Acupuncture for Lower Back Pain

Scientific research shows that acupuncture can be an effective treatment option for patients with chronic lower back pain. This view is supported by an increasing number of (particularly Western) medical guidelines that mention acupuncture as a meaningful, non-pharmacological intervention for lower back pain complaints.

Research
Large-scale observational studies indicate that acupuncture is effective in pain relief in about 76 percent of cases [1]. Major individual patient data meta-analyses confirm that a series of acupuncture treatments can lead to a clinically relevant reduction in chronic pain, including lower back pain [2].

In practice, it typically becomes clear within two to four treatment sessions whether a patient benefits from acupuncture. Moreover, the effects appear to be relatively long-lasting: follow-up data published in The Journal of Pain show that the achieved effect has decreased by only about 15 percent on average after one year [3]. This suggests a sustained therapeutic effect, even after the completion of the treatment series.

Side Effects and Safety
Acupuncture has few side effects, especially compared to pharmacological pain treatment. When they do occur, they are usually mild and short-lived complaints such as a bruise or temporary fatigue.

Safety research shows that after nearly 4.5 million treatments, only 11 serious side effects have been reported [4]. Summaries of safety studies, including those published by Evidence Based Acupuncture, conclude that acupuncture is a safe form of treatment, provided it is performed by a well-trained and qualified acupuncturist [4].

Medical Guidelines
In the Netherlands, acupuncture is mentioned in pain management in the Multidisciplinary Pain Guideline of the Association of Specialists in Geriatric Medicine and Social Geriatrics (Verenso) [5].

Internationally, the recognition is more evident. In English-language medical treatment guidelines, for instance, acupuncture has been positively mentioned nearly 1500 times in recent years, for both acute and chronic pain [6].

Specifically for chronic low back pain, the American College of Physicians (ACP) advises initially opting for non-pharmacological treatment options, including exercise, multidisciplinary rehabilitation, mindfulness-based stress reduction, and acupuncture [7]. The North American Spine Society (NASS) recommends adding acupuncture to usual care to improve pain and functioning in the short term [8]. The Scottish SIGN guideline and the British NICE also endorse this approach for chronic pain [9,10].

Acupuncture within Responsible Care
The Dutch Medical Association KNMG is open to non-conventional treatment methods, provided that certain conditions such as safety, transparency, and proper information are met [11]. Given the available scientific evidence and clinical experiences, acupuncture can be discussed as a possible and safe treatment option for patients with chronic lower back pain, in addition to regular care.

References - Lower Back Pain

Weidenhammer, W., et al, Acupuncture for chronic pain within the research program of 10 German Health Insurance Funds--basic results from an observational study, Journal of Complementary Therapies in Medicine, 2007 Dec;15(4):238-46.
https://pubmed.ncbi.nlm.nih.go... [←]
Vickers A.J. et al, Acupuncture for Chronic Pain, Individual Patient Data Meta-analysis, Archives of Internal Medicine, 2012, Oct 22; Vol172,No.19:1444-53
https://pubmed.ncbi.nlm.nih.go... [←]
Vickers A.J. et al, Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. The Journal of Pain, 2018, May,Vol 19,No.5, 455-474; Epub 2017 Dec
https://pubmed.ncbi.nlm.nih.go...[←].
White, A., The safety of acupuncture – evidence from the UK. Acupuncture in Medicine, 2006, 24(Suppl), 53–57.
https://journals.sagepub.com/d...[←].
Verenso. Multidisciplinary Guideline Pain, Recognition and Treatment of Pain in Vulnerable Elderly. Part 1 – summary, Part 2 – integral text, Part 3 – appendix, Utrecht: Verenso 2011
https://www.verenso.nl/_asset/...[←].
Birch, S., et al, Overview of Treatment Guidelines and Clinical Practical Guidelines That Recommend the Use of Acupuncture: a Bibliometric Analysis, The Journal of Alternative and Complementary Medicine, Vol 24, No 8, 2018 (Aug), pp. 1-18
https://www.liebertpub.com/doi...[←].
American College of Physicians (ACP), Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline, ACP Journals/Annals of Internal Medicine, 2017 (April)
https://www.acpjournals.org/do...[←].
North American Spine Society (NASS), Diagnosis and Treatment of Low Back Pain, Evidence-Based Clinical Guidelines for Multidisciplinary Spine Care, NASS, 2020
https://www.spine.org/Portals/...[←].
Scottish Intercollegiate Guidelines Network (SIGN),
Management of Chronic Pain. A National Clinical Guideline, SIGN, 2013 (Dec)
https://www.guidelinecentral.c...[←].
National Institute for Health and Care Excellence (NICE), Chronic pain (primary and secondary) in over 16s: assessment of all chronic pain and management of chronic primary pain, NICE guideline [NG193], 2021 (April)
https://www.nice.org.uk/guidan...[←].
Physicians' Federation KNMG, Advisory Guidelines for Non-Regular Treatment Methods
https://www.knmg.nl/advies-ric...[←].