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Published in: Current Pain and Headache Reports 9/2023

Open Access 11-07-2023 | Acupuncture | Alternative Treatments for Pain Medicine (M Jones, Section Editor)

Acupuncture for Low Back Pain: Reevaluation of Systematic Reviews and Meta-analyses

Authors: Wen-xi Yan, Hui-ze Lin, Xiang Wang, Wei Zhang, Lan-ping Liu, Jin-na Yu, Tao Yang

Published in: Current Pain and Headache Reports | Issue 9/2023

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Abstract

Purpose of Review

This overview aims to reevaluate the methodological quality, report quality, and evidence quality of systematic reviews (SRs)/meta-analyses (MAs) of acupuncture for low back pain to determine whether acupuncture effectively treats low back pain (LBP).

Recent Findings

Twenty-three SRs/MAs were deemed eligible for the present overview. The AMSTAR 2 score showed that the methodological quality of one SR/MA was of medium quality, one was of low quality, and 21 were of critically low quality. Based on the results of the PRISMA evaluation, there are certain areas for improvement in the quality of reporting of SRs/MAs. There were some reporting flaws in the topic of search strategy (8/23, 34.78%), certainty assessment (4/23, 17.39%), the certainty of evidence (4/23, 17.39%), registration and protocol (3/23, 13.04%), and availability of data, code, and other material (1/23, 4.35%). Results from the GRADE evaluation indicated that 13 of 255 outcomes were rated as moderate, 88 were low, and 154 were very low.

