Introduction
Material and methods
Search strategy
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P (population): Chronic low back pain;
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I (intervention): Acupuncture;
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C (comparison): Standardized, sham, individual, auricular, electroacupuncture, acupuncture combined with Transcutaneous Electrical Nerve Stimulation (TENS);
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O (outcomes): VAS, RMQ.
Data source and extraction
Eligibility criteria
Data extraction
Risk of bias assessment
Statistical analysis
Results
Search result
Methodological quality assessment
Patient demographics
Author, year | Journal | Treatment | Type of protocol | Patients (n) | Follow-up (months) | Mean age | Women (%) | Mean BMI |
---|---|---|---|---|---|---|---|---|
Brinkhaus et al. [15] | Arch Intern Med | Individualized | 12 sessions of 30 min over 8 weeks (2 sessions in each of the first 4 weeks, followed by 1 session per week in the remaining 4 weeks) | 147 | 13 | 59.1 | 64 | 26.7 |
Sham | 75 | 58.2 | 75 | 26.2 | ||||
Control | Patients in the waiting list group did not receive acupuncture treatment for 8 weeks after randomization | 79 | 58.9 | 68 | 26.9 | |||
Camilotti et al. [16] | Fisioter. Mov | Physiotherapy/ Aquatic Therapy | Twice a week | 15 | 61.7 | 27.8 | ||
Auricular/scalp/standardized | 15 | 57.3 | 27.6 | |||||
Control | 14 | 61.2 | 28.7 | |||||
Ceccherelli et al. [17] | The Clinical Journal of Pain | Standardized | 8 sessions for 20 min; the first four sessions were carried out in 2 weeks, whereas the remaining four sessions were carried out once per week | 21 | 3 | 41.7 | 24 | |
Individualized | 21 | 41.6 | 33 | |||||
Cherkin et al. [18] | Arch Intern Med | Individualized | Up to 10 massages or acupuncture treatments over 10 weeks were permitted | 94 | 12 | 45.3 | 52 | |
Control | 78 | 45.7 | 69 | |||||
Control | 90 | 43.8 | 56 | |||||
Cherkin et al. [19] | Arch Intern Med | Individualized | 2 treatments weekly for 3 weeks; then once weekly for 4 weeks | 157 | 13 | 47.0 | 68 | |
Standardized | 158 | 49.0 | 56 | |||||
Sham | 162 | 47.0 | 60 | |||||
Usual care | Patients received no study-related care; just the care, if any, they and their physicians chose (mostly medications, primary care, and physical therapy visits) | 161 | 46.0 | 64 | ||||
Cho et al. [20] | Spine | Individualized | 12 acupuncture sessions (approximately 2 times a week for 6 weeks) | 65 | 6 | 42.4 | 83 | 23.9 |
Sham | 65 | 41.8 | 86 | 24.2 | ||||
Comachio et al. [21] | Journal of Acupuncture and Meridian Studies | Individualized | 1-h sessions, twice a week for 6 weeks | 33 | 3 | 49.0 | 70 | 26.9 |
Electroacupuncture | 33 | 46.0 | 58 | 26.0 | ||||
Di Cesare et al. [22] | Complementary Therapies in Medicine | Control | 1 injection per week for 4 weeks | 29 | 3 | 52.5 | 55 | |
Standardized | 33 | 52.5 | 55 | |||||
Giles et al. [23] | Journal of Manipulative and Physiological Therapeutics | Individualized | 15- to 20-min appointments with subsequent low-volt electrical stimulation applied to the needles, 6 treatments applied in a 3- to 4-week period, (mean 6 treatments) | 20 | 0 | 46.5 | 65 | |
