Acupuncture for chronic non-specific low back pain: a systematic review and meta-analysis.

Abstract

Objectives: To assess the effectiveness of acupuncture for chronic non-specific LBP (CNLBP). Methods: We searched CENTRAL, MEDLINE, Embase, Chinese databases, and trial register databases up to April 2017. We only included RCTs. Population: CNLBP. Intervention: acupuncture. Comparator: sham intervention, no treatment, usual care, other active therapies. Outcome: pain, back-specific function status, quality of life, pain disability, global assessment, side effects. Two authors independently screened the studies, assessed the risk of bias and extracted the data. Two acupuncturists assessed the appropriateness of acupuncture treatment respectively. Qualified studies were meta-analyzed using random-effects model in Review Manager 5.3. GRADE approach was adopted to assess the quality of evidence. Results: We included 38 RCTs (7340 participants). A few trials were assessed as inadequacy on acupuncture due to not using commonly treated BL23 and BL25 acupoints, using unrelated Guanyuan acupoint, < 6 sessions, < 15-min duration, and insufficient training hours. Compared to sham intervention, acupuncture alleviated pain more (MD -8.50, 95% CI -13.27 to -3.74) but not in back-specific function at immediate term (SMD -0.07, 95% CI -0.24 to 0.10). Acupuncture was better than no treatment on pain (MD -2.22, 95% CI - 2.85 to -1.58) and function (SMD -0.42, 95% CI -0.49 to -0.34) at immediate term. Acupuncture showed more pain relief (MD -10.26, 95% CI -17.11 to -3.40) and greater function (SMD -0.47, 95% CI -0.77 to - 0.17) than usual care at immediate term. Conclusions: There was low to moderate quality of evidence that acupuncture might alleviate pain but not improve the function at immediate term compared with sham. There was moderate-quality evidence that compared with no treatment acupuncture was able to improve pain and function at immediate term. There was low-quality evidence that acupuncture seemed to slightly improve pain more and was better on function than usual care at immediate term.