Summary

Acupuncture effectively treated LBP in the SRs/MAs included in the reevaluation. However, the methodological, report, and evidence-based quality of the SRs/MAs on acupuncture for LBP was low. Therefore, further rigorous and comprehensive studies are warranted to improve the quality of SRs/MAs in this field.
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Literature
1.
2.
go back to reference Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. Lancet low back pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. Lancet low back pain Series Working Group. What low back pain is and why we need to pay attention. Lancet. 2018;391(10137):2356-2367.
3.
go back to reference Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–91.CrossRefPubMed Balagué F, Mannion AF, Pellisé F, Cedraschi C. Non-specific low back pain. Lancet. 2012;379(9814):482–91.CrossRefPubMed
4.
go back to reference Chou R. low back pain. Ann Intern Med. 2021;174(8):ITC113-ITC128. Chou R. low back pain. Ann Intern Med. 2021;174(8):ITC113-ITC128.
5.
go back to reference Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L, et al. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):CD013814. Mu J, Furlan AD, Lam WY, Hsu MY, Ning Z, Lao L, et al. Acupuncture for chronic nonspecific low back pain. Cochrane Database Syst Rev. 2020;12(12):CD013814.
6.
go back to reference Zhang W, Wang R, Yang T, Yuan-Yuan K, Zhi-Shun L, Jing-Wen F, et al. A re-evaluation of systematic reviews and meta-analysis of acupuncture and moxibustion for chronic constipation by AMSTAR 2 and GRADE system[J]. World J Tradit Chin Med. 2021;7(03):1-12. Zhang W, Wang R, Yang T, Yuan-Yuan K, Zhi-Shun L, Jing-Wen F, et al. A re-evaluation of systematic reviews and meta-analysis of acupuncture and moxibustion for chronic constipation by AMSTAR 2 and GRADE system[J]. World J Tradit Chin Med. 2021;7(03):1-12.
7.
go back to reference Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;21(358): j4008.CrossRef Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;21(358): j4008.CrossRef
8.
go back to reference Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-6. Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol. 2011;64(4):401-6.
9.
go back to reference Pan C, Wang Z, Zhang F, Zeng Y, Chen X, Huang J, et al. Acupuncture for perimenopausal insomnia: a case report. Acupunct Med. 2021;39(6):740–1.CrossRefPubMed Pan C, Wang Z, Zhang F, Zeng Y, Chen X, Huang J, et al. Acupuncture for perimenopausal insomnia: a case report. Acupunct Med. 2021;39(6):740–1.CrossRefPubMed
10.
go back to reference Yang T, Lin H, Yu J, et al. For acute non-specific low back pain, acupuncture or western medicine? A systematic review of randomized controlled trials [C]. //Proceedings of the Special Event on the Tenth Anniversary of the Inheritance of Chinese Medicine and Acupuncture and the World Federation of Acupuncture and Moxibustion Societies 2020 International Symposium on Acupuncture and Moxibustion. 2020;107-108. Yang T, Lin H, Yu J, et al. For acute non-specific low back pain, acupuncture or western medicine? A systematic review of randomized controlled trials [C]. //Proceedings of the Special Event on the Tenth Anniversary of the Inheritance of Chinese Medicine and Acupuncture and the World Federation of Acupuncture and Moxibustion Societies 2020 International Symposium on Acupuncture and Moxibustion. 2020;107-108.
12.
go back to reference Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: A critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.
13.
go back to reference Ge L, Pan B, Pan JX, Li YN, Wu YT, Guo SJ, et al. An introduction of AMSTAR-2: a quality assessment instrument of systematic reviews including randomized or nonrandomized controlled trials or both. Chin J Drug Evaluat (Chin). 2017;34:334–8. Ge L, Pan B, Pan JX, Li YN, Wu YT, Guo SJ, et al. An introduction of AMSTAR-2: a quality assessment instrument of systematic reviews including randomized or nonrandomized controlled trials or both. Chin J Drug Evaluat (Chin). 2017;34:334–8.
15.
go back to reference Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. GRADE Working Group. Grading quality of evidence and strength of recommendations. BMJ. 2004;328(7454):1490.
16.
17.
go back to reference Zeng Y, Chung JW. Acupuncture for chronic nonspecific low back pain: an overview of systematic reviews. Eur J Integr Med. 2015;7(2):94-107. ISSN 1876-3820. Zeng Y, Chung JW. Acupuncture for chronic nonspecific low back pain: an overview of systematic reviews. Eur J Integr Med. 2015;7(2):94-107. ISSN 1876-3820.
18.
go back to reference Liu M. Meta-analysis of the efficacy of acupuncture in the treatment of lower back pain[J]. Health Care Guide. 2021;1:119. Liu M. Meta-analysis of the efficacy of acupuncture in the treatment of lower back pain[J]. Health Care Guide. 2021;1:119.
20.