Control | Pills given for the defined 3- to 4-week treatment period, (mean 2 prescriptions) | 21 | 35.0 | 81 | ||||
Control | 15 to 20-min appointments, 6 treatments applied in a 3- to 4-week period, (mean 6 treatments) | 36 | 42.5 | 47 | ||||
Giles et al. [24] | Spine | Standardized | 20-min appointments, 2 treatments per week, maximum treatment duration of 9 weeks | 36 | 12 | 37.5 | 44 | 25.8 |
Control | Maximum treatment duration of 9 weeks | 43 | 39.0 | 43 | 25.8 | |||
Control | 20-min appointments, 2 treatments per week, maximum treatment duration of 9 weeks | 36 | 39.0 | 49 | 25.8 | |||
Grant et al. [25] | Pain | Individualized | 2 sessions of manual acupuncture weekly for 4 weeks | 30 | 3 | 75.0 | ||
TENS | 27 | 72.0 | ||||||
Haake et al. [26] | Arch Intern Med | Individualized | Ten 30-min sessions, generally 2 sessions per week, and 5 additional sessions if, after the tenth session, patients experienced a 10% to 50% reduction in pain intensity | 387 | 6 | 49.6 | 57 | 26.9 |
Sham | 387 | 49.2 | 64 | 26.5 | ||||
Control | 388 | 51.3 | 58 | 26.3 | ||||
Hasegawa et al. [27] | Acupunct Med | Standardized | 5 sessions during 28 days | 40 | 0 | 47.0 | 63 | |
Sham | 40 | 43.9 | 65 | |||||
Hunter et al. [28] | Clin J Pain | Physiotherapy | Supervised group exercise session lasting for 1 h a week for 6 weeks | 27 | 6 | 43.2 | 59 | |
Auricular | Manual AA for the first 6 weeks of the trial before each exercise session | 24 | 42.4 | 67 | ||||
Inoue et al. [29] | Acupunct Med | Individualized | Once | 15 | 68.0 | 27 | ||
Sham | 16 | 70.0 | 38 | |||||
Itoh et al. [30] | Complementary Therapies in Clinical Practice | Standardized | 1 weekly treatment over 5 weeks | 7 | 2.5 | 63 | ||
TENS | 7 | |||||||
Acupuncture and TENS | 7 | |||||||
Control | No specific treatment | 7 | ||||||
Itoh et al. [31] | Acupunct Med | Individualized | 2 phases of 3 weeks, 12 weeks in total. Each patient received a total of six 30 min treatments, one per week | 9 | 2.75 | 70.1 | 71 | |
Individualized | 9 | 71.9 | ||||||
Standard | 9 | 73.8 | ||||||
Itoh et al. [30] | Complementary Therapies in Clinical Practice | Standardized | 5 treatments, once per week | 8 | 2.5 | 63 | ||
TENS | 8 | |||||||
Acupuncture and TENS | 8 | |||||||
Control | 8 | |||||||
Kalauokalani et al. [32] | Spine | Control | Up to 10 treatments within 10 weeks | 0 | ||||
Individualized | ||||||||
Control | ||||||||
Control | 66 | 45.0 | 70 | |||||
Control | 69 | 43.0 | 57 | |||||
Kennedy et al. [33] | Complementary Therapies in Medicine | Individualized | Once or twice a week; min 3 and max 12 treatments over 4–6 weeks | 23 | 3 | 46.5 | 46 | |
Sham | 22 | 44.6 | 58 | |||||
Kerr et al. [34] | Clin J Pain | Standard | The treatment program consisted of 6 of these sessions over a 6-week period. This reflected the routine pattern of attendance for outpatient physiotherapy. Patients were given a leaflet regarding their low back pain that included standardized advice and exercises | 26 | 1.5 | 42.6 | 50 | |
Placebo-TENS | 20 | 42.8 | 65 | |||||
Leibing et al. [35] | Pain | Standardized | 20 sessions (each 30 min) of traditional and standardized acupuncture over 12 weeks, plus active physiotherapy. In the first 2 weeks of treatment, acupuncture was done five times a week, and in the next 10 weeks once a week. Plus physiotherapy 26 sessions (each 30 min) over 12 weeks | 40 | 13 | 47.9 | 55 | 26.1 |
