Table 17Chronic low back pain: acupuncture

Author, Year, Followup,a Pain Duration, Study QualityInterventionPopulationFunction and Pain OutcomesOther Outcomes

Brinkhaus, 2006a224

4 and 10 months

Duration of pain: 14.7 vs. 13.6 years

Good

A: Needle acupuncture to body acupoints (n=140) 12 sessions over 8 weeks

B: Sham acupuncture (n=70)

A vs. B

Age: 59 vs. 58 years

Female: 64% vs. 75%

Baseline Functional (FFbH-R) score: 57.1 vs. 57.2

Baseline pain (0-100 VAS): 63 vs. 66

Baseline Pain Disability Index (0-70): 28.9 vs. 31.5

A vs. B

4 months

Functional (0-10, FFbH-R 0, higher scores indicate better function): 66.0 vs. 64.1, difference 1.9 (95% CI −4.2 to 8.0)

Number of days with limited function in past 6 months: 40.9 vs. 59.5, difference −18.6 (95% CI −33.3 to −3.9)

Pain (0-100 VAS): 38.4 vs. 42.1, difference −3.8 (95% CI −12.4 to 4.9)

Pain Disability Index (0-70): 19.3 vs. 21.4, difference −2.1 (95% CI −6.3 to 2.1)

10 months

Functional (0-100 FFbH-R): 66.0 vs. 63.1, difference 2.9 (95% CI −3.2 to 9.0)

Number of days with limited function in past 6 months: 42.4 vs. 52.9, difference −10.5 (95% CI −27.0 to 6.1)

Pain (0-100 VAS): 39.2 vs. 44.9, difference −5.7 (95% CI −14.4 to 3.0)

Pain Disability Index: 19.0 vs. 23.0, difference −4.0 (95% CI −8.1 to 0.1)

A vs. B

4 months

SF-36 bodily pain subscale (0-100): 53.6 vs. 49.6, difference 3.9 (95% CI −2.7 to 10.7)

SF-36 PCS (0-100): 39.3 vs. 37.6, difference 1.7 (95% CI −1.3 to 4.7)

SF-36 MCS (0-100): 49.9 vs. 46.8, difference 3.1 (95% CI −0.5 to 6.6)

Allgemaine Depressionssskala (ADS, t standard): 49.7 vs. 50.3, difference −0.6 (95% CI −2.5 to 3.7)

10 months

SF-36 bodily pain subscale: 52.4 vs. 44.0, difference 8.5 (95% CI 1.7 to 15.2)

SF-36 PCS: 38.9 vs. 36.1, difference 2.8 (95% CI −0.2 to 5.7)

SF-36 MCS: 50.5 vs. 47.2, difference 3.3 (95% CI 0.1 to 6.5)

ADS: 48.2 vs. 50.7, difference −2.5 (95% CI −5.3 to 0.4)

Carlsson, 2001225

1, 3, 6 months

Duration of pain: 6 months or longer

Poor

A. Needle acupuncture or electroacupuncture (n=34), 8 sessions over 8 weeks, with followup session at 3 and 6 months

B. Placebo (sham transcutaneous electrical nerve stimulation) (n=16)

A vs. B (NR)

Age: 50 years

Female: 66%

Baseline function: NR

Baseline Pain (0-100 VAS): 57 vs. 46

A vs. B

1 month

Pain (0-100 VAS): 50 vs. 60, P not reported

Global assessment “pain improved”: 47% vs. 13%, RR 3.76 (95% CI 0.98 to 14.4)

3 months

Pain (0-100 VAS): 42 vs. 56, P not reported

Global assessment “pain improved”: 44% vs. 13%, RR 6.87 (95% CI 1.87 to 25.1)

≥6 months outcomes

Pain (0-100 VAS): 41 vs. 50, P not reported

Global assessment “pain improved”: 41% vs. 13%, RR 3.29 (95% CI 0.85 to 12.8)

A vs. B

≥6 months

Analgesic intake (tablets per week): 21.4 vs. 21.5

Work full time: 32% vs. 31%

Cherkin, 2001176

9.5 months

Duration of pain: 3 to 12 months, mean not reported

Fair

A. Needle acupuncture (n=94),10 sessions over 10 weeks

B. Attention control (education) (n=90)

A vs. B

Age: 54 vs. 44 years

Female: 52% vs. 44%

Baseline symptom bothersomeness (0-10): 6.2 vs. 6.1

Baseline modified RDQ (0-23): 12. vs. 12.0

A vs. B

9.5 months

Symptom bothersomeness (0-10): 4.5 vs. 3.8, adjusted p=0.002

Modified RDQ (0-23): 8.0 vs. 6.4, adjusted p=0.05

A vs. B

9.5 months

≥1 work-loss day due to LBP in past month: No difference (data not reported)

Medication use: 51% vs. 62%, p<0.05

Provider visits:1.9 vs. 1.5

LBP medication fills: 4.4 vs. 4.0

Imaging studies: 0.2 vs. 0.1

Cost of services (1998 $): 252 vs. 200

Cherkin, 2009226

4.5 and 10.5 months

Duration of pain: 3 to 12 months, mean not reported

Fair

A. Needle acupuncture (individualized) (n=157), 10 sessions over 7 weeks

B. Needle acupuncture (standardized) (n=158), 10 sessions over 7 weeks

C. Sham acupuncture (n=162)

D. Usual care (n=161)

A vs. B vs. C vs. D

Age: 47 vs. 49 vs. 47 vs. 46 years

Female: 68% vs. 56% vs. 60% vs. 64%

Symptom bothersomeness (0-10): 5.0 vs. 5.0 vs. 4.9 vs. 5.4

Baseline pain (0-10 VAS): 5.0 vs. 5.0 vs. 4.9 vs. 5.3

Baseline modified RDQ (0-23): 10.8 vs. 10.8 vs. 9.8 vs. 11.0

A vs. B

4.5 months

Symptom bothersomeness (0-10): 3.8 (2.5) vs. 3.7 (2.6) vs. 3.5 (2.7) vs. 4.4 (2.6)

≥2 point decrease in symptom bothersomeness: 49% vs. 44% vs. 48% vs. 41%

Modified RDQ (0-23): 6.8 (5.5) vs. 6.7 (5.8) vs. 6.4 (6.0) vs. 8.4 (6.0)

10.5 months

Symptom bothersomeness (0-10): 3.7 (2.6) vs. 3.5 (2.7) vs. 3.4 (2.7) vs. 4.1 (2.6)

≥2 point decrease in symptom bothersomeness: 52% vs. 49% vs. 50% vs. 47%

Modified RDQ (0-23): 6.0 (5.4) vs. 6.0 (5.8) vs. 6.2 (5.8) vs. 7.9 (6.5)

≥3 point decrease on RDQ: 65% vs. 65% vs. 59% vs. 50%

>7 days with cutting down on activities due to LBP in the past month: A, B and C 5-7% vs. D 18%, p=0.0005

A vs. B

10.5 months

SF-36 PCS: No differences, data not provided

SF-36 MCS: No differences, data not provided

Missed work/school for >1 day in past month: A, B and C 5-10% vs. D 16%, p=0.01

Mean total costs of back-related health services: $160-221 across groups, p=0.65

Cho, 2013227

1.5 and 4 months

Duration of pain: 3 months

Fair

A. Needle acupuncture (n=57), 12 sessions over 6 weeks

B. Sham acupuncture (n=59)

A vs. B

Age: 42 vs. 42 years

Female: 83% vs. 86%

Baseline ODI (0-100): 28.2 vs. 24.2

Baseline pain (0-10 VAS): 6.5 vs. 6.4

A vs. B

1.5 months

ODI (0-100): 15.5 vs. 15.5 bothersomeness (0-10 VAS): 2.83 vs. 3.99

Pain (0-10 VAS): 2.78 vs. 4.06

4 months

ODI: 15.3 vs. 15.3

Symptom bothersomeness: 2.85 vs. 3.63

Pain (0-10 VAS): 2.79 vs. 3.52

A vs. B

1.5 months

Beck Depression Inventory (0-63): 6 vs. 7.5

4 months

Beck Depression Inventory: 6 vs. 7

Haake, 2007228

1.5 and 4.5 months

Duration of pain: Mean 8 years

Fair

A. Needle acupuncture (n=387), 10-15 sessions over 5 weeks

B. Sham acupuncture (n=387)

C. Usual care (n=388)

A vs. B vs. C

Age: 50 vs. 49 vs. 51 years

Female: 57% vs. 64% vs. 58%

Baseline Hannover Functional Ability Questionnaire (0-100): 46.3 vs. 46.3 vs. 46.7

Baseline Von Korff Chronic Pain Grade Scale (0-100): 67.7 vs. 67.8 vs. 67.8

A vs. B

1.5 months

Hannover Functional Ability (0-100): 65.4 vs. 61.3 vs. 56.0

Von Korff Chronic Pain Grade Scale (0-100): 45.4 vs. 48.5 vs. 54.8

4.5 months

Hannover Functional Ability (0-100): 66.8 vs. 62.2 vs. 55.7

Von Korff Chronic Pain Grade Scale: 40.2 vs. 43.3 vs. 52.3

A vs. B

1.5 months

SF-12 PCS (0-100): 40.3 vs. 39.2 vs. 36.1

SF-12 MCS (0-100): 50.5 vs. 50.2 vs. 48.6

Treatment response (≥33% improvement in pain or ≥12% improvement in function): 55.0% (213/387) vs. 51.9% (201/387) vs. 41.9% (162/387), RR 1.05 (95% CI 0.93 to 1.21) for A vs. B and RR 1.31 (95% CI 1.13 to 1.52) for A vs. C

4.5 months

SF-12 PCS (0-100): 41.6 vs. 39. vs. 35.8

SF-12 MCS (0-100): 50.7 vs. 50.9 vs. 49.2

Treatment response: 47.6% (184/387) vs. 44.2% (171/387) vs. 27.4% (106/387), RR 1.08 (95% CI 0.92 to 1.25) for A vs. B and RR 1.74 (95% CI 1.43 to 2.11) for A vs. C

Kerr, 2003229

4.5 months

Duration of pain: Mean 86 vs. 73 months

Poor

A. Needle acupuncture (n=26), 6 sessions over 6 weeks

B. Placebo (sham TENS) (n=20)

A vs. B

Age: 43 vs. 43 years

Female: 50% vs. 35%

Baseline function: NR

Baseline pain (0-100 VAS): 79.7 vs. 76

A vs. B

4.5 months

Pain relief “yes”: 91% vs. 75%, RR 1.19 (95% CI 0.89 to 1.60)

NR

Thomas, 2006230

9 and 21 months

Duration of pain: Mean 17 weeks

Fair

A. Needle acupuncture (n=159), 10 sessions over 12 weeks

B. Usual care (n=80)

A vs. B

Age: 42 vs. 44

Female: 62% vs. 58%

Baseline ODI (0-100): 33.7 vs. 31.4

Baseline McGill Present Pain Index (0-5): 2.64 vs. 2.70

A vs. B

9 months

ODI (0-100): 20.6 vs. 19.6, adjusted difference −0.5 (−5.1 to 4.2)

McGill Present Pain Index (0-5): 1.43 vs. 1.53, adjusted difference −0.1 (−0.4 to 0.3)

21 months

ODI: 18.3 vs. 21.0, adjusted difference −3.4 (−7.8 to 1.0)

McGill Present Pain Index: 1.42 (1.1) vs. 1.71, adjusted difference −0.2 (−0.6 to 0.1)

A vs. B

9 months

SF-36 bodily pain (0-100): 64.0 vs. 58.3, adjusted difference 5.6 (95% CI −0.2 to 11.4)

21 months

Used medication for LBP in the past 4 weeks: 40% vs. 59%, difference −19% (−35 to −3), p=0.03

21 months

SF-36 bodily pain: 67.8 vs. 59.5, adjusted difference 8.0 (2.8 to 13.2)

CI = confidence interval; FFbH-R = Funktionsfragebogen Hannover-Rücken (Hannover Functional Ability Questionnaire-back); LBP = low back pain; MCS = Mental Component Summary; NR = not reported; ODI = Oswestry Disability Index; PCS = Physical Component Summary; RDQ = Roland-Morris Disability Questionnaire; RR = Relative risk; SF-36 = Short-Form 36 Questionnaire; TENS = transcutaneous electrical nerve stimulation; VAS = visual analog scale

a

Unless otherwise noted, followup time is calculated from the end of the treatment period

From: Results

Cover of Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update
Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update [Internet].
Comparative Effectiveness Review, No. 227.
Skelly AC, Chou R, Dettori JR, et al.

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