go back to reference Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW. Expertise-Based RCT Working Group. The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review. Spine. 2008;33(8):914-8. https://doi.org/10.1097/BRS.0b013e31816b4be4. Johnston BC, da Costa BR, Devereaux PJ, Akl EA, Busse JW. Expertise-Based RCT Working Group. The use of expertise-based randomized controlled trials to assess spinal manipulation and acupuncture for low back pain: a systematic review. Spine. 2008;33(8):914-8. https://​doi.​org/​10.​1097/​BRS.​0b013e31816b4be4​.
21.
go back to reference Huang F, Qiu M, Zhao S, Dai L, Xu Y, Yang Y, et al. Evaluating the characteristics, reporting and methodological quality of systematic reviews of acupuncture for low back pain by using the Veritas plot. J Pain Res. 2020;19(13):2633–52. https://doi.org/10.2147/JPR.S254234. .PMID: 33116806; PMCID: PMC7585549. Huang F, Qiu M, Zhao S, Dai L, Xu Y, Yang Y, et al. Evaluating the characteristics, reporting and methodological quality of systematic reviews of acupuncture for low back pain by using the Veritas plot. J Pain Res. 2020;19(13):2633–52. https://​doi.​org/​10.​2147/​JPR.​S254234. .PMID: 33116806; PMCID: PMC7585549.
26.
go back to reference Fuentes RC, Organ B, Creech J, Broszko CM, Nashelsky J. Acupuncture for low back pain. Can Fam Physician. 2020;66(3):186-187. PMID: 32165466; PMCID: PMC8302339 Fuentes RC, Organ B, Creech J, Broszko CM, Nashelsky J. Acupuncture for low back pain. Can Fam Physician. 2020;66(3):186-187. PMID: 32165466; PMCID: PMC8302339
27.
go back to reference Sung WS, Park JR, Park K, Youn I, Yeum HW, Kim S, et al. The effectiveness and safety of electroacupuncture for nonspecific chronic low back pain: a protocol for systematic review and/or meta-analysis. Medicine (Baltimore). 2021;100(4):e24281. https://doi.org/10.1097/MD.0000000000024281. PMID: 33530216; PMCID: PMC7850747. Sung WS, Park JR, Park K, Youn I, Yeum HW, Kim S, et al. The effectiveness and safety of electroacupuncture for nonspecific chronic low back pain: a protocol for systematic review and/or meta-analysis. Medicine (Baltimore). 2021;100(4):e24281. https://​doi.​org/​10.​1097/​MD.​0000000000024281​. PMID: 33530216; PMCID: PMC7850747.
29.
go back to reference McIntosh G, Hall H. Low back pain (acute). BMJ Clin Evid. 2011:1102. PMID: 21549023; PMCID: PMC3217769. McIntosh G, Hall H. Low back pain (acute). BMJ Clin Evid. 2011:1102. PMID: 21549023; PMCID: PMC3217769.
30.
go back to reference Liang YD, Li Y, Zhao J, Wang XY, Zhu HZ, Chen XH, et al. Study of acupuncture for low back pain in recent 20 years: a bibliometric analysis via CiteSpace. J Pain Res. 2017;24(10):951–64. https://doi.org/10.2147/JPR.S132808. PMID: 28479858; PMCID: PMC5411170. Liang YD, Li Y, Zhao J, Wang XY, Zhu HZ, Chen XH, et al. Study of acupuncture for low back pain in recent 20 years: a bibliometric analysis via CiteSpace. J Pain Res. 2017;24(10):951–64. https://​doi.​org/​10.​2147/​JPR.​S132808. PMID: 28479858; PMCID: PMC5411170.
31.
go back to reference Kong JC, Lee MS, Shin BC, et al. Randomized clinical trials on acupuncture in Korean literature: a systematic review. Evid Based Complement Alternat Med. 2009;6(1):41-8. https://doi.org/10.1093/ecam/nem130. Epub 2007 Oct 5. PMID: 18955298; PMCID: PMC2644266. Kong JC, Lee MS, Shin BC, et al. Randomized clinical trials on acupuncture in Korean literature: a systematic review. Evid Based Complement Alternat Med. 2009;6(1):41-8. https://​doi.​org/​10.​1093/​ecam/​nem130. Epub 2007 Oct 5. PMID: 18955298; PMCID: PMC2644266.
33.
go back to reference Liang FF, Chen WY, Chen B, Wang HH, Xu QG, Zhan HS, et al. Meta-analysis of the efficacy of acupuncture in the treatment of lower back pain [J]. Chin J Orthop. 2016,29(05):449-455. Liang FF, Chen WY, Chen B, Wang HH, Xu QG, Zhan HS, et al. Meta-analysis of the efficacy of acupuncture in the treatment of lower back pain [J]. Chin J Orthop. 2016,29(05):449-455.
34.
go back to reference Fang H, Dai HX, Yao JF, Zhu HW, Zhang Y, Chen XEM. Meta-analysis of wrist and ankle acupuncture in the treatment of low back pain[J]. Evid Based Nurs. 2022;8(09):1145–51. Fang H, Dai HX, Yao JF, Zhu HW, Zhang Y, Chen XEM. Meta-analysis of wrist and ankle acupuncture in the treatment of low back pain[J]. Evid Based Nurs. 2022;8(09):1145–51.
36.
go back to reference Fei J, Lin H, Zhang P, Liu L, Wang X, Shen J, et al. Meta-analysis of the effectiveness and safety of exercise acupuncture in the treatment of acute nonspecific low back pain [J/OL]. Chinese Gen Pract.1-10[2023-01-14]. Fei J, Lin H, Zhang P, Liu L, Wang X, Shen J, et al. Meta-analysis of the effectiveness and safety of exercise acupuncture in the treatment of acute nonspecific low back pain [J/OL]. Chinese Gen Pract.1-10[2023-01-14].
38.
