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Am Fam Physician. 2006;73(3):525-528

Chronic low back pain is the most common obstacle to normal activity for persons younger than 45 years. One survey showed that 54 percent of patients who reported back or neck pain had undergone alternative therapies such as acupuncture. Until recently, most studies of acupuncture as therapy for low back pain have had major limitations. In light of the recent publication of several well-designed, randomized controlled trials, Manheimer and colleagues performed a meta-analysis to determine the short-term effectiveness of acupuncture in treating low back pain.

The authors performed a thorough literature search that included reports written in Germanic and Romance languages (including English), Japanese, Chinese, and Korean. Thirty-three studies comparing acupuncture to sham treatment or no therapy met inclusion criteria, which required random assignment of patients to intervention and control groups and data on one or more of the following outcomes: pain, measures of functional status, overall improvement, time to return to work, and analgesic use. For the purpose of this analysis, acupuncture was broadly defined as any intervention that involved the insertion of needles into the skin for reasons other than injection. Study size ranged from 17 to 262 patients.

Studies were classified into subgroups based on the duration of back pain, style of acupuncture (i.e., Chinese, Japanese, Western), and type of treatment, if any, provided to the control group. Control groups. received therapies such as transcutaneous electrical nerve stimulation, spinal manipulation, physical therapy, and massage. Acupuncture groups underwent multiple sessions per week.

Because of limited data and heterogeneity of studies on acute low back pain, the authors were unable to draw any conclusions about the usefulness of acupuncture for this condition. However, all three styles of acupuncture were more effective statistically at relieving chronic low back pain (i.e., lasting longer than three months) compared with sham treatment or no therapy. When this treatment effect was applied to a visual analogue scale and standard disability score previously established by members of the Cochrane Collaboration, it also reached clinical significance. Spinal manipulation was more effective than acupuncture in two studies.

The authors conclude that acupuncture appears to be beneficial for the treatment of chronic low back pain. Acupuncture was not found to be more effective than other active therapies.

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