (Random, 95% CI)

‐6.8 [‐12.60, 1.00]

6 global measure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

Analysis 12.6

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 6 global measure.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 6 global measure.

6.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

Analysis 12.7

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 7 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 7 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen.

7.1 Immediately after the end of the sessions

3

173

Std. Mean Difference (IV, Random, 95% CI)

‐0.95 [‐1.27, ‐0.63]

7.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

99

Std. Mean Difference (IV, Random, 95% CI)

‐0.95 [‐1.37, ‐0.54]

7.3 Intermediate‐term follow‐up (3 months to 1 year)

2

115

Std. Mean Difference (IV, Random, 95% CI)

‐0.55 [‐0.92, ‐0.18]

8 spine range of motion: difference between within group changes Show forest plot

1

difference between (Random, 95% CI)

Totals not selected

Analysis 12.8

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 8 spine range of motion: difference between within group changes.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 8 spine range of motion: difference between within group changes.

8.1 Immediately after the end of the sessions

1

difference between (Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Intermediate‐term follow‐up (3 months to 1 year)

1

difference between (Random, 95% CI)

0.0 [0.0, 0.0]

9 Side effects / Complications Show forest plot

2

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

Analysis 12.9

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 9 Side effects / Complications.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 9 Side effects / Complications.

9.1 Immediately after the end of the sessions

2

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Acupuncture compared to no treatment, placebo or sham therapy
Figuras y tablas -
Figure 1

Acupuncture compared to no treatment, placebo or sham therapy

Acupuncture compared to another intervention or added to other interventions
Figuras y tablas -
Figure 2

Acupuncture compared to another intervention or added to other interventions

Effects of dry‐needling at trigger points
Figuras y tablas -
Figure 3

Effects of dry‐needling at trigger points

Comparison between two techniques of acupuncture
Figuras y tablas -
Figure 4

Comparison between two techniques of acupuncture

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS) (lower values are better).
Figuras y tablas -
Analysis 1.1

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS) (lower values are better).

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 2 functional status (higher scores are better). Generic instrument.
Figuras y tablas -
Analysis 1.2

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 2 functional status (higher scores are better). Generic instrument.

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination: finger‐floor distance (lower values are better).
Figuras y tablas -
Analysis 1.3

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination: finger‐floor distance (lower values are better).

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 4 mean difference in pain (final ‐ initial).
Figuras y tablas -
Analysis 1.4

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 4 mean difference in pain (final ‐ initial).

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 5 mean difference in functional status (final ‐ initial) Generic instrument.
Figuras y tablas -
Analysis 1.5

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 5 mean difference in functional status (final ‐ initial) Generic instrument.

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 6 mean difference in physical examination (final ‐ initial): finger‐floor distance.
Figuras y tablas -
Analysis 1.6

Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 6 mean difference in physical examination (final ‐ initial): finger‐floor distance.

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS): lower values are better.
Figuras y tablas -
Analysis 2.1

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS): lower values are better.

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 2 global measure (higher values are better).
Figuras y tablas -
Analysis 2.2

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 2 global measure (higher values are better).

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination (finger floor distance).
Figuras y tablas -
Analysis 2.3

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination (finger floor distance).

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 4 Side effects / Complications.
Figuras y tablas -
Analysis 2.4

Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 4 Side effects / Complications.

Comparison 3 acupuncture versus acupuncture. ((Sub)acute LBP: < 3 months), Outcome 1 global measure.
Figuras y tablas -
Analysis 3.1

Comparison 3 acupuncture versus acupuncture. ((Sub)acute LBP: < 3 months), Outcome 1 global measure.

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 1 pain (instruments: VAS and number of words).
Figuras y tablas -
Analysis 4.1

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 1 pain (instruments: VAS and number of words).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 2 global measure (improvement).
Figuras y tablas -
Analysis 4.2

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 2 global measure (improvement).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 3 functional status (higher values are better).
Figuras y tablas -
Analysis 4.3

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 3 functional status (higher values are better).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 4 limitation of activity (higher values are worse).
Figuras y tablas -
Analysis 4.4

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 4 limitation of activity (higher values are worse).

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 5 functional status (standardized measures).
Figuras y tablas -
Analysis 4.5

Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 5 functional status (standardized measures).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).
Figuras y tablas -
Analysis 5.1

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 2 global improvement (higher values are better).
Figuras y tablas -
Analysis 5.2

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 2 global improvement (higher values are better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).
Figuras y tablas -
Analysis 5.3

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 4 physical examination (fingertips‐to‐floor distance).( Lower values are better).
Figuras y tablas -
Analysis 5.4

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 4 physical examination (fingertips‐to‐floor distance).( Lower values are better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 5 improvement in physical examination.
Figuras y tablas -
Analysis 5.5

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 5 improvement in physical examination.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 6 Sick leave (higher values mean worse).
Figuras y tablas -
Analysis 5.6

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 6 Sick leave (higher values mean worse).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 7 Well being (SF‐36). (Higher values are better).
Figuras y tablas -
Analysis 5.7

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 7 Well being (SF‐36). (Higher values are better).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 8 Side effects / Complications.
Figuras y tablas -
Analysis 5.8

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 8 Side effects / Complications.

