title: Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis.
abstract: METHODS
  A systematic review and meta-analysis of randomized controlled trials (RCTs).
  
  
  OBJECTIVE
  To evaluate the totality of evidence in relation to the effectiveness of acupuncture for nonspecific chronic low back pain (NSCLBP).
  
  
  BACKGROUND
  Acupuncture has become a popular alternative for treating clinical symptoms of NSCLBP. A number of RCTs have examined the effectiveness of acupuncture in the treatment of NSCLBP.
  
  
  METHODS
  A systematic literature search was completed without date or language restrictions up to May 2012. Studies included in the review were RCTs that examined all forms of acupuncture that adhered to the Traditional Acupuncture Theory for treating NSCLBP. Outcome measures included impairment, activity limitation, and participation restriction. The methodological quality of the studies was examined using the Cochrane risk of bias tool.
  
  
  RESULTS
  Thirty-two studies were included in the systematic review, of which 25 studies presented relevant data for the meta-analysis. Acupuncture had a clinically meaningful reduction in levels of self-reported pain (mean difference =-16.76 [95% confidence interval, -33.33 to -0.19], P = 0.05, I = 90%) when compared with sham, and improved function (standard mean difference =-0.94 [95% confidence interval, -1.41 to -0.47], P < 0.00, I = 78%) when compared with no treatment immediately postintervention. Levels of function also clinically improved when acupuncture in addition to usual care, or electroacupuncture was compared with usual care alone. When acupuncture was compared with medications (NSAIDs, muscle relaxants, and analgesics) and usual care, there were statistically significant differences between the control and the intervention groups but these differences were too small to be of any clinical significance. There was no evidence in support of acupuncture over transcutaneous electrical nerve stimulation.
  
  
  CONCLUSIONS
  This systematic review demonstrates that acupuncture may have a favorable effect on self-reported pain and functional limitations on NSCLBP. However, the results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies.
  
  
  METHODS
  1.
authors.affiliation: *Department of School of Social Work & Social Policy, Trinity College Dublin, Dublin, Republic of Ireland; and †School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland.
authors.forename: Megan
authors.initials: M
authors.lastname: Lam
authors.forename: Rose
authors.initials: R
authors.lastname: Galvin
authors.forename: Philip
authors.initials: P
authors.lastname: Curry
mesh_terms: D015670:Acupuncture Therapy / Q000379:methods*; D002908:Chronic Disease; D006801:Humans; D017116:Low Back Pain / Q000628:therapy*; D010147:Pain Measurement; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome