Acupuncture for Low Back Pain

Acupuncture, a traditional Chinese medicine technique involving the insertion of thin needles into specific points on the body, has been the subject of numerous clinical trials investigating its effectiveness in treating low back pain (LBP). LBP is a prevalent and debilitating condition affecting a significant portion of the global population, leading to substantial healthcare costs and reduced quality of life. Therefore, exploring alternative and complementary therapies like acupuncture for LBP management is of considerable clinical interest.

Protocols Studied in Research

[1] Hand-ear acupuncture and standard acupuncture for chronic low-back pain (cLBP). (Cited by: 5) (pmid: 32186108)

• Protocol: A randomized controlled trial (RCT) with 152 participants with cLBP randomly assigned to hand-ear acupuncture, standard acupuncture, or usual care. 18 treatments were given over 7 weeks. Outcomes were measured using RMDQ and VAS at baseline and 6 months post-treatment.
• Outcome: Hand-ear acupuncture showed significantly greater and more persistent improvement in cLBP compared to standard acupuncture and usual care, as measured by RMDQ and VAS scores at 6 months. The efficacy rate was substantially higher for hand-ear acupuncture.

[2] Manual acupuncture (MA) and electroacupuncture (EA) for chronic non-specific low back pain. (Cited by: 21) (pmid: 32224119)

• Protocol: A randomized controlled trial comparing MA and EA in 66 patients (20-60 years) with chronic low back pain (≥3 months duration, ≥3/10 pain). Participants received 12 sessions of either MA or EA.
• Outcome: Both MA and EA showed similar effectiveness in reducing pain and disability. MA showed a statistically significant reduction in kinesiophobia compared to EA. These effects were maintained at 3-month follow-up.

[3] Electroacupuncture at different frequencies for chronic low back pain in older adults. (Cited by: 2) (pmid: 36988362)

• Protocol: A triple-blind, placebo-controlled, randomized clinical trial with 125 elderly participants with chronic low back pain. Participants received either electroacupuncture at various frequencies, manual acupuncture, or placebo for five weeks.
• Outcome: No significant difference in pain reduction was found between electroacupuncture at different frequencies, manual acupuncture, and placebo. Placebo showed the best overall improvement in some secondary outcomes. The study concludes that electroacupuncture is not superior to manual acupuncture or placebo for this condition.

[4] Ear acupuncture for pregnancy-related lower back and posterior pelvic girdle pain (LBPGP). (Cited by: 12) (pmid: 31034580)

• Protocol: A four-group, multicenter, randomized controlled trial comparing verum, nonspecific, and placebo ear acupuncture plus standard obstetric care against standard obstetric care alone in 205 pregnant women (24-36 weeks gestation) with LBPGP. Midwives administered the acupuncture.
• Outcome: Verum ear acupuncture significantly reduced pain intensity, improved quality of life, and decreased functional disability compared to standard obstetric care alone at 2 weeks and 3 months postpartum.

[5] Electroacupuncture (real vs. sham) for chronic low back pain. (Cited by: 21) (pmid: 33107921)

• Protocol: A double-blind, randomized clinical trial of 121 adults with chronic low back pain received 12 sessions of real or sham electroacupuncture over 6 weeks. Pain intensity and disability were assessed before and after treatment.
• Outcome: No significant difference in pain intensity between real and sham electroacupuncture. Real electroacupuncture showed significantly greater reduction in disability compared to sham. Effective coping predicted better outcomes.

[6] Electroacupuncture of different frequencies for chronic low back pain in older adults. (Cited by: 0) (pmid: 37192255)

• Protocol: The abstract is missing, so no protocol details are available.
• Outcome: The abstract is missing, so no outcome details are available.

[7] Dry needling of muscle motor points for chronic low-back pain. (Cited by: 32) (pmid: 6446774)

• Protocol: A randomized clinical trial with long-term follow-up was conducted, but details on participants and intervention administration are unavailable due to the absence of an abstract.
• Outcome: No outcome information is available due to the absence of an abstract.

