Meta-Analysis

. 2023 Dec;33(4):661-672.

doi: 10.1007/s10926-023-10125-3. Epub 2023 Nov 22.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults

Hainan Yu¹, Dan Wang¹, Leslie Verville¹, Danielle Southerst¹, André Bussières^{2

3}, Douglas P Gross⁴, Paulo Pereira⁵, Silvano Mior^{1

6}, Andrea C Tricco^{7

8

9}, Christine Cedraschi^{10

11}, Ginny Brunton^{1

12

13}, Margareta Nordin¹⁴, Heather M Shearer^{1

6

15}, Jessica J Wong¹, Gaelan Connell¹, Danny Myrtos¹⁶, Sophia da Silva-Oolup^{17

18}, James J Young^{6

19

20}, Martha Funabashi^{2

6}, Andrew Romanelli¹⁶, Joyce G B Lee⁶, Kent Stuber^{6

21}, Brett Guist¹⁸, Javier Muñoz Laguna^{22

23

24}, Léonie Hofstetter^{22

23

24}, Kent Murnaghan²⁵, Cesar A Hincapié^{26

27

28}, Carol Cancelliere²⁹

Affiliations

¹ Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
² Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
³ School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
⁴ Department of Physical Therapy, University of Alberta, Edmonton, Canada.
⁵ Department of Neurosurgery, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal.
⁶ Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
⁸ Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁹ Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada.
¹⁰ Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland.
¹¹ Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.
¹² EPPI-Centre, UCL Institute of Education, University College London, London, England, UK.
¹³ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
¹⁴ Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, USA.
¹⁵ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
¹⁶ Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada.
¹⁷ Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada.
¹⁸ Department of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada.
¹⁹ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
²⁰ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
²¹ Parker University Research Center, Dallas, USA.
²² EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
²³ Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
²⁴ University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
²⁵ Library and Information Services, Canadian Memorial Chiropractic College, Toronto, Canada.
²⁶ EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland. cesar.hincapie@uzh.ch.
²⁷ Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
²⁸ University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
²⁹ Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. carolina.cancelliere@ontariotechu.ca.

PMID: 37991648
PMCID: PMC10684627
DOI: 10.1007/s10926-023-10125-3

Meta-Analysis

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults

Hainan Yu et al. J Occup Rehabil. 2023 Dec.

. 2023 Dec;33(4):661-672.

doi: 10.1007/s10926-023-10125-3. Epub 2023 Nov 22.

Authors

Affiliations

¹ Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
² Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada.
³ School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
⁴ Department of Physical Therapy, University of Alberta, Edmonton, Canada.
⁵ Department of Neurosurgery, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal.
⁶ Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada.
⁷ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
⁸ Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
⁹ Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada.
¹⁰ Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland.
¹¹ Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.
¹² EPPI-Centre, UCL Institute of Education, University College London, London, England, UK.
¹³ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
¹⁴ Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, USA.
¹⁵ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
¹⁶ Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada.
¹⁷ Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada.
¹⁸ Department of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada.
¹⁹ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
²⁰ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
²¹ Parker University Research Center, Dallas, USA.
²² EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
²³ Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
²⁴ University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
²⁵ Library and Information Services, Canadian Memorial Chiropractic College, Toronto, Canada.
²⁶ EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland. cesar.hincapie@uzh.ch.
²⁷ Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
²⁸ University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
²⁹ Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. carolina.cancelliere@ontariotechu.ca.

PMID: 37991648
PMCID: PMC10684627
DOI: 10.1007/s10926-023-10125-3

Abstract

Purpose: Evaluate benefits and harms of needling therapies (NT) for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.

Methods: Electronic databases were searched for randomized controlled trials (RCTs) assessing NT compared with placebo/sham, usual care, or no intervention (comparing interventions where the attributable effect could be isolated). We conducted meta-analyses where indicated and graded the certainty of evidence.