Study

Group

Follow‐up

Number of patients

Percent of baseline

Standard Deviation

p value

Short‐term follow‐up (up to 3 months after the end of the sessions)

Carlsson (even)

Acupuncture

1 month

34

87%

32

0.003

Carlsson (even)

Placebo

1 month

16

123%

46

Carlsson (morn)

Acupuncture

1 month

34

88%

32

0.000

Carlsson (morn)

Placebo

1 month

16

138%

40

Intermediate‐term follow‐up (3 months to 1 year)

Carlsson (even)

Acupuncture

3 months

23

75%

34

0.007

Carlsson (even)

Placebo

3 months

9

120%

50

Carlsson (morn)

Acupuncture

3 months

23

76%

37

0.001

Carlsson (morn)

Placebo

3 months

9

130%

39

Long‐term follow‐up (more than 1 year)

Carlsson (even)

Acupuncture

6 months or longer

21

69%

31

0.056

Carlsson (even)

Placebo

6 months or longer

6

100%

48

Carlsson (morn)

Acupuncture

6 months or longer

21

76%

33

0.128

Carlsson (morn)

Placebo

6 months or longer

6

133%

76

Figuras y tablas -
Analysis 5.9

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 9 pain (percent of baseline values).

Study

Group

Time

Full time work

Sick leave part‐time

Sick leave full time

p value

Long‐term follow‐up

Carlsson 2001

Acupuncture

Baseline

7

6

8

Carlsson 2001

After 6 months

11

7

3

0.024

Carlsson 2001

Placebo

Baseline

4

2

5

Carlsson 2001

After 6 months

5

1

5

0.655

Figuras y tablas -
Analysis 5.10

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 10 sick leave.

Study

Group

Value

p value

Immediately after the end of the sessions

Lehmann 1986

Acupuncture

10.59

F 2,50 = 1.66 (p<0.2)

Lehmann 1986

TENS

9.16

Lehmann 1986

Sham TENS

9.00

Intermediate‐term follow‐up (3 months to 1 year)

Lehmann 1986

Acupuncture

11.08

F 2,41=3.57
p=0.04 (not adjusted for multiple comparisons).
p=0.1 (adjusted for multiple comparisons)

Lehmann 1986

TENS

8.28

Lehmann 1986

Sham TENS

7.94

Figuras y tablas -
Analysis 5.11

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 11 general level of pain (0‐15 points)(more points mean less pain).

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 12 pain: difference between within group changes.
Figuras y tablas -
Analysis 5.12

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 12 pain: difference between within group changes.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 13 function: difference between within group changes.
Figuras y tablas -
Analysis 5.13

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 13 function: difference between within group changes.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 14 Pain: percentage of patients with >50% pain reduction.
Figuras y tablas -
Analysis 5.14

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 14 Pain: percentage of patients with >50% pain reduction.

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 15 spine range of motion: difference between within group changes.
Figuras y tablas -
Analysis 5.15

Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 15 spine range of motion: difference between within group changes.

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).
Figuras y tablas -
Analysis 6.1

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 2 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen.
Figuras y tablas -
Analysis 6.2

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 2 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen.

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 3 return to work (higher values mean better).
Figuras y tablas -
Analysis 6.3

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 3 return to work (higher values mean better).

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 4 Side effects / Complications.
Figuras y tablas -
Analysis 6.4

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 4 Side effects / Complications.

Study

Comparison

Outcome measure

Timing

p value

Immediately after the end of the sessions

Tsukayama 2002

Acupuncture versus TENS

Functional status (JOA): higher scores are better

Immediately after

0.24

Tsukayama 2002

Short‐term follow‐up (up to 3 months after the end of the sessions)

Cherkin 2001 (mass)

Acupuncture versus massage

Pain

9 weeks

0.23

Cherkin 2001 (mass)

Function

9 weeks

0.01 (massage is better)

Cherkin 2001 (sc)

Acupuncture versus self‐care education

Pain

9 weeks

0.55

Cherkin 2001 (sc)

Function

9 weeks

0.75

Intermediate‐term follow‐up (3 months to 1 year)

Cherkin 2001 (mass)

Acupuncture versus massage

Pain

52 weeks

0.002 (massage is better)

Cherkin 2001 (mass)

Function

52 weeks

0.05 (massage is better)

Cherkin 2001 (sc)

Acupuncture versus self‐care education

Pain

52 weeks

0.10

Cherkin 2001 (sc)

Function

52 weeks

0.10

Figuras y tablas -
Analysis 6.5

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 5 pain and function (adjusted for baseline values).

Study

Group

Value

p value

Immediately after the end of the sessions

Lehmann 1986

Acupuncture

10.59

F 2,50 = 1.66 (p<0.2)

Lehmann 1986

TENS

9.16

Lehmann 1986

Sham TENS

9.00

Intermediate‐term follow‐up (3 months to 1 year)

Lehmann 1986

Acupuncture

11.08

F 2,41=3.57
p=0.04 (not adjusted for multiple comparisons).
p=0.1 (adjusted for multiple comparisons)

Lehmann 1986

TENS

8.28

Lehmann 1986

Sham TENS

7.94

Figuras y tablas -
Analysis 6.6

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 6 general level of pain (0‐15 points)(more points mean less pain).

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 7 pain: difference between within group changes.
Figuras y tablas -
Analysis 6.7

Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 7 pain: difference between within group changes.

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).
Figuras y tablas -
Analysis 7.1

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 2 Improvement (higher values are better).
Figuras y tablas -
Analysis 7.2

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 2 Improvement (higher values are better).

Study

Improvement

Technique 1: Regular

Technique 2: Ancient

p value

Immediately after the end of the sessions

Ding 1998

Marked effective

4

8

Ding 1998

Improved

6

3

Ding 1998

No change

5

2

Ding 1998

Short‐term follow‐up (up to 3 months after the end of the sessions)

Ding 1998

Cure

4

22

Chi‐square=12.44
p<0.01

Ding 1998

Marked effective

4

8

Ding 1998

Improved

6

3

Ding 1998

No change

5

2

Figuras y tablas -
Analysis 7.3

Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 3 improvement.

Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 1 global measure (higher values are better).
Figuras y tablas -
Analysis 8.1

Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 1 global measure (higher values are better).

Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 2 Side effects / Complications.
Figuras y tablas -
Analysis 8.2

Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 2 Side effects / Complications.

Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 1 pain (VAS): lower values are better.
Figuras y tablas -
Analysis 9.1

Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 1 pain (VAS): lower values are better.

Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 2 global measure.
Figuras y tablas -
Analysis 9.2

Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 2 global measure.

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 1 pain score (lower values mean better).
Figuras y tablas -
Analysis 10.1

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 1 pain score (lower values mean better).

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 2 pain recovery: higher values are better.
Figuras y tablas -
Analysis 10.2

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 2 pain recovery: higher values are better.

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).
Figuras y tablas -
Analysis 10.3

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 4 back specific functional status (higher scores are better). Ex: Japan Orthopedic Association Score..
Figuras y tablas -
Analysis 10.4

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 4 back specific functional status (higher scores are better). Ex: Japan Orthopedic Association Score..

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 5 Side effects / Complications.
Figuras y tablas -
Analysis 10.5

Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 5 Side effects / Complications.

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 1 pain (lower values are better).
Figuras y tablas -
Analysis 11.1

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 1 pain (lower values are better).

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 2 pain recovery (higher values are better).
Figuras y tablas -
Analysis 11.2

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 2 pain recovery (higher values are better).

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).
Figuras y tablas -
Analysis 11.3

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 4 functional status (higher values are better).
Figuras y tablas -
Analysis 11.4

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 4 functional status (higher values are better).

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 5 physical examination (finger‐floor distance) Higher values are better..
Figuras y tablas -
Analysis 11.5

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 5 physical examination (finger‐floor distance) Higher values are better..

Study

Improvement

Technique 1: Ac+cupp

Technique 2: Acup

p value

Long‐term follow‐up (more than 1 year)

Li 1997

Cure

33

22

<0.01

Li 1997

Marked effective

32

28

Li 1997

Improved

13

26

Li 1997

No change

0

2

Figuras y tablas -
Analysis 11.6

Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 6 improvement.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).
Figuras y tablas -
Analysis 12.1

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 2 pain: difference between within group changes.
Figuras y tablas -
Analysis 12.2

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 2 pain: difference between within group changes.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).
Figuras y tablas -
Analysis 12.3

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 4 Pain: percentage of patients with >50% pain reduction.
Figuras y tablas -
Analysis 12.4

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 4 Pain: percentage of patients with >50% pain reduction.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 5 function: difference between within group changes.
Figuras y tablas -
Analysis 12.5

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 5 function: difference between within group changes.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 6 global measure.
Figuras y tablas -
Analysis 12.6

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 6 global measure.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 7 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen.
Figuras y tablas -
Analysis 12.7

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 7 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 8 spine range of motion: difference between within group changes.
Figuras y tablas -
Analysis 12.8

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 8 spine range of motion: difference between within group changes.

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 9 Side effects / Complications.
Figuras y tablas -
Analysis 12.9

Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 9 Side effects / Complications.

Table 1. Criteria for the Risk of Bias Assessment

Criteria

Operationalization

A. Was the method of randomization adequate?

A. A random (unpredictable) assignment sequence. Examples of adequate methods are computer generated random number table and use of sealed opaque envelopes. Methods of allocation using date of birth, date of admission, hospital numbers, or alternation should not be regarded as appropriate.

B. Was the treatment allocation concealed?

B. Assignment generated by an independent person not responsible for determining the eligibility of the patients. This person has no information about the persons included in the trial and has no influence on the assignment sequence or on the decision about eligibility of the patient.

C. Were the groups similar at baseline regarding the most important prognostic indicators?

C. In order to receive a "yes," groups have to be similar at baseline regarding demographic factors, duration and severity of complaints, percentage of patients with neurologic symptoms, and value of main outcome measure(s).

D. Was the patient blinded to the intervention?

D. The reviewer determines if enough information about the blinding is given in order to score a "yes."

E. Was the care provider blinded to the intervention?

E. The reviewer determines if enough information about the blinding is given in order to score a "yes."

F. Was the outcome assessor blinded to the intervention?

F. The reviewer determines if enough information about the blinding is given in order to score a "yes."

G. Were cointerventions avoided or similar?

G. Cointerventions should either be avoided in the trial design or similar between the index and control groups.

H. Was the compliance acceptable in all groups?

H. The reviewer determines if the compliance to the interventions is acceptable, based on the reported intensity, duration, number and frequency of sessions for both the index intervention and control intervention(s).

I. Was the drop‐out rate described and acceptable?

I. The number of participants who were included in the study but did not complete the observation period or were not included in the analysis must be described and reasons given. If the percentage of withdrawals and drop‐outs does not exceed 20% for immediate and short‐term follow‐ups, 30% for intermediate and long‐term follow‐ups and does not lead to substantial bias a "yes" is scored.

J. Was the timing of the outcome assessment in all groups similar?

J. Timing of outcome assessment should be identical for all intervention groups and for all important outcome assessments.

K. Did the analysis include an intention‐to‐treat analysis?

K. All randomized patients are reported/analyzed in the group they were allocated to by randomization for the most important moments of effect measurement (minus missing values) irrespective of noncompliance and cointerventions.

