The American College of Physicians’ new guidelines on the treatment of chronic low back pain strongly recommend the use of acupuncture as a first-line treatment, finding it to be more effective for pain relief and improvement in function than pharmaceutical drugs. The Clinical Guidelines Committee based their recommendations on a systematic review of RCTs covering pharmacological and non-pharmacological treatments for low back pain published up until the end of November 2016 (see below). Clinical outcomes evaluated included reduction of low pain, improvement in function, improvement in quality of life, reduction in disability, number/frequency of back pain episodes, patient satisfaction and adverse effects. The recommendation states that when treating low back pain, doctors should initially select non-pharmacological treatments (exercise, rehabilitation, acupuncture and mindfulness-based stress reduction, which are backed up by moderate-quality evidence, or tai chi, yoga, progressive relaxation, biofeedback, laser therapy, cognitive behavioral therapy and spinal manipulation, which are backed up by low-quality evidence) and that drug treatment should only be considered for patients who do not improve with non-pharmacological interventions. Non-steroidal anti-inflammatory drugs, which were found to have only a small to moderate effect on pain and at best a small effect on function, were recommended over opioids, which the authors concluded should be considered only in patients for whom other therapies have failed because of the substantial harms with which they are associated. The guidelines also recommend acupuncture as a first-line treatment for acute low back pain (along with heat, massage and spinal manipulation), although the evidence for this is considered to be of lower quality.
Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017 Apr 4;166(7):514-530.
A systematic review of non-pharmacological therapies for low back pain carried out for the American College of Physicians concludes that several of them, including acupuncture and tai chi, are associated with small to moderate effects on pain. Data came from randomised trials of nine non-pharmacological treatment options versus sham treatment, wait list, usual care or each other. Acupuncture was evaluated in 49 trials. The data showed that for acute low back pain, real acupuncture decreased pain intensity more than sham, but had no clear effects on function. Compared with non-steroidal anti-inflammatory drugs (NSAIDs), acupuncture was associated with a slightly greater likelihood of overall improvement at the end of treatment. The evidence for acupuncture’s effects in chronic low back pain was more convincing. Acupuncture was associated with lower pain intensity and better function compared with no acupuncture. Acupuncture also decreased pain intensity more than sham acupuncture immediately after the intervention and through to 12 week follow-up. Compared with medications (NSAIDs, muscle relaxants, or analgesics), acupuncture resulted in greater pain relief and better function immediately after the intervention. Tai chi and mindfulness-based stress reduction were also found to be moderately effective for chronic low back pain.
Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Ann Intern Med. 2017 Apr 4;166(7):493-505.