Results: We screened 1831 citations and 109 full text RCTs, yeilding 37 RCTs. The certainty of evidence was low or very low across all included outcomes. There was little or no difference between NT and comparisons across most outcomes; there may be some benefits for certain outcomes. Compared with sham, NT improved health-related quality of life (HRQoL) (physical) (2 RCTs; SMD = 0.20, 95%CI 0.07; 0.32) at 6 months. Compared with no intervention, NT reduced pain at 2 weeks (21 RCTs; MD = - 1.21, 95%CI - 1.50; - 0.92) and 3 months (9 RCTs; MD = - 1.56, 95%CI - 2.80; - 0.95); and reduced functional limitations at 2 weeks (19 RCTs; SMD = - 1.39, 95%CI - 2.00; - 0.77) and 3 months (8 RCTs; SMD = - 0.57, 95%CI - 0.92; - 0.22). In older adults, NT reduced functional limitations at 2 weeks (SMD = - 1.10, 95%CI - 1.71; - 0.48) and 3 months (SMD = - 1.04, 95%CI - 1.66; - 0.43). Compared with usual care, NT reduced pain (MD = - 1.35, 95%CI - 1.86; - 0.84) and functional limitations (MD = - 2.55, 95%CI - 3.70; - 1.40) at 3 months.

Conclusion: Based on low to very low certainty evidence, adults with CPLBP experienced some benefits in pain, functioning, or HRQoL with NT; however, evidence showed little to no differences for other outcomes.

Keywords: Acupuncture; Dry needling; Function; Low back pain; Meta-analysis; Pain; Systematic review.

PubMed Disclaimer

Conflict of interest statement

All team members provided DOI forms to WHO for evaluation at inception. CC (Carol Cancelliere), LV, DS, HY, GC, JJW, HMS report funding from the Canadian Chiropractic Guideline Initiative. ACT is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis. JJW is funded by a Banting Postdoctoral Fellowship from the Canadian Institutes of Health Research (CIHR). CAH reports grants to the University of Zurich from the Foundation for the Education of Chiropractors in Switzerland, the Swiss National Science Foundation (SNSF), and the European Centre for Chiropractic Research Excellence (ECCRE) outside the submitted work. SM reports grants from the Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, and CIHR outside of submitted work. JJW reports grants from the CIHR and Canadian Chiropractic Research Foundation (paid to university), and travel reimbursement for research meetings from the Chiropractic Academy of Research Leadership outside the submitted work. JML reports a grant from the European Cooperation in Science and Technology (COST) outside the submitted work. AB reports grants from the Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, and Health Canada outside the submitted work. JJY is funded by an Arthritis Society Canada Postdoctoral Training Fellowship, CIHR Fellowship, and grant from the Danish Foundation for Chiropractic Research and Post-graduate Education, all outside the submitted work.

Ethical Approval

Ethical approval was not required for this systematic review of previously published studies.

Figures

**Fig. 1**
Flow diagram of literature search

**Fig. 2**
Needling therapies versus no intervention, and needling therapies versus additional comparison interventions where the attributable effect of could be isolated for pain in the immediate term (closest to 2 weeks); scale range is 0 to 10

**Fig. 3**
Needling therapies versus no intervention, and needling therapies versus additional comparison interventions where the attributable effect could be isolated for pain in the short term (closest to 3 months); scale range is 0 to 10

**Fig. 4**
Needling therapies versus no intervention, and needling therapies versus additional comparison interventions where the attributable effect could be isolated for function in the immediate term (closest to 2 weeks)

See this image and copyright information in PMC

References

1. Lu L, Zhang Y, Tang X, Ge S, Wen H, Zeng J, et al. Evidence on acupuncture therapies is underused in clinical practice and health policy. BMJ. 2022;376:e067475. doi: 10.1136/bmj-2021-067475. - DOI - PMC - PubMed
1. Berman BM, Langevin HM, Witt CM, Dubner R. Acupuncture for chronic low back pain. N Engl J Med. 2010;363(5):454–461. doi: 10.1056/NEJMct0806114. - DOI - PubMed
1. Cabyoglu MT, Ergene N, Tan U. The mechanism of acupuncture and clinical applications. Int J Neurosci. 2006;116(2):115–125. doi: 10.1080/00207450500341472. - DOI - PubMed
1. Dommerholt J. Dry needling in orthpedic physical therapy practice. Orthop Phy Ther Pract. 2004;16(3):15–20.
1. Lao L. Acupuncture techniques and devices. J Altern Complement Med. 1996;2(1):23–25. doi: 10.1089/acm.1996.2.23. - DOI - PubMed

Publication types

Actions
Actions
Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults

Affiliations

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Research Materials