Figuras y tablas -
Table 1. Criteria for the Risk of Bias Assessment
Table 2. Methodological quality assessment

Study

A and B

C

D, E and F

G

H

I

J

K

Comments, flaws, etc

Araki 2001

Y and Y

Y

Y, N, Y

Y

Y

Y

Y

Y

Score=10 and no serious flaws (High)

Carlsson 2001

Y and Y

DK

Y, N, Y

DK

DK

Y (1 month); N (3 and 6 months)

Y

Y

Score=7 at 1 month (follow‐up=100%), Score=6 at 3 and 6 months (follow‐up=64% and 54% respectively) (High)

Ceccherelli 2002

Y and DK

Y

DK, N, Y

DK

DK

Y

Y

Y

Score=6. No serious flaws. (High)

Cherkin 2001

Y and DK

Y

N, N, Y

Y

Y

Y

Y

Y

Score=8. No serious flaws (High)

Coan 1980

Y and Y

DK

N, N, N

DK

N

N

N

N

Score=2 (Low)

Ding 1998

DK and N

DK

Y, N, N

DK

DK

Y

Y

N

Score=3 (Low). Main outcome is very subjective.

Edelist 1976

DK and DK

DK

Y, N, Y

DK

Y

DK

DK

DK

Score=3 (Low). Main outcome is a subjective measure. Methods poorly described.

Garvey 1989

Y and DK

DK

Y, N, Y

Y

Y

Y

Y

Y

Score=8. No serious flaws (High). Baseline characteristics are not shown. Groups are very different in size.

Giles 1999

DK and Y

DK

N, N, Y

DK

N

N

Y

N

Fatal flaw= 52% drop out during treatment period in the acupuncture group.

Giles 2003

Y and Y

Y

N, N, DK

Y

DK

N

Y

Y

Score=6. 39% drop out at 9‐weeks (Low). No adjustment for multiple comparisons

Grant 1999

Y and Y

N

N, N, Y

Y

DK

Y

Y

N

Fatal flaw= baseline differences in main outcome measures. VAS (range 0‐200) at baseline in acup group was 140 and in the TENS group was 101.

Gunn 1980

N and DK

DK

N, N, DK

DK

DK

Y

N

N

Score=1 (Low). Allocation by alternation and not concealed. No mention of blinded assessments. We don't have baseline values for pain. Co‐interventions were allowed and not standardized or monitored. No ITT: this is not a big problem for the 12‐week follow‐up, but maybe for the longer term follow‐up

He 1997

DK and N

Y

Y, N, N

DK

DK

N

Y

DK

Score=3 (Low). No information about allocation of patients. No description of lost patients.

Inoue 2000

Y and Y

DK

Y,N, Y

Y

Y

Y

Y

Y

Score=9 (High). We believe there were no losses because the follow‐up was shortly after the single session.

Inoue 2001

Y and Y

DK

Y,N,Y

Y

Y

Y

Y

Y

Score=9 (High). We believe there were no losses because the follow‐up was shortly after the single session.

Kerr 2003

Y and DK

DK

Y,N,Y

DK

DK

N

Y

N

Score=4 (Low). Co‐interventions might have influenced the results. Patients followed: 76% in the short and 66.7% in the intermediate follow‐ups.

Kittang 2001

N and DK

N

DK,DK,Y

Y

Y

Y

Y

Y

Score=6. No serious flaws (High). Baseline differences in three factors (days of sick leave previous year, previous attendance at back schools and use of pain killers)

Kurosu 1979(a); Kurosu 1979(b)

DK and DK

DK

N, N, DK

DK

Y

DK

Y

DK

Score=2 (Low)

Lehmann 1986

DK and DK

DK

N, N, N

Y

DK

N

Y

N

Score=2 (Low). Follow‐up: 77% immediately after and 61% after 6 months.

Leibing 2002

Y and Y

Y

Y,N, Y

Y

DK

N

Y

DK

Score=7 (High) However, drop‐out rate: 24% in the short and 37% in the long‐term

Li 1997

DK and N

DK

Y, N, N

DK

DK

N

Y

DK

Score=2 (Low) No information about allocation of patients. No description of lost patients.

Lopacz 1979

DK and DK

DK

N, N, N

Y

DK

Y

Y

Y

Score=4 (Low). No information about randomisation and not blinded.

MacDonald 1983

DK and DK

Y

Y, N, DK

DK

DK

Y

DK

Y

Score=4 (Low). No information about randomisation and timing of follow‐up measures

Mendelson 1983

DK and DK

Y

Y, N, Y

DK

DK

Y

Y

N

Score=5 (Low). Cross over study.

Meng 2003

Y and Y

Y (pain); N (Roland)

N, N, N

Y

DK

Y

Y

Y

Score=7 (small difference in baseline in pain outcomes). Score= 6 (important baseline difference in RDQ (acupuncture group: 9.8 and control group: 11.8). (High)

Molsberger 2002

Y and Y

Y

Y, N, Y

DK

Y

Y (immed), N (short)

Y

Y

Score=9 (immediately after) and Score=8 (short‐term: drop‐out rate at 3 months was 34%) (High). Blinding was between verum and sham acupuncture, but not between verum and nothing.

Sakai 1998

DK and DK

N

N,N,DK

DK

DK

N

N

DK

Score=0 (Low). Methods poorly described. A statistically significant difference was observed in disability score at baseline. ADL was 7.6 in acupuncture group and 10.3 in medication group. Other parameters such as subjective symptom of pain, JOA score, duration of pain, gender were not statistically different at baseline.

Sakai 2001

Y and Y

Y

N,N, Y

Y

Y

Y

Y

N

Score=8. No serious flaws (High)

Takeda 2001

Y and DK

DK

Y,N,N

DK

Y

Y

Y

DK

Score=5 (Low)

Thomas 1994

DK and DK

Y

N,N, DK

N

Y

DK

Y

Y

Score=4 (Low). We get different results when we re‐analysed using the data from the figures.

Tsukayama 2002

Y and Y

Y

N, N, Y

Y

Y

Y

Y

Y

Score=9. No serious flaws (High). Outcome assessor was blinded, but patient was not. So it is possible that the blindness was broken, especially because the outcomes are subjective.

