Closer examination of the articles included in the review reveals that the results of the RCT’s show a trend towards study groups receiving some form of acupuncture intervention show improvement/positive treatment effects. However in agreement with the review author there are some methodological issues within the studies that prevent the drawing of definitive conclusions. A systematic review8 concluded that in chronic LBP acupuncture is more effective than no treatment or sham treatment at up to 3 month follow up. It was also reported that acupuncture as an adjunct to conventional therapies is more effective than conventional therapies alone. Dry needling is also considered in this review and reported as a useful adjunct to other therapies for chronic LBP. A larger systematic review 1 inclusive of both acute and chronic LBP focused on the primary outcome of short term pain relief reports that acupuncture is described as statistically significantly and clinically important and is more effective than sham acupuncture and concludes that acupuncture effectively relieves chronic LBP. It is noteworthy that of the 33 RCTs included in the review only 22 could be included in the meta-analysis due to the heterogeneity across the study samples and methodologies in the remaining 11 RCTs, 4 of which were related to chronic LBP. The quality of the studies included in the meta-analysis is variable, as such the findings from this review should only be considered as somewhat preliminary. Future publication of larger trials would have an impact on the evidence overall. A more recent systematic review17 inclusive of 6 RCTs not published when previous reviews1 8 were carried out reported that there is moderate evidence that acupuncture is more effective than no treatment and strong evidence of no significant difference between acupuncture and sham acupuncture for short term pain relief for chronic LBP. Considering 3 systematic reviews1 8 17 of reasonable quality the evidence shows a trend towards acupuncture being more effective than no treatment, however the evidence remains limited. There are inconsistent findings for acupuncture versus sham acupuncture. There is consistent evidence that acupuncture is a useful adjunct to other conservative treatments A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 6 (physiotherapy, exercise based therapy, education, osteopathy). It remains unclear whether acupuncture is more effective than other aforementioned conservative treatments and this requires further investigation. Six12-14 18-22 RCT’s of reasonable quality consistently reported that acupuncture has ‘minimal’ or ‘some’ positive effect on chronic LBP. Due to the differences in study population and methodologies it is difficult to compare these studies, therefore the evidence to support acupuncture for chronic LBP is limited. There were only 2 studies which included (sub)acute LBP; 1 RCT22 and 1 systematic review8 . The RCT included a sham group and an acupuncture treatment group, the treatment group reported statistically significant improvement in pain at 3 months post treatment and reported taking less pain control medication. However this study is underpowered and alone offers little towards a definitive conclusion around the efficacy of acupuncture for (sub)acute LBP. The systematic review8 reports that there is insufficient evidence to support the efficacy of acupuncture or dry needling in acute LBP. Based on this evidence it is not possible to draw definitive conclusions about the effect of acupuncture for treating (sub)acute LBP. When considering back pain associated with lumbar disc herniation radiculopathy (LDHR) there is no evidence for the use of acupuncture10. As such acupuncture is not recommended as a treatment for this pathology. Lower back Author/Study Level of evidence Findings/Adverse effects 1a. Lynton et al (2003) Chronic Spinal Pain: A Randomized Clinical Trial Comparing Medication, Acupuncture and Spinal Manipulation 1+ Acupuncture minimally effective Manipulation gives greater pain relief in short term Adverse effects – none reported for acupuncture 1b. Muller et al (2005) Longterm follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes 1+ Acupuncture minimally effective Manipulation gives greater pain relief in long term Adverse effects - none reported 2a. Cherkin et al (2008) Efficacy of acupuncture for chronic low back pain: protocol for a randomized controlled trial 2b. Cherkin et al (2009) A Randomised Trial Comparing Acupuncture and Usual Care 1- Acupuncture produced short & long term improvement in function but not symptoms Acupuncture more effective than ‘usual care’ Site & depth of penetration appear unimportant in eliciting therapeutic benefit. A c c i d e n t C o m p e n s a t i o n C o r p o r a t i o n Page 7 Lower back for Chronic Low Back Pain May represent placebo or non-specific effects Adverse effects – none reported 3. Itoh et al (2006) Effects of trigger point acupuncture on chronic low back pain in elderly patients -- a shamcontrolled randomised trial 1+ Trigger point acupuncture effective for short term relief of low back pain in elderly patients Trigger point acupuncture more effective than sham Adverse effects – none reported 4. Itoh et al (2004) Trigger