[8] Time method acupuncture (TA) + routine acupuncture (RA) for chronic low-back pain (cLBP). (Cited by: 4) (pmid: 24755566)

• Protocol: A randomized controlled trial (RCT) in a Beijing outpatient clinic compared RA alone vs. RA + TA in 60 participants with cLBP. Participants received acupuncture treatments according to assigned protocols.
• Outcome: Adding TA to RA significantly improved pain reduction (VAS scores), reduced the number of treatment sessions, decreased work absences, and lowered pain relapse rates at 12-week follow-up compared to RA alone.

[9] Tuina (TN), physiotherapy (PT), or a combination (TP) for Chronic nonspecific low back pain (CNLBP). (Cited by: 0) (pmid: 39395482)

• Protocol: A randomized, single-blind trial with 204 CNLBP patients received 6 sessions of TN, PT, or TP over 8 weeks. Outcomes were assessed at baseline, post-treatment (week 9), and 20-week follow-up.
• Outcome: All three interventions (TN, PT, TP) significantly reduced pain and improved disability scores, with effects lasting 20 weeks. No significant differences were found between the interventions.

[10] Dry needle acupuncture for chronic mechanical low back pain (CMLBP). (Cited by: 0) (pmid: 39081147)

• Protocol: A randomized controlled trial comparing dry needle acupuncture to muscle strengthening and stretching exercises in 30 adults (20-45 years) with CMLBP. Outcomes measured included pain, functional impairment, and lumbar range of motion.
• Outcome: Dry needle acupuncture showed significantly greater improvement in pain intensity, functional disability, and lumbar range of motion compared to exercise, suggesting its efficacy in treating CMLBP.

[11] Cupping and scraping therapy with medicated balm for chronic nonspecific low-back pain (CNLBP). (Cited by: 0) (pmid: 38311541)

• Protocol: A prospective, multicenter randomized controlled trial (RCT) comparing cupping/scraping with a medicated balm versus diclofenac/capsaicin plaster in 156 CNLBP patients over one week.
• Outcome: Cupping and scraping therapy showed significantly greater improvements in pain (VAS), quality of life (JOA), and TCM symptoms (TCMS) compared to the control group, with no adverse events reported.

[12] Invasive laser acupuncture (ILA) at 650nm and 830nm wavelengths for chronic non-specific low back pain (CNLBP). (Cited by: 4) (pmid: 35639723)

• Protocol: A randomized, placebo-controlled trial with 45 participants assigned to sham laser, 650nm ILA, or 830nm ILA groups. Participants received 10 minutes of ILA followed by 10 minutes of electroacupuncture twice weekly for four weeks.
• Outcome: 650nm ILA showed significant improvements in pain and functional disability compared to the control group. 830nm ILA showed significant improvement in functional disability. No adverse events were reported.

[13] Laser acupuncture therapy (LAT) for postpartum low back pain (LBP). (Cited by: 0) (pmid: 36058819)

• Protocol: A prospective randomized controlled trial (RCT) assigned postpartum women with LBP to either LAT plus standard care or standard care alone. Outcomes were assessed using various scales and salivary cortisol.
• Outcome: LAT combined with standard care significantly reduced LBP intensity, limitations in daily activities and physical activity, perceived stress, and salivary cortisol levels compared to standard care alone.

[14] Motion style acupuncture treatment (MSAT) combined with integrative Korean medicine (IKM) for acute low back pain (aLBP) due to road traffic accidents. (Cited by: 0) (pmid: 38513746)

• Protocol: A pragmatic, randomized controlled trial comparing IKM with and without 3 days of MSAT in 96 aLBP inpatients. Participants were followed for 90 days.
• Outcome: MSAT combined with IKM significantly reduced low back pain (NRS scores) compared to IKM alone, improving range of motion in patients with aLBP.