Von Mencke 1988

DK and DK

DK

Y, N, Y

N

N

N

N

N

Score=2 (Low)

Wang 1996

DK and N

DK

Y, N, N

DK

N

N

DK

DK

Score=1 (Low). Not adequately randomised. Doubts about reliability of outcome measures

Wu 1991

N and N

DK

Y,N,N

DK

Y

N

Y

DK

Score=3 (Low). Not adequately randomised. Doubts about reliability of outcome measures

Yeung 2003

DK and Y

Y

N, N, Y

Y

Y

Y

Y

Y

Score=8. No serious flaws (High). Outcome assessor was blinded, but patient was not. So it is possible that the blindness was broken, especially because the outcomes are subjective. One of the few studies that adjusted for confounders in the analysis, but small sample size and did not account for attention effects.

Total "Yes"

17 14

14

18, 0, 19

15

15

20

28

16

Total "No"

3 5

3

15, 34, 10

2

3

12

4

10

Total "DK"

15 16

18

2, 1, 6

18

17

3

3

9

Figuras y tablas -
Table 2. Methodological quality assessment
Table 3. Clinical relevance assessment

Study

Patients

Interventions

Relevant outcomes

Size of effect

Benefits and harms

Serious deficiencies?

Araki 2001

N

Y

Y

DK

DK

Population is poorly described. Power to detect a difference (alpha 0.05, 2‐tailed) in pain is 12% and in function is 5.1%.

Carlsson 2001

Y

Y

Y

Y

Y

Ceccherelli 2002

Y

Y

N

DK

DK

Cherkin 2001

Y

N

Y

DK

Y

Intervention is individualized to each patient. Pragmatic trial.

Coan 1980

Y

N

Y

Y

DK

Intervention is poorly described

Ding 1998

Y

N

Y

Y

Y

The strong and deep needling technique may not be practical for all acupuncture settings.

Edelist 1976

N

Y

N

N

DK

Irrelevant outcomes.

Garvey 1989

N

Y

N

Y

N

Benefists do not seem to be worth the harms

Giles 1999

N

N

Y

Y

DK

Patients and interventions are poorly described

Giles 2003

N

Y

Y

DK

DK

Difficult to interpret results due to nature of data presentation. No follow‐up beyond 9 weeks.

Grant 1999

N

N

Y

N

N

Population and interventions are poorly described

Gunn 1980

Y

N

N

Y

DK

We don't know how co‐interventions were applied. We don't have a separate measure for pain.

He 1997

Y

N

Y

Y

DK

No description of acupuncture points used. Not sure about validity/reliability of outcome measure.

Inoue 2000

N

Y

DK

N

DK

Inoue 2001

N

Y

DK

Y

Y

Kerr 2003

N

Y

Y

N

DK

No clinically important effects detected in this study

Kittang 2001

Y

N

Y

N

DK

Kurosu 1979(a); Kurosu 1979(b)

N

Y

N

DK

DK

Li 1997

Y

N

Y

Y

DK

No description of acupuncture points used. Not sure about validity/reliability of outcome measure.

Lehmann 1986

N

N

N

DK

Y

No description of acupuncture points used. Teh Chi unclear.

Leibing 2002

Y

Y

Y

DK

N

Lopacz 1979

N

N

N

DK

DK

Poor description of patients and interventions.

MacDonald 1983

Y

Y

Y

Y

DK

It is not meridian acupuncture and the depth is too superficial. Very small sample size

Mendelson 1983

Y

Y

Y

N

DK

Meng 2003

Y

Y

Y

DK

DK

Size of effect might be biased by small sample size. Harms were assessed, but should be evaluated in larger sample.

Molsberger 2002

Y

Y

Y

Y

DK

Sakai 1998

Y

N

Y

DK

DK

Not sure about validity of JOA score. Number of points and sessions too small.

Sakai 2001

Y

Y

Y

N

DK

Not sure about validity of JOA score. Number of points and sessions too small.

Takeda 2001

N

Y

Y

N

DK

Thomas 1994

N

Y

Y

N

DK

Tsukayama 2002

Y

Y

Y

DK

N

Von Mencke 1988

Y

Y

Y

Y

DK

Teh Chi unclear.

Wang 1996

Y

Y

Y

Y

Y

Wu 1991

Y

Y

Y

Y

Y

Yeung 2003

Y

Y

Y

Y

Y

Figuras y tablas -
Table 3. Clinical relevance assessment
Table 4. Improvement in pain

Comparison group

Acute

Chronic

Unknown / Mixed

Acupuncture

Number of studies

2

16

8

Average improvement

52%

32%

51%

Standard deviation

39%

24%

19%

Minimum

25%

‐17%

22%

Maximum

80%

62%

77%

No treatment

Number of studies

6

Average improvement

6%

Standard deviation

25%

Minimum

‐33%

Maximum

42%

Sham / placebo

Number of studies

1

6

3

Average improvement

22%

23%

25%

Standard deviation

22%

17%

Minimum

‐19%

6%

Maximum

44%

37%

Other treatments

Number of studies

1

6

3

Average improvement

79%

25%

99%

Standard deviation

19%

73%

Minimum

0%

41%

Maximum

50%

181%

Figuras y tablas -
Table 4. Improvement in pain
Table 5. Adequacy of acupuncture

Study

Choice of acupoints

Number of sessions

Needling technique

Experience

Control group

Comments

Araki 2001

Adequate because this is acute low‐back pain

Adequate because it is acute low‐back pain

Adequate

Adequate

Appropriate sham acupuncture

But there is no description about credibility of sham acupuncture.

Carlsson 2001

Adequate

Adequate

Adequate

Adequate

Adequate sham TENS

The authors also compared needle acupuncture with electroacupuncture.

