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Meta-Analysis
. 2005 Jan 25;2005(1):CD001351.
doi: 10.1002/14651858.CD001351.pub2.

Acupuncture and dry-needling for low back pain

A D Furlan  1 , M W van Tulder, D C Cherkin, H Tsukayama, L Lao, B W Koes, B M Berman
Affiliations
Meta-Analysis

Acupuncture and dry-needling for low back pain

A D Furlan et al. Cochrane Database Syst Rev. .

Abstract

Background: Although low-back pain is usually a self-limiting and benign disease that tends to improve spontaneously over time, a large variety of therapeutic interventions are available for its treatment.

Objectives: To assess the effects of acupuncture for the treatment of non-specific low-back pain and dry-needling for myofascial pain syndrome in the low-back region.

Search strategy: We updated the searches from 1996 to February 2003 in CENTRAL, MEDLINE, and EMBASE. We also searched the Chinese Cochrane Centre database of clinical trials and Japanese databases to February 2003.

Selection criteria: Randomized trials of acupuncture (that involves needling) for adults with non-specific (sub)acute or chronic low-back pain, or dry-needling for myofascial pain syndrome in the low-back region.

Data collection and analysis: Two reviewers independently assessed methodological quality (using the criteria recommended by the Cochrane Back Review Group) and extracted data. The trials were combined using meta-analyses methods or levels of evidence when the data reported did not allow statistical pooling.

Main results: Thirty-five RCTs were included; 20 were published in English, seven in Japanese, five in Chinese and one each in Norwegian, Polish and German. There were only three trials of acupuncture for acute low-back pain. They did not justify firm conclusions, because of small sample sizes and low methodological quality of the studies. For chronic low-back pain there is evidence of pain relief and functional improvement for acupuncture, compared to no treatment or sham therapy. These effects were only observed immediately after the end of the sessions and at short-term follow-up. There is evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain. No clear recommendations could be made about the most effective acupuncture technique.

Authors' conclusions: The data do not allow firm conclusions about the effectiveness of acupuncture for acute low-back pain. For chronic low-back pain, acupuncture is more effective for pain relief and functional improvement than no treatment or sham treatment immediately after treatment and in the short-term only. Acupuncture is not more effective than other conventional and "alternative" treatments. The data suggest that acupuncture and dry-needling may be useful adjuncts to other therapies for chronic low-back pain. Because most of the studies were of lower methodological quality, there certainly is a further need for higher quality trials in this area.

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Conflict of interest statement

Three coauthors of this review (DC, HT and LXL) are also authors of some included trials. In order to avoid any conflict of interest, they were not involved in the methodological quality assessment or data extraction of their own study.

