Chronic Lower Back Pain.
Low back pain (LBP) is a common musculoskeletal disorder among adults and approximately 1 in 4 people seek medical attention in a 6-month period. 1 It has been estimated that around 50% of the population will experience LBP by the age of 30, whereas 70% of the population will experience LBP at one point in their adulthood. 1 The majority of symptoms resolve within 1 month, but between 10% and 40% of patients develop chronic symptoms lasting more than 6 weeks.1 In many cases the underlying cause of the pain is unknown, a condition referred to as non-specific chronic low back pain (NSCLBP).
A systematic review published in 2013 concluded: “Acupuncture may be effective for pain and functional limitation in chronic non-specific lower back pain”.1
In 2017, The American College of Physicians updated their clinical practice guidelines, making a strong recommendation for the use of acupuncture in both chronic and acute low back pain.2
Numerous systematic reviews on acupuncture for chronic low back pain have been conducted in USA by the Assessment of Health Research Quality (AHRQ)3, The Institute for Clinical and Economic Review (ICER)4, The American College of Physicians5, in Europe by The European Spine Society6 and in New Zealand by the Accident Compensation Corporation (ACC)7. Acupuncture has been consistently found to improve both pain and function in chronic low back pain, when used either alone or as an adjunct to conventional care. Acupuncture has been found to be a cost-effective treatment option8 and electroacupuncture has been found to be more cost effective than non-steroidal anti-inflammatory medications (NSAIDS).9 Acupuncture may also reduce the need for lumbar surgery.10
The U.S. Centers for Medicare & Medicaid Services is currently conducting a National Coverage Analysis for acupuncture in the treatment of chronic low back pain, to decide whether Medicare should cover acupuncture for chronic low back pain for 16 million US senior citizens. Their research found 8 systematic reviews/ meta-analyses undertaken in the previous five years studying acupuncture for chronic low back pain and all 8 found acupuncture to be effective. 11
1. Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013;38(24):2124-38.
2. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine. 2017;166(7):514-30.
3. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. AHRQ Comparative Effectiveness Reviews. Noninvasive Treatments for Low Back Pain. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016.
4. Institute for Clinical and Economic Review (2017) Cognitive and Mind-Body Therapies for Chronic Low Back and Neck Pain: Effectiveness and Value – Final Evidence Report https://icerreview.org/wpcontent/uploads/2017/03/CTAF_LBNP_Final_Evidence_Report_110617.pdf
5. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Annals of internal medicine. 2017;166(7):493-505.
6. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-803.
7. The International Centre for Allied Health Evidence (2018). Effectiveness and Safety of Acupuncture Interventions for the Treatment of Musculoskeletal Conditions. Technical Report. Prepared for the Accident Compensation Corporation, New Zealand. https://www.acc.co.nz/assets/research/2b0c243f75/acupuncture-musculoskeletal-conditions-review.pdf
8. Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Applied health economics and health policy. 2016.
9. Toroski M, Nikfar S, Mojahedian MM, Ayati MH. Comparison of the Cost-utility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugs in the Treatment of Chronic Low Back Pain. Journal of acupuncture and meridian studies. 2018;11(2):62-6.
10. Koh W, Kang K, Lee YJ, Kim MR, Shin JS, Lee J, et al. Impact of acupuncture treatment on the lumbar surgery rate for low back pain in Korea: A nationwide matched retrospective cohort study. PloS one. 2018;13(6):e0199042.
11. Centers for Medicare & Medicaid Services. Proposed National Coverage Determination for Acupuncture for Chronic Low Back Pain (CAG-00452N) July 15th, 2019. https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=295
Acute Ankle Sprain (in adults).
For the treatment of ankle sprains, acupuncture is used as a stand-alone treatment or a secondary intervention accompanying standard medical treatment (e.g. the PRICE technique or physiotherapy), depending on the clinical situation (Li 2008;Park 2004). Traditional acupuncture is applied according to the various concepts of the balance of Yin and Yang, Qi theory, five element theory, meridian theory and traditional diagnostic methods of oriental medicine (Berman 2010). Recently, acupuncture has been reinterpreted and is used increasingly as ’western medical acupuncture’ this revised technique is based on the knowledge of neurophysiology and scientific methodology (White 2009). Acupuncture is thought to generate analgesic effects through the local, segmental and central regulation of anti-pain mechanisms (White 2008).In addition, it has been suggested that acupuncture modulates the anti-inflammatory response and the recovery of soft tissue injuries (Li 2009;Zhang 2005). In particular, specific manipulation techniques (e.g. the winding of acupuncture needles) may be relevant to the cytoskeletal remodelling of connective tissue fibroblasts, which can contribute to the healing of the ligament injury (Langevin 2002;Langevin 2006).
Park J, Hahn S, Park JY, Park HJ, Lee H. Acupuncture for ankle sprain: systematic review and meta-analysis.
BMC Complement Altern Med. 2013;13:55.
Acute Lower Back Pain.
Acupuncture is one of the most frequently sought complementary and alternative medicine modalities among patients suffering from LBP.7,8
Clinical experience has shown that acute nonspecific LBP, which is mostly diagnosed as acute lumbar sprain, responds rapidly to acupuncture, which achieves alleviation in pain intensity and duration, and also contributes to the prompt return of patients to their normal working activity. Therefore, we decided to critically evaluate the evidence for or against acupuncture for acute LBP, compared with sham acupuncture or other (active) interventions.
Compared with nonsteroidal anti-inflammatory drugs, acupuncture may more effectively improve symptoms of acute LBP. For pain, there exists inconsistent evidence that acupuncture is more effective than medication. Compared with sham acupuncture, acupuncture may more effectively relieve pain but not function/disability. Acupuncture appears to be associated with few side effects.
Low back pain (LBP) refers to spinal and paraspinal symptoms in the lumbosacral region (ie, pain localized below the lowest ribs and above the inferior gluteal folds, with or without leg pain). Acute LBP (LBP) means symptoms have been present for fewer than 4 weeks, or some-times for fewer than 3 months when grouped with subacuteLBP.1
Lee JH, Choi TY, Lee MS, Lee H, Shin BC, Lee H. Acupuncture for acute low back pain: a systematic review. Clin J Pain. 2013 Feb;29(2):172-85.