Acupuncture for Chronic Lower Back Pain: A Holistic Treatment Approach


Chronic lower back pain is a common condition that can significantly impact an individual’s quality of life. It is characterized by persistent pain and discomfort in the lower back area, which may result from a variety of causes, including muscle strain, herniated discs, degenerative conditions, or poor posture. Traditional medical treatments for chronic lower back pain often include medications, physical therapy, and, in some cases, surgical intervention. However, many individuals seek complementary therapies, such as acupuncture, to help manage pain, improve mobility, and enhance overall well-being.

Acupuncture, a key practice in Traditional Chinese Medicine (TCM), involves the insertion of fine needles into specific points on the body to stimulate energy flow, promote healing, and restore balance. It is increasingly recognized as an effective treatment option for chronic lower back pain, particularly for those seeking an alternative to pharmaceuticals or invasive procedures.


Benefits of Acupuncture for Chronic Lower Back Pain

Research and clinical experience suggest that acupuncture may offer several benefits for individuals with chronic lower back pain, including:

  • Pain Relief: Acupuncture is believed to stimulate the body’s natural pain-relieving mechanisms, helping to reduce discomfort and improve pain tolerance.
  • Improved Circulation: By promoting blood flow to the affected area, acupuncture may help to alleviate muscle stiffness, reduce inflammation, and accelerate the healing process.
  • Muscle Relaxation: Acupuncture can help to relax tense muscles, which are often a contributing factor to lower back pain.
  • Enhanced Mobility: Regular acupuncture treatments may improve flexibility and range of motion, making it easier to perform daily activities without pain.
  • Stress Reduction: Acupuncture has been shown to help reduce stress and anxiety, which can often exacerbate the experience of pain.

By addressing both the physical and emotional components of chronic lower back pain, acupuncture offers a holistic treatment approach that can complement other therapies and improve long-term outcomes.


Research

For low back pain, acupuncture was rated as ‘effective(possibly) in the Australian DVA review (2010) and ‘unclear’ in the USVA Evidence map of acupuncture (2014) (1, 2). The main reason given for the ‘unclear’ rating in the USVA Evidence map was that ‘sham acupuncture controlled trials tended towards statistically nonsignificant results’ and a Cochrane systematic review in 2005 which drew no firm conclusions on the effectiveness of acupuncture for acute low back pain (2). The problems associated with the interpretation of the effects of sham acupuncture have already been discussed. When reviews separate the evidence on chronic low back pain from acute low back pain, as was done in the recent review by the US Agency for Healthcare Research and Quality, it was found that there is moderate-quality evidence for the effectiveness of acupuncture in chronic low back pain for both pain intensity and function, but only low-quality evidence for pain intensity and function in acute low back pain (3).

In a systematic review of 32 randomised controlled trials for acupuncture treatment of chronic non-specific low back pain, acupuncture was superior (both statistically and clinically significant) to sham acupuncture in pain reduction and improved function immediately after treatment (4). Acupuncture was equivalent but not superior to usual care in pain and function, but acupuncture plus usual care was superior to usual care alone (4). The reviewers rated the evidence level of their review as Level of Evidence I (4). A systematic review of 11 randomised controlled trials on acute low back pain, acupuncture was superior to NSAIDS for improving symptoms (small effect), and superior to sham for pain but not function (5). A narrative review of non-invasive and alternative treatments for chronic low back pain rated the evidence for the effectiveness of acupuncture as high and for acupressure as moderate (6).

A review of 16 systematic reviews found that acupuncture alone, or when added to usual care, provided short-term improvement in pain and function for chronic low back pain (medium to large clinical effects) and hence ‘should be advocated in routine clinical practice’(7). For acute low back pain, the reviewers could not make firm conclusions about the effectiveness of acupuncture due the inclusion of only two systematic reviews (7). Two studies found that acupuncture is likely to be cost-effective for low back pain or chronic non-specific low back pain, respectively (8, 9).


References

1. Biotext. Alternative therapies and Department of Veterans’ Affairs Gold and White Card arrangements. In: Australian Government Department of Veterans’ Affairs, editor: Australian Government Department of Veterans’ Affairs; 2010.

2. Hempel S, Taylor SL, Solloway MR, Miake-Lye IM, Beroes JM, Shanman R, et al. VA Evidence-based Synthesis Program Reports. Evidence Map of Acupuncture. Washington (DC): Department of Veterans Affairs; 2014.

3. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. AHRQ Comparative Effectiveness Reviews. Noninvasive Treatments for Low Back Pain. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016.

4. Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013 Nov 15;38(24):2124-38.

5. Lee JH, Choi TY, Lee MS, Lee H, Shin BC, Lee H. Acupuncture for acute low back pain: a systematic review. Clin J Pain. 2013 Feb;29(2):172-85.

6. Wellington J. Noninvasive and alternative management of chronic low back pain (efficacy and outcomes). Neuromodulation. 2014 Oct;17 Suppl 2:24-30.

7. Liu L, Skinner M, McDonough S, Mabire L, Baxter GD. Acupuncture for low back pain: an overview of systematic reviews. Evid Based Complement Alternat Med. 2015;2015:328196.

8. Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Appl Health Econ Health Policy. 2016 Aug 22.

9. Taylor P, Pezzullo L, Grant SJ, Bensoussan A. Cost-effectiveness of Acupuncture for Chronic Nonspecific Low Back Pain. Pain Pract. 2014 Sep;14(7):599-606.