Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis

Alice Baroncini; Nicola Maffulli; Jörg Eschweiler; Friedrich Molsberger; Alexandra Klimuch; Filippo Migliorini

doi:10.1186/s13018-022-03212-3

Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis

J Orthop Surg Res. 2022 Jun 20;17(1):319. doi: 10.1186/s13018-022-03212-3.

Authors

Alice Baroncini¹, Nicola Maffulli^{2

3

4}, Jörg Eschweiler¹, Friedrich Molsberger⁵, Alexandra Klimuch¹, Filippo Migliorini⁶

Affiliations

¹ Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074, Aachen, Germany.
² Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.
³ Faculty of Medicine, School of Pharmacy and Bioengineering, Keele University, Stoke-on-Trent, ST4 7QB, England.
⁴ Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, E1 4DG, England.
⁵ Acupuncture Study Group, Grafing, Germany.
⁶ Department of Orthopaedics, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, 52074, Aachen, Germany. migliorini.md@gmail.com.

Abstract

Background: This Bayesian network meta-analysis investigated the available randomized control trials (RCTs) to point out which acupuncture protocol is the most effective for chronic aspecific low back pain (LBP). Efficacy was measured in terms of pain (Visual Analogic Scale, VAS) and disability (Roland Morris Disability Questionnaire, RMQ), Transcutaneous Electrical Nerve Stimulation (TENS).

Methods: PubMed, Google scholar, Embase, and Scopus were accessed in March 2022. All the RCTs comparing two or more acupuncture modalities for aspecific chronic LBP were accessed. Only studies which investigated the efficacy of acupuncture on patients with symptoms lasting a minimum of 1.5 months, or with at least three episodes in the previous 12 months, were considered eligible. The Review Manager Software (The Nordic Cochrane Collaboration, Copenhagen) was used for the methodological quality assessment. The STATA Software/MP, Version 14.1 (StataCorporation, College Station, Texas, USA), was used for the statistical analyses. The NMA was performed through the STATA routine for Bayesian hierarchical random-effects model analysis.

Results: Data from 44 RCTs (8338 procedures) were retrieved. 56% of patients were women. The mean age of the patients was 48 ± 10.6 years. The mean BMI was 26.3 ± 2.2 kg/m². The individual group (95% confidence interval (CI) 2.02, 7.98) and the standard combined with TENS (95% CI 2.03, 7.97) demonstrated the highest improvement of the RMQ. The VAS score was lower in the standard combined with TENS group (95% CI 3.28, 4.56). Considering the standard acupuncture group, different studies used similar protocols and acupuncture points and the results could thus be compared. The equation for global linearity did not find any statistically significant inconsistency in any of the network comparison.

Conclusion: Verum acupuncture is more effective than sham treatment for the non-pharmacological management of LBP. Among the verum protocols, individualized acupuncture and standard acupuncture with TENS were the protocols that resulted in the highest improvement in pain and quality of life.

Level of evidence: Level I, Bayesian network meta-analysis of RCTs.

Keywords: Acupuncture; Individualized acupuncture; Low back pain; Sham acupuncture; Verum acupuncture.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Acupuncture Therapy* / methods
Adult
Chronic Pain* / therapy
Female
Humans
Low Back Pain* / diagnosis
Low Back Pain* / therapy
Male
Middle Aged
Network Meta-Analysis
Pain Measurement
Transcutaneous Electric Nerve Stimulation* / methods