Figures

1
1
Acupuncture compared to no treatment, placebo or sham therapy
2
2
Acupuncture compared to another intervention or added to other interventions
3
3
Effects of dry‐needling at trigger points
4
4
Comparison between two techniques of acupuncture
1.1
1.1. Analysis
Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS) (lower values are better).
1.2
1.2. Analysis
Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 2 functional status (higher scores are better). Generic instrument.
1.3
1.3. Analysis
Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination: finger‐floor distance (lower values are better).
1.4
1.4. Analysis
Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 4 mean difference in pain (final ‐ initial).
1.5
1.5. Analysis
Comparison 1 acupuncture versus placebo or sham intervention ((Sub)acute LBP: < 3 months), Outcome 5 mean difference in functional status (final ‐ initial) Generic instrument.
1.6
1.6. Analysis
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.
2.1
2.1. Analysis
Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 1 pain (VAS): lower values are better.
2.2
2.2. Analysis
Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 2 global measure (higher values are better).
2.3
2.3. Analysis
Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 3 physical examination (finger floor distance).
2.4
2.4. Analysis
Comparison 2 acupuncture versus other intervention ((Sub)acute LBP: < 3 months), Outcome 4 Side effects / Complications.
3.1
3.1. Analysis
Comparison 3 acupuncture versus acupuncture. ((Sub)acute LBP: < 3 months), Outcome 1 global measure.
4.1
4.1. Analysis
Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 1 pain (instruments: VAS and number of words).
4.2
4.2. Analysis
Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 2 global measure (improvement).
4.3
4.3. Analysis
Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 3 functional status (higher values are better).
4.4
4.4. Analysis
Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 4 limitation of activity (higher values are worse).
4.5
4.5. Analysis
Comparison 4 acupuncture versus no treatment. (Chronic LBP: > 3 months), Outcome 5 functional status (standardized measures).
5.1
5.1. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).
5.2
5.2. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 2 global improvement (higher values are better).
5.3
5.3. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).
5.4
5.4. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 4 physical examination (fingertips‐to‐floor distance).( Lower values are better).
5.5
5.5. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 5 improvement in physical examination.
5.6
5.6. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 6 Sick leave (higher values mean worse).
5.7
5.7. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 7 Well being (SF‐36). (Higher values are better).
5.8
5.8. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 8 Side effects / Complications.
5.12
5.12. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 12 pain: difference between within group changes.
5.13
5.13. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 13 function: difference between within group changes.
5.14
5.14. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 14 Pain: percentage of patients with >50% pain reduction.
5.15
5.15. Analysis
Comparison 5 acupuncture versus placebo or sham intervention (Chronic LBP: > 3 months), Outcome 15 spine range of motion: difference between within group changes.
6.1
6.1. Analysis
Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).
6.2
6.2. Analysis
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.
6.3
6.3. Analysis
Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 3 return to work (higher values mean better).
6.4
6.4. Analysis
Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 4 Side effects / Complications.
6.7
6.7. Analysis
Comparison 6 acupuncture versus other intervention. (Chronic LBP: > 3 months), Outcome 7 pain: difference between within group changes.
7.1
7.1. Analysis
Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 1 pain (lower values mean better).
7.2
7.2. Analysis
Comparison 7 acupuncture versus acupuncture. (Chronic LBP: > 3 months), Outcome 2 Improvement (higher values are better).
8.1
8.1. Analysis
Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 1 global measure (higher values are better).
8.2
8.2. Analysis
Comparison 8 dry‐needling versus other intervention ((Sub)acute LBP < 3 months), Outcome 2 Side effects / Complications.
9.1
9.1. Analysis
Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 1 pain (VAS): lower values are better.
9.2
9.2. Analysis
Comparison 9 acupuncture versus placebo or sham intervention (unknown / mixed duration of low back pain), Outcome 2 global measure.
10.1
10.1. Analysis
Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 1 pain score (lower values mean better).
10.2
10.2. Analysis
Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 2 pain recovery: higher values are better.
10.3
10.3. Analysis
Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).
10.4
10.4. Analysis
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..
10.5
10.5. Analysis
Comparison 10 acupuncture versus other intervention (unknown / mixed duration of low back pain), Outcome 5 Side effects / Complications.
11.1
11.1. Analysis
Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 1 pain (lower values are better).
11.2
11.2. Analysis
Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 2 pain recovery (higher values are better).
11.3
11.3. Analysis
Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 3 global measure (higher values are better).
11.4
11.4. Analysis
Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 4 functional status (higher values are better).
11.5
11.5. Analysis
Comparison 11 acupuncture versus acupuncture. (unknown / mixed duration of low back pain), Outcome 5 physical examination (finger‐floor distance) Higher values are better..
12.1
12.1. Analysis
Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 1 pain (lower values are better).
12.2
12.2. Analysis
Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 2 pain: difference between within group changes.
12.3
12.3. Analysis
Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 3 pain disability index (lower values are better).
12.4
12.4. Analysis
Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 4 Pain: percentage of patients with >50% pain reduction.
12.5
12.5. Analysis
Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 5 function: difference between within group changes.
12.6
12.6. Analysis
Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 6 global measure.
12.7
12.7. Analysis
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.
12.8
12.8. Analysis
Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 8 spine range of motion: difference between within group changes.
12.9
12.9. Analysis
Comparison 12 acupuncture plus intervention versus other intervention alone. (Chronic LBP: > 3 months), Outcome 9 Side effects / Complications.
See this image and copyright information in PMC

Update of

References

References to studies included in this review

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Leibing 2002 {published data only}
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Li 1997 {published data only}
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Tsukayama 2002 {published data only}
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References to studies excluded from this review

Cai 1996 {published data only}
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Duplan 1983 {published data only}
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Galacchi 1981 {published data only}
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Ghia 1976 {published data only}
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Hackett 1988 {published data only}
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Ishimaru 1993 {published data only}
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Junnila 1982 {published data only}
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Kinoshita 1965 {published data only}
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Kinoshita 1971 {published data only}
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Kinoshita 1981 {published data only}
    1. 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: ]
Koike 1975 {published data only}
    1. 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: ]
Kuramoto 1977 {published data only}
    1. 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: ]
Laitinen 1976 {published data only}
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Li 1994 {published data only}
    1. 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: ]
Megumi 1979 {published data only}
    1. 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: ]
Ren 1996 {published data only}
    1. 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}
    1. 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: ]
Sodipo 1981 {published data only}
    1. Sodipo JOA. Transcutaneous electrical nerve stimulation (TENS) and acupuncture: comparison of therapy for low‐back pain. Pain. 1981:S277.
Sugiyama 1984 {published data only}
    1. 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: ]
Wang 1997 {published data only}
    1. 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: ]
Wang 2000 {published data only}
    1. 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. - PubMed
Wedenberg 2000 {published data only}
    1. 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. - PubMed
Xingsheng 1998 {published data only}
    1. 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}
    1. 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}
    1. Yue SJ. Acupuncture for chronic back and neck pain. Acupuncture & Electro‐Therapeut Res Int J 1978;3:323‐24.
Zhang 1995 {published data only}
    1. 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: ]
Zhang 1996 {published data only}
    1. 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: ]
Zhi 1995 {published data only}
    1. 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.

References to ongoing studies

Cherkin {unpublished data only}
    1. Efficacy of Acupuncture for Chronic Low Back Pain. Ongoing study Funding: National Center for Complementary and Alternative Medicine (NCCAM).
GerAc {unpublished data only}
    1. German Acupuncture Trials. Ongoing study Starting date of trial not provided. Contact author for more information.
Harvard Med School {unpublished data only}
    1. Physical CAM Therapies for Chronic Low Back Pain. Ongoing study Funding: NIH.
Kong {unpublished data only}
    1. Ongoing study Starting date of trial not provided. Contact author for more information.
Munglani {unpublished data only}
    1. 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}
    1. Longer term clinical and economic benefits of offering acupuncture to patients with chronic low back pain.. Ongoing study Funding: NHS. - PubMed

Additional references

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