[15] Fu's subcutaneous needling (FSN) for chronic non-specific low back pain (LBP). (Cited by: 0) (pmid: 39214379)

• Protocol: A randomized controlled trial comparing FSN to traditional acupuncture (TA) in 90 participants with chronic LBP. Treatment involved three consecutive days of either FSN or TA. Outcomes were assessed before, after each treatment day, and one month later.
• Outcome: FSN demonstrated significantly greater improvements in pain intensity, fear-avoidance beliefs, trunk extensor endurance, and lumbar range of motion compared to TA, persisting one month post-treatment. FSN is suggested as an effective treatment for chronic LBP.

[16] Catgut-embedding acupuncture for functional anorectal pain (FAP). (Cited by: 0) (pmid: 37933076)

• Protocol: A randomized controlled trial compared catgut-embedding acupuncture to sham acupuncture in 71 FAP patients. Treatment involved two sessions per month for two months. Outcomes included pain scores, anal incontinence, and quality of life.
• Outcome: Catgut-embedding acupuncture showed significantly greater improvement in pain, quality of life, and other measures compared to sham acupuncture, with no adverse effects reported. The treatment was highly effective.

[17] Acupuncture (4, 7, or 10 sessions) for chronic low back pain. (Cited by: 12) (pmid: 28459161)

• Protocol: A randomized controlled feasibility trial of 45 participants with chronic low back pain. Participants received usual care plus a varying number of acupuncture sessions. Outcomes were assessed at multiple time points.
• Outcome: The study demonstrated the feasibility of a larger RCT. While most outcomes showed no significant differences between groups, the 10-session acupuncture group showed superior results on most secondary outcomes at 12 weeks, suggesting a dose-response relationship. High participant satisfaction was reported.

[18] Baduanjin exercise for chronic nonspecific low back pain (CNLBP). (Cited by: 0) (pmid: 37904426)

• Protocol: A randomized controlled trial comparing Baduanjin exercise to walking in 60 CNLBP patients. Participants underwent 4 weeks of intervention (5 sessions/week). Pain, disability, and electromyographic muscle activity were assessed.
• Outcome: Baduanjin exercise significantly reduced pain and disability compared to walking, improving lumbar erector spinae muscle strength and flexibility. Electromyography data supported these findings.

[19] Trigger point acupuncture for chronic non-specific low back pain (CNLBP). (Cited by: 2) (pmid: 36760118)

• Protocol: A randomized, single-blind trial with 33 participants (11 per group) compared trigger point acupuncture, traditional acupuncture, and a waiting list control. Treatment lasted 4 weeks (3x/week).
• Outcome: Trigger point acupuncture provided short-term (4 weeks) pain relief and improved disability in CNLBP patients compared to the control group. However, these effects were not sustained at 8 weeks.

[20] Hand-pressed pellet therapy for chronic lower back pain (CLBP) in elderly individuals. (Cited by: 0) (pmid: 38702676)

• Protocol: A six-week randomized controlled trial comparing hand-pressed pellet therapy to a placebo in 51 elderly (≥65) CLBP patients from welfare centers. The intervention targeted eleven acupressure points related to CLBP.
• Outcome: Hand-pressed pellet therapy significantly reduced pain intensity (VAS), improved pain pressure threshold, and decreased disability (K-ODI) compared to the placebo group, indicating effectiveness in alleviating CLBP.

[21] Classical massage therapy (KMT) and acupuncture (AKU) for chronic, unspecific back pain. (Cited by: 4) (pmid: 30321900)

• Protocol: A randomized controlled non-inferiority trial comparing KMT (n=66) to AKU (n=66) in patients with chronic back pain. Outcomes measured at one-month follow-up using the Hannover Function Questionnaire (HFAQ) and the Von Korff pain questionnaire.
• Outcome: Classical massage was not shown to be non-inferior to acupuncture in reducing pain and functional impairment. The study failed to demonstrate non-inferiority within the defined margin.

[22] Dry cupping therapy for persistent nonspecific low back pain. (Cited by: 1) (pmid: 35770601)

• Protocol: A randomized controlled trial (RCT) compared dry cupping to sham cupping in 37 participants with persistent low back pain. Treatment involved five 10-minute sessions twice weekly, targeting specific acupoints. Pain (VAS) and disability (ODI) were assessed.
• Outcome: Dry cupping showed significantly greater improvement in pain compared to sham cupping at both post-treatment and follow-up. While initially showing improved functional disability, this difference was not sustained at follow-up.

[23] Acupuncture versus sham acupuncture for low back pain. (Cited by: 0) (pmid: 16932721)

• Protocol: The provided abstract contains no information to summarize the study design, participants, or intervention administration.
• Outcome: The provided abstract contains no information to summarize the study findings or conclusions.

[24] Trigger point acupuncture plus exercise for chronic low back pain in older adults. (Cited by: 3) (pmid: 35770581)

• Protocol: A randomized controlled trial compared exercise plus trigger point acupuncture (Ex+TrPAcp) to exercise alone (Ex) in 14 older adults (≥65 years) with chronic low back pain for at least 3 months. Interventions lasted 3 months.
• Outcome: Ex+TrPAcp showed significantly greater improvement in pain intensity (measured by NRS) compared to Ex alone. One participant in the Ex+TrPAcp group reported mild adverse effects from acupuncture.

[25] Electronic Acupuncture Shoes (EAS) for chronic low back pain. (Cited by: 6) (pmid: 33104004)

• Protocol: A double-blinded, randomized controlled trial compared EAS plus placebo NSAIDs to sham EAS plus NSAIDs in 83 patients with chronic low back pain over 20 visits (6 weeks). Pain, range of motion, and quality of life were assessed.
• Outcome: While EAS showed a higher treatment success rate and greater pain reduction than NSAIDs alone at some visits, statistically significant differences were limited and not consistently observed across all assessments. EAS may be a viable alternative for patients unable to tolerate NSAIDs.

[26] Electroacupuncture (EA) and diclofenac sodium for low back pain (LBP) in athletes. (Cited by: 4) (pmid: 32429680)

• Protocol: A randomized controlled trial comparing EA, sham EA, and diclofenac sodium in athletes with acute or chronic LBP. Pain scores (VAS) and serum catecholamine levels were measured. In vitro TNF-alpha production was also assessed.
• Outcome: EA induced epinephrine release, activating the sympathetic nervous system. While EA and diclofenac provided similar pain relief, in vitro data suggested epinephrine and norepinephrine reduced inflammation.

[27] Hegu acupuncture and Standard acupuncture for Chronic Low Back Pain (CLBP). (Cited by: 11) (pmid: 22339101)

• Protocol: A randomized controlled trial comparing Hegu acupuncture, Standard acupuncture, and Usual Care in 187 CLBP patients. 18 treatments were given over 7 weeks. RMDQ and VAS scores measured outcomes.
• Outcome: Both acupuncture types showed significantly better outcomes than usual care at 8 and 48 weeks. Hegu acupuncture was superior to Standard acupuncture, particularly at 48 weeks.

[28] Low-level laser acupuncture combined with auricular acupressure (LAA) for low-back pain (LBP) in nurses. (Cited by: 4) (pmid: 36402666)

• Protocol: A randomized controlled trial comparing LAA to sham laser acupuncture in 76 Taiwanese nurses with LBP. The LAA group received treatment for 4 weeks. Pain and quality of life were assessed at baseline, 2 weeks, and 4 weeks.
• Outcome: LAA significantly reduced pain intensity and interference, and improved quality of life compared to sham treatment. These benefits persisted for at least 4 weeks post-intervention, with lower LBP recurrence rates in the LAA group.

