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The Effectiveness of Acupuncture in the Management of Acute and Chronic Low Back Pain: A Systematic Review Within the Framework of the Cochrane Collaboration Back Review Group

van Tulder, Maurits W., PhD*; Cherkin, Daniel C., PhD; Berman, Brian, MD; Lao, Lixing, PhD, LAc; Koes, Bart W., PhD*

Literature Review

Study Design. A systematic review of randomized controlled trials.

Objectives. To evaluate the efficacy and effectiveness of acupuncture for the management of nonspecific low back pain.

Summary of Background Data. Acupuncture is one of the oldest forms of therapy, but little is known about the effectiveness of acupuncture for low back pain.

Methods. Randomized controlled trials were done to assess the effectiveness of all types of acupuncture treatment, which involves needling for subjects with nonspecific low back pain. Two reviewers blinded with respect to authors, institution, and journal independently assessed the methodologic quality of the studies. Because data were statistically and clinically too heterogeneous, a qualitative review was performed. The evidence was classified into four levels: strong, moderate, limited, or no evidence.

Results. Eleven randomized controlled trials were included. Overall, the methodologic quality was low. Only two studies met the preset “high quality” level for this review. No study clearly evaluated acupuncture for acute low back pain. The results indicate that there was no evidence showing acupuncture to be more effective than no treatment. There was moderate evidence indicating that acupuncture is not more effective than trigger-point injection or transcutaneous electrical nerve stimulation, and there was limited evidence that acupuncture is not more effective than placebo or sham acupuncture for the management of chronic low back pain.

Conclusions. Because this systematic review did not clearly indicate that acupuncture is effective in the management of back pain, the authors would not recommend acupuncture as a regular treatment for patients with low back pain. There clearly is a need for more high-quality randomized controlled trials.

From the *Institute for Research in Extramural Medicine, Vrije Universiteit, Amsterdam, the Netherlands, †Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington, and ‡Division of Complementary Medicine, Department of Family Medicine, University of Maryland, Baltimore, Maryland.

Supported by the Dutch Health Insurance Board, the Netherlands.

Acknowledgment date: December 23, 1998.

Acceptance date: December 23, 1998.

Address reprint requests to

Maurits van Tulder, PhD

Institute for Research in Extramural Medicine

Vrije Universiteit

van der Boechorststraat 7

1081 BT Amsterdam

the Netherlands


Device status category: 1.

© 1999 Lippincott Williams & Wilkins, Inc.