Sham | 20 sessions (each 30 min) of minimal acupuncture over 12 weeks, plus active physiotherapy 26 sessions (each 30 min) over 12 weeks | 45 | 49.0 | 60 | 25.9 | |||
Control | Active physiotherapy with no other treatment 26 sessions (each 30 min) over 12 weeks | 46 | 47.5 | 59 | 26.9 | |||
Liu et al. [36] | Clin Rehab | Standardized | Usual care + assigned acupuncture intervention according to group allocation. 30-min treatment sessions were administered twice weekly | 15 | 3 | 30.0 | 60 | 23.9 |
Standardized | 15 | 37.1 | 60 | 27.0 | ||||
Standardized | 15 | 30.8 | 73 | 27.4 | ||||
Luo et al. [37] | Journal of traditional Chinese medicine | Auricular | 18 treatments were provided over 7 weeks | 54 | 6 | 39.0 | 20 | |
Standardized | 50 | 36.0 | 24 | |||||
Control | 48 | 37.0 | 19 | |||||
Macdonald et al. [38] | Annals of the Royal College of Surgeons of England | Individualized | Over a short period of time once a week. The maximum number of treatments between the two assessments was arbitrarily defined as 10 | 8 | 0 | 75 | ||
Control | 9 | 67 | ||||||
Mendelson et al. [39] | The American Journal of Medicine | Standardized | 4 weeks of treatment, twice weekly | 36 | 1 | 54.5 | 47 | |
Control | 41 | 53.6 | 56 | |||||
Meng et al. [40] | Rheumatology | Standardized | In addition to standard therapy, subjects in this group received acupuncture treatments twice a week for 5 weeks, for a total of 10 sessions | 31 | 2.25 | 72.0 | 58 | |
Control | 5 weeks | 24 | 70.0 | 63 | ||||
Miyazaki et al. [14] | Clin J Pain | Standardized | A washout period of at least 4 weeks took place between phases 1 and 2 | 42 | 20.8 | 22.7 | ||
Control | 39 | 21.0 | 25.1 | |||||
Molsberger et al. [41] | Pain | Sham | In addition to the daily conservative orthopedic therapy, all patients received 12 sham treatments, (30 min, 3/ week) | 61 | 3 | 50.0 | 46 | |
Standardized | In addition to the conventional conservative orthopedic therapy, 12 verum acupuncture treatments (30 min, 3/ week) | 65 | 49.0 | 45 | ||||
Control | These patients received the daily conventional conservative orthopedic treatment over 4 weeks | 60 | 49.0 | 53 | ||||
Pach et al.[42] | Evidence-Based Complementary and Alternative Medicine | Standardized | 2 treatment sessions per week had to be applied, with a maximum number of 10 to 15 sessions depending on the patient’s individual needs. The needle retention time was about 25 min | 78 | 6.5 | 59.3 | 54 | 27.2 |
Individualized | 72 | 56.1 | 63 | 27.0 | ||||
Rajfur et al. [43] | Medical science monitor | TENS | A series of 15 treatments, 5 times a week (Monday to Friday) for a period of 3 weeks | 20 | 0 | 50.2 | 55 | 26.7 |
Acupuncture and TENS | 20 | 52.1 | 60 | 27.0 | ||||
Control | 19 | 47.8 | 58 | 26.3 | ||||
Control | 21 | 48.7 | 62 | 26.1 | ||||
Control | 22 | 52.1 | 59 | 25.9 | ||||
Control | Motor improvement exercises were used for 3 weeks, 5 times a week, from Monday to Friday | 21 | 49.8 | 62 | 26.1 | |||
Sator-Katzenschlager [44] | Pain Medicine | Electroacupuncture | The acupuncture needles with the P-Stim™ devices were withdrawn 48 h after insertion in all cases and the acupuncture treatment was performed once a week for 48 h at home, for a total study period of 6 wk | 61 | 1.5 | 54.1 | 71 | 26.6 |