[29] Minimal acupuncture treatment for chronic low back pain (CLBP). (Cited by: 7) (pmid: 35594274)

• Protocol: A randomized controlled trial (RCT) with 142 CLBP patients (pain ≥4/10 on NRS) receiving 8 acupuncture sessions over 4 weeks. Pre-treatment expectations were assessed using the Expectation for Treatment Scale (ETS).
• Outcome: Higher pre-treatment expectations correlated with greater pain reduction after four sessions, but this effect wasn't sustained after the full eight sessions. The effect was similar in males and females.

[30] LSM-01 orthopedic device for low back pain due to muscle tension. (Cited by: 0) (pmid: 36316867)

• Protocol: A randomized, single-blinded, sham-controlled pilot trial with 30 participants. Participants received 6 treatments over 2 weeks (2-3 times weekly). Primary outcome was VAS; secondary outcomes included PPT, ODI, and PGIC.
• Outcome: LSM-01 significantly reduced low back pain (VAS, PPT, PGIC) compared to the sham device, with no reported side effects. Results support a larger-scale trial.

[31] LSM-01 orthopedic device for low back pain. (Cited by: 1) (pmid: 35060507)

• Protocol: A randomized, single-blinded, sham-controlled pilot trial (2 weeks) comparing LSM-01 to a sham device in participants with low back pain. Primary outcome: visual analog scale (VAS) pain score.
• Outcome: This abstract describes the study protocol, not the results. The study aims to assess the safety and efficacy of LSM-01 and will inform a larger future trial.

[32] Ma's bamboo-based medicinal moxibustion (MBMM) for low back pain in lumbar disc herniation (LDH). (Cited by: 1) (pmid: 38803694)

• Protocol: A two-center, randomized, controlled, non-inferiority trial comparing MBMM to acupuncture in 312 LDH patients. Primary outcome was 14-day change in Visual Analogue Scale (VAS) score.
• Outcome: MBMM was non-inferior to acupuncture in reducing low back pain. MBMM showed potential post-treatment advantages in improving lumbar function and daily living, demonstrating safety and efficacy as an alternative LDH treatment.

[33] Head acupuncture combined with exercise therapy for nonspecific low back pain. (Cited by: 0) (pmid: 35543941)

• Protocol: A randomized controlled trial comparing head acupuncture plus exercise therapy to conventional acupuncture in 62 patients with nonspecific low back pain. Treatments were administered for 14 days over a 2-week period.
• Outcome: Head acupuncture combined with exercise therapy demonstrated superior pain relief, functional improvement, and increased local temperature compared to conventional acupuncture for nonspecific low back pain.

[34] Fateh massage, acupuncture, and physiotherapy for chronic low back pain (CLBP). (Cited by: 1) (pmid: 35770546)

• Protocol: A randomized controlled trial compared the effectiveness of Fateh massage, acupuncture, and physiotherapy on 84 CLBP patients (28 per group). Each group received 10 therapy sessions. Pain and disability were measured using VAS and Roland-Morris scores.
• Outcome: All three interventions significantly reduced pain and disability in CLBP patients. No significant differences were found between the three treatment groups in their effectiveness.

[35] Acupuncture and myofascial meridian stretching exercises for acute/subacute low back pain. (Cited by: 1) (pmid: 36537117)

• Protocol: A randomized controlled trial (RCT) with 81 participants assigned to acupuncture, myofascial meridian stretching, or control groups. Interventions were administered for six weeks, with assessments at baseline, two, and six weeks.
• Outcome: Both acupuncture and myofascial meridian stretching showed significant improvements in pain and disability scores compared to the control group, particularly within the first two weeks. Stretching showed greater improvement in lumbar range of motion.

[36] Battlefield acupuncture (BFA) for low back pain in emergency department patients. (Cited by: 2) (pmid: 34364702)

• Protocol: A non-blinded randomized controlled trial compared BFA to standard pharmacologic treatment in adult ED patients with low back pain. Pain reduction was the primary outcome.
• Outcome: BFA demonstrated a statistically non-significant trend towards greater pain reduction compared to standard pharmacologic treatment at 30-40 minutes post-intervention, with no adverse events reported. Further research is warranted.

[37] Bee venom acupuncture (BVA) for chronic low back pain (CLBP). (Cited by: 26) (pmid: 29112155)

• Protocol: A randomized, double-blind, sham-controlled trial with 54 patients receiving six sessions of BVA or sham BVA over three weeks, alongside daily loxonin. Outcomes were assessed weekly during treatment and at follow-up points.
• Outcome: BVA demonstrated significantly greater improvement in pain bothersomeness, intensity, and functional status compared to sham treatment after three weeks. Minimal adverse events resolved without intervention. BVA is suggested as a potential adjunct to conventional CLBP treatment.

[38] Acupuncture plus interlaminar epidural steroid injection for low back pain due to low-grade spondylolisthesis. (Cited by: 8) (pmid: 24693959)

• Protocol: A randomized controlled pilot trial (14 participants) compared acupuncture plus interlaminar epidural steroid injections to injections alone. Treatment lasted five weeks, with injections administered weekly for three weeks and acupuncture sessions (experimental group only) thrice weekly for three weeks.
• Outcome: This pilot study aimed to determine the feasibility and safety of adding acupuncture to existing pain management for low-grade spondylolisthesis, providing data to inform a larger-scale trial. No specific outcome results from the trial are reported in this abstract.

[39] Yamamoto's scalp acupuncture for acute non-specific low back pain (ANLBP). (Cited by: 17) (pmid: 24316509)

• Protocol: A randomized, double-blind, placebo-controlled trial compared Yamamoto's acupuncture (intervention group) to sham acupuncture (control group) in 80 ANLBP patients over 28 days with five treatment sessions.
• Outcome: Yamamoto's acupuncture demonstrated significantly greater improvements in pain, function, quality of life, and reduced anti-inflammatory medication use compared to sham acupuncture, although the primary endpoint (≥2 cm VAS reduction) wasn't met.

[40] Climbing intervention for chronic low back pain. (Cited by: 11) (pmid: 26247548)

• Protocol: A prospective randomized controlled trial compared climbing (10 sessions over 8 weeks) to no treatment in 30 participants (18-45 years old, BMI <25, no prior climbing experience). Outcomes were assessed using Oswestry Disability Index, VAS, Likert scale, and MRI.
• Outcome: Climbing significantly improved Oswestry Disability Index scores and VAS scores in minimal finger-floor-distance position compared to the control group. MRI showed reduced disc protrusion size in the climbing group, suggesting climbing may be an effective, low-cost treatment option.

Research Interpretation: Summary and Conclusion

The reviewed studies employed diverse acupuncture techniques (manual, electroacupuncture, ear acupuncture, dry needling, laser acupuncture, etc.) and protocols, varying in treatment duration, frequency, and specific acupoints targeted. While several studies demonstrated significant pain reduction and improved functional disability with various acupuncture modalities compared to controls (placebo, usual care, or other interventions), others found no significant differences between real and sham acupuncture or compared to other treatments. Consistent findings suggest that acupuncture may offer benefits for low back pain, but the optimal type, duration, and intensity of treatment remain unclear. The significant heterogeneity in study designs and outcomes highlights the need for larger, well-designed, standardized trials to definitively establish the efficacy and optimal application of acupuncture for low back pain. Furthermore, patient expectations and coping mechanisms appear to influence treatment outcomes in some studies. Finally, some studies suggest a potential dose-response relationship, indicating that a greater number of sessions may lead to improved outcomes.

Publications

[1] Luo Y; Yang M; Liu T; Zhong X; Tang W; Guo M; Hu Y (2019). Effect of hand-ear acupuncture on chronic low-back pain: a randomized controlled trial Journal of traditional Chinese medicine = Chung i tsa chih ying wen pan 39 (4) :587-598.