Ceccherelli 2002

Adequate

Adequate

Adequate for the purpose of the study, which was to compare two techniques of acupuncture.

Not reported

Other acupuncture technique

Cherkin 2001

Individualized points.

Adequate

TCM typically with Teh Chi

Adequate

Other common therapies.

Coan 1980

Not reported

Adequate

Not reported

Not reported

Waiting list. No treatment

Poorly reported, but seems OK (published in 1980).

Ding 1998

Adequate

Adequate

Adequate

Adequate

Other acupuncture technique

Edelist 1976

Adequate

Few sessions

Adequate

Not reported

Sham acupuncture (but may have some analgesic effect)

The control group used needles placed in areas devoid of classic acupuncture points.

Garvey 1989 (dry needling)

Adequate (dry‐needling)

Adequate

Not reported

Not reported

Three common treatments

Giles 1999

Not reported

Adequate

Not reported.

Adequate

Two common treatments: manipulation and drugs

Giles 2003

Not reported

Adequate

Not reported.

Adequate

Two common treatments: manipulation and drugs

Grant 1999

Individualized points.

Adequate

Not reported.

Not reported

Another common treatment: TENS

Gunn 1980 (dry needling)

Muscle motor points. Not adequate for dry needling.

Adequate

Adequate

Not reported

Standar therapy: physiotherapy, remedial exercises, occupational therapy, industrial assessment.

He 1997

Adequate

Adequate

Adequate

Not reported

Chinese herbs.

No information about which herbs were used.

Inoue 2000

Adequate

Adequate for the purpose of the study.

Not reported

Adequate

Sham acupuncture

But there is no description about credibility of sham acupuncture.

Inoue 2001

Adequate (non meridian)

Adequate for the purpose of the study

Not reported

Not reported

Sham acupuncture

But there is no description about credibility of sham acupuncture.

Kerr 2003

Adequate

Adequate

Adequate

Not reported

Sham TENS

Kittang 2001

Seems adequate

Not reported

Not reported

Not reported

Naproxen: adequate dose and duration of treatment

Kurosu 1979(a)

Adequate

Adequate for the purpose of the study.

Adequate

Not reported

Garlic moxibustion may be adequate treatment for LBP in some cases

Kurosu 1979(b)

Adequate

Adequate for the purpose of the study.

Adequate

Not reported

Other acupuncture technique (needle insertion and no retention)

Lehmann 1986

Choice of meridians is OK

Adequate

Adequate

Adequate

Sham TENS

Leibing 2002

Adequate

Adequate

Adequate

Adequate

Sham acupuncture

Li 1997

Adequate

Adequate

Adequate

Not reported

Manual acupuncture without cupping.

Lopacz 1979

Not reported

Adequate

Not reported

Not reported

Placebo: to control for attention effect.

MacDonald 1983

Adequate (not meridian)

Adequate

Adequate for the purpose of the study

Not reported

Sham TENS.

It is easy for patients to perceive that they were receiving different treatments.

Mendelson 1983

Adequate

Adequate

Adequate

Adequate

Maybe not adequate placebo. May have some analgesic effect.

Meng 2003

Adequate

Adequate

Adequate

Adequate

Standard therapy

Molsberger 2002

Adequate

Adequate

Adequate

Adequate

Sham acupuncture: good placebo.

Sakai 1998

Adequate

Adequate for the purpose of the study

Not reported

Not reported

Medication

Sakai 2001

Adequate (not meridian)

Adequate for the purpose of the study

Not reported

Not reported

TENS: seems adequate.

But number of sessions too small.

Takeda 2001

Adequate for the purpose of the study

Adequate

Not reported

Not reported

Other acupuncture technique: local versus distal points.

But there is no description about credibility of sham acupuncture.

Thomas 1994

Adequate

Adequate

Adequate

Adequate

No treatment

Tsukayama 2002

Adequate

Adequate for the purpose of the study

Adequate

Not reported

TENS

but number of sessions too small.

Von Mencke 1988

Adequate

Adequate

Adequate

Not reported

Sham acupuncture

Wang 1996

Adequate

Adequate

Adequate

Adequate

Active acupuncture: distal points

Wu 1991

Adequate (for acute LBP)

Adequate (single session for acute LBP)

Adequate

Adequate

Another active acupuncture treatment

Yeung 2003

Adequate

Adequate for the purpose of the study

Adequate

Adequate

Physiotherapy (standard exercises)

Patients in the exercise group did not receive the same attention as in the acupuncture group.

Figuras y tablas -
Table 5. Adequacy of acupuncture
Comparison 1. acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (VAS) (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Immediately after end of sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 functional status (higher scores are better). Generic instrument Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 physical examination: finger‐floor distance (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 mean difference in pain (final ‐ initial) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Immediately after end of sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 mean difference in functional status (final ‐ initial) Generic instrument Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 mean difference in physical examination (final ‐ initial): finger‐floor distance Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

6.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 1. acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months)
Comparison 2. acupuncture versus other intervention ((Sub)acute LBP: < 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (VAS): lower values are better Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 global measure (higher values are better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Long‐term follow‐up (more than 1 year)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 physical examination (finger floor distance) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Side effects / Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 2. acupuncture versus other intervention ((Sub)acute LBP: < 3 months)
Comparison 3. acupuncture versus acupuncture. ((Sub)acute LBP: < 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 global measure Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Immediately after the end of the sessions

2

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 3. acupuncture versus acupuncture. ((Sub)acute LBP: < 3 months)
Comparison 4. acupuncture versus no treatment. (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (instruments: VAS and number of words) Show forest plot

2

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

90

Std. Mean Difference (IV, Random, 95% CI)

‐0.73 [‐1.19, ‐0.28]

