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Acupuncture and Dry-Needling for Low Back Pain: An Updated Systematic Review Within the Framework of the Cochrane Collaboration

Furlan, Andrea D. MD*; van Tulder, Maurits PhD; Cherkin, Dan PhD; Tsukayama, Hiroshi LAc, BA, MPh§; Lao, Lixing PhD, LAc; Koes, Bart PhD; Berman, Brian MD

doi: 10.1097/01.brs.0000158941.21571.01
Cochrane Collaboration Review

Objectives. To assess the effects of acupuncture and dry-needling for the treatment of nonspecific low back pain.

Background. Low back pain is usually a self-limiting condition that tends to improve spontaneously over time. However, for many people, back pain becomes a chronic or recurrent problem for which a large variety of therapeutic interventions are employed.

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 controlled trials of acupuncture (that involved needling) or dry-needling for adults with nonspecific acute/subacute or chronic low back pain.

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

Results. Thirty-five randomized clinical trials were included: 20 were published in English, 7 in Japanese, 5 in Chinese, and 1 each in Norwegian, Polish, and German. There were only 3 trials of acupuncture for acute low back pain. These studies did not justify firm conclusions because of their small sample sizes and low methodologic quality. 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 in short-term follow-up. There is also evidence that acupuncture, added to other conventional therapies, relieves pain and improves function better than the conventional therapies alone. However, the effects are onlysmall. 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.

Conclusions. The data do not allow firm conclusions regarding 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 methodologic quality, there is a clear need for higher quality trials in this area.

This updated systematic review concluded that there is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low back pain. For chronic low back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment in measurements taken up to 3 months. The results also show that for chronic low back pain, acupuncture is more effective for improving function than no treatment in the short-term. Acupuncture is not more effective than other conventional and “alternative” treatments. When acupuncture is added to other conventional therapies, it 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.

From the *Institute for Work & Health, Toronto, Ontario, Canada, †VU University Medical Center, Amsterdam, The Netherlands, ‡Group Health Center for Health Studies, Seattle, Washington, §Tsukuba College of Technology Clinic, Tsukuba, Japan, ∥Complementary Medicine Program, University of Maryland School of Medicine, Baltimore, Maryland, and ¶Erasmus University, Rotterdam, The Netherlands.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Andrea D. Furlan is supported by the Canadian Institute of Health Research (CIHR) and the University of Toronto Centre for the Study of Pain (UTCSP).

Institutional funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Andrea D. Furlan, MD, Evidence-based Practice Co-ordinator, Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, ON, Canada, M5G 2E9; E-mail: afurlan@iwh.on.ca.

© 2005 Lippincott Williams & Wilkins, Inc.