go back to reference Dai X. Clinical study on the selection and efficacy evaluation of acupuncture treatment plan for lower back pain [D]. Liaoning University of Traditional Chinese Medicine. 2018. Dai X. Clinical study on the selection and efficacy evaluation of acupuncture treatment plan for lower back pain [D]. Liaoning University of Traditional Chinese Medicine. 2018.
41.
go back to reference Xiang Y, He JY, Tian HH, Cao BY, Li R. Evidence of efficacy of acupuncture in the management of low back pain: a systematic review and meta-analysis of randomised placebo- or sham-controlled trials. Acupunct Med. 2020;38(1):15–24. https://doi.org/10.1136/acupmed-2017-011445. Epub 2019 Sep 16 PMID: 31526013. Xiang Y, He JY, Tian HH, Cao BY, Li R. Evidence of efficacy of acupuncture in the management of low back pain: a systematic review and meta-analysis of randomised placebo- or sham-controlled trials. Acupunct Med. 2020;38(1):15–24. https://​doi.​org/​10.​1136/​acupmed-2017-011445. Epub 2019 Sep 16 PMID: 31526013.
44.
45.
go back to reference Wang L, Yin Z, Zhang Y, Sun M, Yu Y, Lin Y, et al. Optimal acupuncture methods for nonspecific low back pain: a systematic review and Bayesian network meta-analysis of randomized controlled trials. J Pain Res. 2021;20(14):1097–112. https://doi.org/10.2147/JPR.S310385. PMID: 33907457; PMCID: PMC8068518. Wang L, Yin Z, Zhang Y, Sun M, Yu Y, Lin Y, et al. Optimal acupuncture methods for nonspecific low back pain: a systematic review and Bayesian network meta-analysis of randomized controlled trials. J Pain Res. 2021;20(14):1097–112. https://​doi.​org/​10.​2147/​JPR.​S310385. PMID: 33907457; PMCID: PMC8068518.
47.
go back to reference Yang LH, Duan PB, Hou QM, Du SZ, Sun JF, Mei SJ, et al. Efficacy of auricular acupressure for chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2017;6383649. https://doi.org/10.1155/2017/6383649. Epub 2017 Jul 18. PMID: 28804504; PMCID: PMC5539928. Yang LH, Duan PB, Hou QM, Du SZ, Sun JF, Mei SJ, et al. Efficacy of auricular acupressure for chronic low back pain: a systematic review and meta-analysis of randomized controlled trials. Evid Based Complement Alternat Med. 2017;6383649. https://​doi.​org/​10.​1155/​2017/​6383649. Epub 2017 Jul 18. PMID: 28804504; PMCID: PMC5539928.
49.
go back to reference Wu B, Yang L, Fu C, Jian G, Zhuo Y, Yao M, et al. Efficacy and safety of acupuncture in treating acute low back pain: a systematic review and Bayesian network meta-analysis. Ann Palliat Med. 2021;10(6):6156–67. https://doi.org/10.21037/apm-21-551. Epub 2021 May 24 PMID: 34118845. Wu B, Yang L, Fu C, Jian G, Zhuo Y, Yao M, et al. Efficacy and safety of acupuncture in treating acute low back pain: a systematic review and Bayesian network meta-analysis. Ann Palliat Med. 2021;10(6):6156–67. https://​doi.​org/​10.​21037/​apm-21-551. Epub 2021 May 24 PMID: 34118845.
50.
go back to reference Li J. (Ricardo Tavares Valério). A systematic review and META analysis of acupuncture for acute lumbar sprains in the last 10 years [D]. Beijing University of Traditional Chinese Medicine. 2016. Li J. (Ricardo Tavares Valério). A systematic review and META analysis of acupuncture for acute lumbar sprains in the last 10 years [D]. Beijing University of Traditional Chinese Medicine. 2016.
51.
go back to reference Wang Y, Sun Y, Wu Y, Zhang J, Zhang Y. Meta-analysis of a clinical randomized controlled trial of electroacupuncture at Houxi point for acute lumbar sprain (in English)[J]. J Acupunct Tuina Sci. 2015,13(05):332-338. Wang Y, Sun Y, Wu Y, Zhang J, Zhang Y. Meta-analysis of a clinical randomized controlled trial of electroacupuncture at Houxi point for acute lumbar sprain (in English)[J]. J Acupunct Tuina Sci. 2015,13(05):332-338.
52.
go back to reference Tao L, Yang F, Zhang L, Li Jiao. Systematic evaluation and meta-analysis of internal heat acupuncture and other acupuncture therapies for low back pain[J]. Chin Traditional Chin Med Acute Care. 2021,30(11):1891-1896. Tao L, Yang F, Zhang L, Li Jiao. Systematic evaluation and meta-analysis of internal heat acupuncture and other acupuncture therapies for low back pain[J]. Chin Traditional Chin Med Acute Care. 2021,30(11):1891-1896.
53.
go back to reference Hu X. Systematic evaluation of “sports acupuncture” in the treatment of acute lumbar sprains [D]. Chengdu University of Traditional Chinese Medicine. 2015. Hu X. Systematic evaluation of “sports acupuncture” in the treatment of acute lumbar sprains [D]. Chengdu University of Traditional Chinese Medicine. 2015.
Metadata
Title
Acupuncture for Low Back Pain: Reevaluation of Systematic Reviews and Meta-analyses
Authors
Wen-xi Yan
Hui-ze Lin
Xiang Wang
Wei Zhang
Lan-ping Liu
Jin-na Yu
Tao Yang
Publication date
11-07-2023
Publisher
Springer US
Published in
Current Pain and Headache Reports / Issue 9/2023
Print ISSN: 1531-3433
Electronic ISSN: 1534-3081
DOI
https://doi.org/10.1007/s11916-023-01139-w

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