1.2 Intermediate‐term follow‐up (3 months to 1 year)

1

40

Std. Mean Difference (IV, Random, 95% CI)

‐0.78 [‐1.52, ‐0.04]

2 global measure (improvement) Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 functional status (higher values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 limitation of activity (higher values are worse) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 functional status (standardized measures) Show forest plot

2

Effect size (Random, 95% CI)

Subtotals only

5.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

90

Effect size (Random, 95% CI)

0.63 [0.19, 1.08]

5.2 Intermediate‐term follow‐up (3 months to 1 year)

1

40

Effect size (Random, 95% CI)

0.03 [‐0.70, 0.76]

Figuras y tablas -
Comparison 4. acupuncture versus no treatment. (Chronic LBP: > 3 months)
Comparison 5. acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values mean better) Show forest plot

5

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Immediately after the end of the sessions

4

314

Mean Difference (IV, Random, 95% CI)

‐10.21 [‐14.99, ‐5.44]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

138

Mean Difference (IV, Random, 95% CI)

‐17.79 [‐25.50, ‐10.07]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

2

96

Mean Difference (IV, Random, 95% CI)

‐5.74 [‐14.72, 3.25]

1.4 Long‐term follow‐up (more than 1 year)

1

27

Mean Difference (IV, Random, 95% CI)

‐12.0 [‐41.83, 17.83]

2 global improvement (higher values are better) Show forest plot

6

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

2.1 Immediately after the end of the sessions

3

234

Risk Ratio (M‐H, Random, 95% CI)

1.23 [1.04, 1.46]

2.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

3

171

Risk Ratio (M‐H, Random, 95% CI)

1.44 [0.92, 2.24]

2.3 Intermediate‐term follow‐up (3 months to 1 year)

1

40

Risk Ratio (M‐H, Random, 95% CI)

1.19 [0.89, 1.60]

2.4 Long‐term follow‐up (more than 1 year)

1

50

Risk Ratio (M‐H, Random, 95% CI)

3.29 [0.85, 12.80]

3 pain disability index (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 physical examination (fingertips‐to‐floor distance).( Lower values are better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

4.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

5 improvement in physical examination Show forest plot

1

Odds Ratio (M‐H, Random, 95% CI)

Totals not selected

5.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Odds Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6 Sick leave (higher values mean worse) Show forest plot

2

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

6.1 Intermediate‐term follow‐up (3 months to 1 year)

2

58

Risk Ratio (M‐H, Random, 95% CI)

0.58 [0.22, 1.54]

7 Well being (SF‐36). (Higher values are better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

7.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

8 Side effects / Complications Show forest plot

3

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

8.1 Immediately after the end of the sessions

2

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Intermediate‐term follow‐up (3 months to 1 year)

2

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

9 pain (percent of baseline values) Show forest plot

Other data

No numeric data

9.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

Other data

No numeric data

9.2 Intermediate‐term follow‐up (3 months to 1 year)

Other data

No numeric data

9.3 Long‐term follow‐up (more than 1 year)

Other data

No numeric data

10 sick leave Show forest plot

Other data

No numeric data

10.1 Long‐term follow‐up

Other data

No numeric data

11 general level of pain (0‐15 points)(more points mean less pain) Show forest plot

Other data

No numeric data

11.1 Immediately after the end of the sessions

Other data

No numeric data

11.2 Intermediate‐term follow‐up (3 months to 1 year)

Other data

No numeric data

12 pain: difference between within group changes Show forest plot

1

differences between (Random, 95% CI)

Totals not selected

12.1 Immediately after the end of the sessions

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

12.2 Intermediate‐term follow‐up (3 months to 1 year)

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

13 function: difference between within group changes Show forest plot

1

differences between (Random, 95% CI)

Totals not selected

13.1 Immediately after the end of the sessions

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

13.2 Intermediate‐term follow‐up (3 months to 1 year)

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

14 Pain: percentage of patients with >50% pain reduction Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

14.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

14.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

15 spine range of motion: difference between within group changes Show forest plot

1

difference between (Random, 95% CI)

Totals not selected

15.1 Immediately after the end of the sessions

1

difference between (Random, 95% CI)

0.0 [0.0, 0.0]

15.2 Intermediate‐term follow‐up (3 months to 1 year)

1

difference between (Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 5. acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months)
Comparison 6. acupuncture versus other intervention. (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values are better) Show forest plot

7

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Immediately after the end of the sessions

5

284

Std. Mean Difference (IV, Random, 95% CI)

0.48 [0.21, 0.75]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

356

Std. Mean Difference (IV, Random, 95% CI)

‐0.19 [‐2.74, 2.36]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

2

356

Std. Mean Difference (IV, Random, 95% CI)

2.48 [1.02, 3.94]

2 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen Show forest plot

6

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Immediately after the end of the sessions

4

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2.3 Intermediate‐term follow‐up (3 months to 1 year)

2

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 return to work (higher values mean better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3.1 Intermediate‐term follow‐up (3 months to 1 year)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 Side effects / Complications Show forest plot

7

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

4.1 Immediately after the end of the sessions

4

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.3 Intermediate‐term follow‐up (3 months to 1 year)

3

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 pain and function (adjusted for baseline values) Show forest plot

Other data

No numeric data

5.1 Immediately after the end of the sessions

Other data

No numeric data

5.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

Other data

No numeric data

5.3 Intermediate‐term follow‐up (3 months to 1 year)

Other data

No numeric data

6 general level of pain (0‐15 points)(more points mean less pain) Show forest plot

Other data

No numeric data

6.1 Immediately after the end of the sessions

Other data

No numeric data

6.2 Intermediate‐term follow‐up (3 months to 1 year)

Other data

No numeric data

7 pain: difference between within group changes Show forest plot

1

differences between (Random, 95% CI)

