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REVIEW

Meta-Analysis: Acupuncture for Low Back Pain

Eric Manheimer, MS; Adrian White, MD, BM, BCh; Brian Berman, MD; Kelly Forys, MA; and Edzard Ernst, MD, PhD

19 April 2005 | Volume 142 Issue 8 | Pages 651-663

Background: Low back pain limits activity and is the second most frequent reason for physician visits. Previous research shows widespread use of acupuncture for low back pain.

Purpose: To assess acupuncture's effectiveness for treating low back pain.

Data Sources: Randomized, controlled trials were identified through searches of MEDLINE, Cochrane Central, EMBASE, AMED, CINAHL, CISCOM, and GERA databases through August 2004. Additional data sources included previous reviews and personal contacts with colleagues.

Study Selection: Randomized, controlled trials comparing needle acupuncture with sham acupuncture, other sham treatments, no additional treatment, or another active treatment for patients with low back pain.

Data Extraction: Data were dually extracted for the outcomes of pain, functional status, overall improvement, return to work, and analgesic consumption. In addition, study quality was assessed.

Data Synthesis: The 33 randomized, controlled trials that met inclusion criteria were subgrouped according to acute or chronic pain, style of acupuncture, and type of control group used. The principal measure of effect size was the standardized mean difference, since the trials assessed the same outcome but measured it in various ways. For the primary outcome of short-term relief of chronic pain, the meta-analyses showed that acupuncture is significantly more effective than sham treatment (standardized mean difference, 0.54 [95% CI, 0.35 to 0.73]; 7 trials) and no additional treatment (standardized mean difference, 0.69 [CI, 0.40 to 0.98]; 8 trials). For patients with acute low back pain, data are sparse and inconclusive. Data are also insufficient for drawing conclusions about acupuncture's short-term effectiveness compared with most other therapies.

Limitations: The quantity and quality of the included trials varied.

Conclusions: Acupuncture effectively relieves chronic low back pain. No evidence suggests that acupuncture is more effective than other active therapies.

Editors' Notes Context Many people with back pain seek treatment with acupuncture, but the effectiveness of acupuncture for low back pain is controversial. Contribution This meta-analysis of 33 randomized, controlled trials that compared acupuncture with sham, other active, or no treatment found evidence that acupuncture is more effective than sham or no treatment for patients with chronic low back pain. Evidence about acupuncture's effectiveness compared with other active treatments or for patients with acute back pain is inconclusive. Cautions Quality of included trials varied. –The Editors

 

Author and Article Information

From University of Maryland School of Medicine, Center for Integrative Medicine, Baltimore, Maryland, and Peninsula Medical School, Plymouth, United Kingdom.

Disclaimer: The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the National Center for Complementary and Alternative Medicine or the National Institutes of Health.

Acknowledgments: The authors thank M. Romoli for providing the report of Nobili and colleagues (46) and interpreting aspects of the study; H. Yamashita and Y. Mukaino for repeatedly surveying Japanese databases and for extracting data from relevant studies; T. Alraek for extracting data from a study in Norwegian; J. Park and L. Lao for extracting data from a Chinese study; Barbara Wider for advice on several translation problems; Johan Nguyen for providing access to his GERA database and providing some reports; Basia Kielczynska for detailed explanation of the paper by Lopacz in Polish; Heather Dubnick for reviewing and editing the manuscript and providing helpful comments; Aakanksha Khandelwal and Phuong Pham for assisting with data checks; and Tiffanie Sim for assisting with charts.

Grant Support: By the National Center for Complementary and Alternative Medicine (grant no. R24 AT001293; E. Manheimer, B. Berman, and K. Forys) and BackCare and the British Medical Acupuncture Society (A. White).

Potential Financial Conflicts of Interest: Employment: A. White (British Medical Acupuncture Society); Grants received: A. White (BackCare), B. Berman (National Institutes of Health); Grants pending: B. Berman (National Institutes of Health).

Requests for Single Reprints: Eric Manheimer, MS, Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207.

Current Author Addresses: Mr. Manheimer and Dr. Berman: Center for Integrative Medicine, University of Maryland School of Medicine, 2200 Kernan Drive, Kernan Hospital Mansion, Baltimore, MD 21207.

Dr. White: Peninsula Medical School, ITTC Building, Tamar Science Park, Plymouth PL6 8BX, United Kingdom.

Ms. Forys: Department of Psychology 116B, VA Palo Alto Healthcare System, 3801 Miranda Avenue, Palo Alto, CA 94304.

Dr. Ernst: Complementary Medicine, Peninsula Medical School, 25 Victoria Park Road, Exeter, Devon EX2 4NT, United Kingdom.

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