Recent research has provided substantial evidence supporting the efficacy of acupuncture in managing chronic nonspecific low back pain (CLBP). A comprehensive Bayesian network meta-analysis, published in the Journal of Orthopaedic Surgery and Research, evaluated various acupuncture protocols to determine their effectiveness in alleviating CLBP symptoms.

Study Overview

The meta-analysis incorporated data from 44 randomized controlled trials (RCTs), encompassing a total of 8,338 procedures. The mean age of participants was 48 years, with 56% being female. The primary outcomes assessed were pain intensity, measured using the Visual Analog Scale (VAS), and functional disability, evaluated through the Roland Morris Disability Questionnaire (RMQ).

 

Acupuncture Protocols Evaluated

The study compared several acupuncture modalities, including:

• Standard Acupuncture: Utilizing predefined acupoints commonly associated with low back pain relief.
• Individualized Acupuncture: Tailoring acupoint selection based on individual patient assessments.
• Standard Acupuncture Combined with Electroacupuncture: Integrating electroacupuncture therapy with standard acupuncture protocols. 

Findings

The analysis revealed that both individualized acupuncture and standard acupuncture combined with electroacupuncture demonstrated significant improvements in functional disability and pain reduction:

• Functional Disability (RMQ): Both individualized acupuncture and standard acupuncture combined with electroacupuncture showed the highest improvement in RMQ scores, with a 95% confidence interval (CI) of 2.02 to 7.98.
• Pain Intensity (VAS): The standard acupuncture combined with electroacupuncture group exhibited the most substantial reduction in VAS scores, with a 95% CI of 3.28 to 4.56.  

Acupuncture Techniques and Protocols

The study highlighted specific acupuncture techniques and protocols associated with effective outcomes:

• Acupoint Selection: Commonly utilized points included BL23 (Shenshu), BL25 (Dachangshu), BL40 (Weizhong), and GV3 (Yaoyangguan). These points are traditionally linked to lumbar region pain relief.
• Needle Specifications: Needles with a gauge of 0.25 mm were inserted to depths ranging from 20 to 40 mm, depending on the patient’s body habitus and muscle thickness.
• Needle Manipulation: Manual stimulation was applied to elicit the deqi (得气) sensation, characterized by a dull ache or tingling, indicating effective needle placement.
• Treatment Frequency: Sessions were conducted twice weekly over a period of 6 to 12 weeks, totaling 12 to 24 sessions.
• Electroacupuncture Integration: In protocols combining acupuncture with electroacupuncture, electrodes were attached to the needles at specific acupoints, delivering low-frequency electrical stimulation to enhance analgesic effects. 

Biomedical Mechanisms

The therapeutic effects of acupuncture in chronic low back pain (CLBP) management are attributed to several biomedical mechanisms:

•  Endorphin Release: Acupuncture stimulates the release of endogenous opioids, such as endorphins, which modulate pain perception.
•  Anti-Inflammatory Effects: The treatment has been associated with reduced levels of pro-inflammatory cytokines, including interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α), contributing to decreased inflammation in the affected areas.
• Enhanced Blood Flow: Needling at specific points promotes increased local blood circulation, facilitating tissue repair and reducing muscle tension.

Clinical Implications

For licensed acupuncturists, these findings underscore the importance of individualized treatment plans and the potential benefits of integrating electroacupuncture with traditional acupuncture. Tailoring acupoint selection and employing appropriate needle techniques are crucial for optimizing patient outcomes in CLBP management.

Conclusion

This meta-analysis provides robust evidence supporting the efficacy of acupuncture, particularly individualized protocols and those combined with electroacupuncture, in reducing pain and improving function in patients with chronic nonspecific low back pain. The detailed insights into acupuncture techniques and biomedical mechanisms offer valuable guidance for practitioners aiming to enhance therapeutic outcomes in CLBP management.

 

Source:

1. Baroncini, A., Maffulli, N., Eschweiler, J., Molsberger, F., Klimuch, A., & Migliorini, F. (2022). Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis. Journal of Orthopaedic Surgery and Research, 17, Article number: 319.