Totals not selected

7.1 Immediately after the end of the sessions

1

differences between (Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 6. acupuncture versus other intervention. (Chronic LBP: > 3 months)
Comparison 7. acupuncture versus acupuncture. (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values mean better) Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

1.1 Immediately after the end of the sessions

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

2 Improvement (higher values are better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2.2 Intermediate‐term follow‐up (3 months to 1 year)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

3 improvement Show forest plot

Other data

No numeric data

3.1 Immediately after the end of the sessions

Other data

No numeric data

3.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

Other data

No numeric data

Figuras y tablas -
Comparison 7. acupuncture versus acupuncture. (Chronic LBP: > 3 months)
Comparison 8. dry‐needling versus other intervention ((Sub)acute LBP < 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 global measure (higher values are better) Show forest plot

4

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

1.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

4

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

2 Side effects / Complications Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 8. dry‐needling versus other intervention ((Sub)acute LBP < 3 months)
Comparison 9. acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (VAS): lower values are better Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Short term (immediately after end of sessions)

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 global measure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

2.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 9. acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain)
Comparison 10. acupuncture versus other intervention (unknown / mixed duration of low back pain)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain score (lower values mean better) Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Immediately after the end of the sessions

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 pain recovery: higher values are better Show forest plot

1

Std. Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Immediately after the end of the sessions

1

Std. Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 global measure (higher values are better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 back specific functional status (higher scores are better). Ex: Japan Orthopedic Association Score. Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Immediately after the end of the sessions

2

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 Side effects / Complications Show forest plot

1

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

5.1 Immediately after the end of the sessions

1

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 10. acupuncture versus other intervention (unknown / mixed duration of low back pain)
Comparison 11. acupuncture versus acupuncture. (unknown / mixed duration of low back pain)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

1.1 Short term (immediately after end of sessions)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

2 pain recovery (higher values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

2.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3 global measure (higher values are better) Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

3.1 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4 functional status (higher values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

4.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

5 physical examination (finger‐floor distance) Higher values are better. Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

6 improvement Show forest plot

Other data

No numeric data

6.1 Long‐term follow‐up (more than 1 year)

Other data

No numeric data

Figuras y tablas -
Comparison 11. acupuncture versus acupuncture. (unknown / mixed duration of low back pain)
Comparison 12. acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months)

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 pain (lower values are better) Show forest plot

4

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Immediately after the end of the sessions

4

289

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.02, ‐0.50]

1.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

3

182

Std. Mean Difference (IV, Random, 95% CI)

‐1.10 [‐1.62, ‐0.58]

1.3 Intermediate‐term follow‐up (3 months to 1 year)

2

115

Std. Mean Difference (IV, Random, 95% CI)

‐0.76 [‐1.14, ‐0.38]

2 pain: difference between within group changes Show forest plot

2

differences between (Random, 95% CI)

Subtotals only

2.1 Immediately after the end of the sessions

2

differences between (Random, 95% CI)

‐1.07 [‐2.14, ‐0.00]

2.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

differences between (Random, 95% CI)

‐0.7 [‐1.33, ‐0.07]

2.3 Intermediate‐term follow‐up (3 months to 1 year)

1

differences between (Random, 95% CI)

‐0.8 [‐1.80, 0.20]

3 pain disability index (lower values are better) Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

3.1 Immediately after the end of the sessions

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

3.2 Intermediate‐term follow‐up (3 months to 1 year)

1

Mean Difference (IV, Random, 95% CI)

0.0 [0.0, 0.0]

4 Pain: percentage of patients with >50% pain reduction Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

4.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

4.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

5 function: difference between within group changes Show forest plot

2

differences between (Random, 95% CI)

Subtotals only

5.1 Immediately after the end of the sessions

2

differences between (Random, 95% CI)

‐6.51 [‐14.99, 1.98]

5.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

differences between (Random, 95% CI)

‐3.1 [‐5.26, ‐0.94]

5.3 Intermediate‐term follow‐up (3 months to 1 year)

1

differences between (Random, 95% CI)

‐6.8 [‐12.60, 1.00]

6 global measure Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Totals not selected

6.1 Immediately after the end of the sessions

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

6.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

1

Risk Ratio (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

7 back specific functional status (lower scores mean better). Ex: RDQ, Oswestry and Aberdeen Show forest plot

3

Std. Mean Difference (IV, Random, 95% CI)

Subtotals only

7.1 Immediately after the end of the sessions

3

173

Std. Mean Difference (IV, Random, 95% CI)

‐0.95 [‐1.27, ‐0.63]

7.2 Short‐term follow‐up (up to 3 months after the end of the sessions)

2

99

Std. Mean Difference (IV, Random, 95% CI)

‐0.95 [‐1.37, ‐0.54]

7.3 Intermediate‐term follow‐up (3 months to 1 year)

2

115

Std. Mean Difference (IV, Random, 95% CI)

‐0.55 [‐0.92, ‐0.18]

8 spine range of motion: difference between within group changes Show forest plot

1

difference between (Random, 95% CI)

Totals not selected

8.1 Immediately after the end of the sessions

1

difference between (Random, 95% CI)

0.0 [0.0, 0.0]

8.2 Intermediate‐term follow‐up (3 months to 1 year)

1

difference between (Random, 95% CI)

0.0 [0.0, 0.0]

9 Side effects / Complications Show forest plot

2

Risk Difference (M‐H, Random, 95% CI)

Totals not selected

9.1 Immediately after the end of the sessions

2

Risk Difference (M‐H, Random, 95% CI)

0.0 [0.0, 0.0]

Figuras y tablas -
Comparison 12. acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months)