Acupuncture | 53.1 | 25.3 | ||||||
Shankar et al. [45] | Indian Journal of Physiology and Pharmacology | Electroacupuncture | 10 treatments over 3 weeks | 30 | 0 | 36.2 | 53 | 22.9 |
Control | 10 days of Valdecoxib and 3 weeks of physiotherapy | 30 | 34.5 | 80 | 22.0 | |||
Control | 30 | 35.9 | 57 | 23.3 | ||||
Szczurko et al. [46] | PLoS ONE | Acupuncture | Twice per week to receive 24 treatments over a period of 12 weeks | 39 | 3 | 45.3 | 56 | 28.7 |
Control | Participants randomized to the control group received an educational booklet (causes of back pain, prognosis, appropriate use of imaging studies and specialists, and exercises for promoting recovery and preventing recurrences) | 36 | 48.0 | 44 | 27.7 | |||
Thomas et al. [47] | BMJ | Individualized | 10 individualized treatment sessions over 3 months | 159 | 24 | 42.0 | 62 | |
Control | Patients in the usual care group received NHS treatment according to their general practitioner’s assessment of need | 80 | 44.0 | 58 | ||||
Witt et al. [48] | American J Epidemiology | Individualized | Maximum of 15 acupuncture sessions over 3 months | 1451 | 6 | 53.1 | 58 | |
Control | Conventional therapy | 1390 | 52.6 | 57 | ||||
Yeung et al. [49] | Journal of Alternative and Complementary Medicine | Control | An hourly session each week for 4 consecutive weeks + daily 15 months of home exercise | 26 | 3 | 55.6 | 81 | 24.2 |
Standardized | EA three times/ week, 4 weeks | 26 | 50.4 | 85 | 25.5 | |||
Tsui et al. [50] | The journal of alternative and complementary medicine | Electroacupuncture | Treatment for 20 min on a total of 6 acupuncture points. Treatment was delivered twice per week for 4 weeks (a total of 8 sessions) | 14 | 1 | 39.7 | 76 | |
Electroacupuncture | 14 | 39.1 | 71 | |||||
Control | 14 | 40.9 | 62 | |||||
Tsukayama et al. [51] | Acupuncture in medicine | Electroacupuncture | Twice a week for 2 weeks | 10 | 0 | 47.0 | 89 | 22.5 |
TENS | 10 | 43.0 | 80 | 22.2 | ||||
Weiß et al. [52] | The journal of alternative and complementary medicine | Standardized | 21-day inpatient rehabilitation and acupuncture twice weekly | 74 | 3 | 49.8 | 27 | 30.0 |
Control | 21-day inpatient rehabilitation | 69 | 51.7 | 39 | 28.8 | |||
Yoo et al. [53] | Journal of Korean Medicine Rehabilitation | Standardized | Treatment within 5 days. A total of 2 treatments | 15 | 0 | 37.9 | 22.3 | |
Sham | 15 | 37.9 | 23.9 | |||||
Yuan et al. [54] | Complementary Therapies in Medicine | Individualized | 10 treatments; 2 times/week | 15 | 12 | 43.5 | 40 | 27.0 |
10 treatments; 5 times/week | 15 | 43.9 | 40 | 27.3 | ||||
Yun et al. [55] | The Journal of Alternative and Complementary Medicine | Control | 18 treatments were provided over 7 weeks, every other day for 3 weeks and then twice weekly for 4 weeks | 64 | 11 | 35.0 | 22 | |
Individualized | 60 | 34.0 | 27 | |||||
Control | 63 | 33.0 | 19 | |||||
Zaringhalam et al. [56] | Chinese Medicine Journal | Standardized | Twice a week for 5 weeks | 20 | 2.5 | 54.2 | 0 | 32.5 |
Control | daily | 20 | 55.1 | 29.2 | ||||
Control | Twice a week for 5 weeks | 20 | 54.2 | 30.3 | ||||
Control | 20 | 54.3 | 31.0 |