[2] Comachio J; Oliveira CC; Silva IFR; Magalhaes MO; Marques AP (2020). Effectiveness of Manual and Electrical Acupuncture for Chronic Non-speci fi c Low Back Pain: A Randomized Controlled Trial Journal of acupuncture and meridian studies 13 (3) :87-93.

[3] Torres SF; de Macedo ACB; Sakai RY; Bressan GCS; Dos Santos MBR; Marques AP (2023). Effect of Different Frequencies of Electroacupuncture on Chronic Low Back Pain in Older Adults: A Triple-blind, Placebo-controlled, Randomized Clinical Trial Pain physician 26 (2) :161-173.

[4] Vas J; Cintado MC; Aranda-Regules JM; Aguilar I; Rivas Ruiz F (2019). Effect of ear acupuncture on pregnancy-related pain in the lower back and posterior pelvic girdle: A multicenter randomized clinical trial Acta obstetricia et gynecologica Scandinavica 98 (10) :1307-1317.

[5] Kong JT; Puetz C; Tian L; Haynes I; Lee E; Stafford RS; Manber R; Mackey S (2020). Effect of Electroacupuncture vs Sham Treatment on Change in Pain Severity Among Adults With Chronic Low Back Pain: A Randomized Clinical Trial JAMA network open 3 (10) :e2022787.

[6] Cheng Y; Yang Y; Yang L (2023). Comments on "Effect of Different Frequencies of Electroacupuncture on Chronic Low Back Pain in Older Adults: A Triple-blind, Placebo-controlled, Randomized Clinical Trial" Pain physician 26 (3) :E246-E247.

[7] Gunn CC; Milbrandt WE; Little AS; Mason KE (1980). Dry needling of muscle motor points for chronic low-back pain: a randomized clinical trial with long-term follow-up Spine 5 (3) :279-91.

[8] Bahrami-Taghanaki H; Liu Y; Azizi H; Khorsand A; Esmaily H; Bahrami A; Xiao Zhao B (2014). A randomized, controlled trial of acupuncture for chronic low-back pain Alternative therapies in health and medicine 20 (3) :13-9.

[9] Ma Q; Zhou X; Liang H; Guo Y; He K; Shen L; Fan Q; Yang J; Celia TIC; Bauer BA; Chen J (2024). Tuina versus physiotherapy or a combination of both for the management of chronic nonspecific low back pain: A randomized controlled trial Complementary therapies in medicine 86 :103098.

[10] Alrawaili SM; Elshiwi AM; Sulieman A; Azab AR; Ezzat W; Abdelbasset WK; Koura GM (2024). Short-term effect of acupuncture dry needle in treatment of chronic mechanical low back pain: a randomized controlled clinical trial European review for medical and pharmacological sciences 28 (14) :3973-3981.

[11] He JY; Tu XY; Yin ZF; Mu H; Luo MJ; Chen XY; Cai WB; Zhao X; Peng C; Fang FF; Lu C; Li B (2024). Short-term effects of cupping and scraping therapy for chronic nonspecific low-back pain: A prospective, multicenter randomized trial Journal of integrative medicine 22 (1) :39-45.

[12] Kim JH; Na CS; Cho MR; Park GC; Lee JS (2022). Efficacy of invasive laser acupuncture in treating chronic non-specific low back pain: A randomized controlled trial PloS one 17 (5) :e0269282.

[13] Cheng HY; Wu BY; Tung TH; Shieh C; Liu CT (2023). Laser Acupuncture Analgesia on Postpartum Low Back Pain: A Prospective Randomized Controlled Study Pain management nursing : official journal of the American Society of Pain Management Nurses 24 (1) :89-95.

[14] Kwon OB; Hwang DW; Kang DH; Yoo SJ; Lee DH; Kwon M; Jang SW; Cho HW; Kim SD; Park KS; Kim ES; Lee YJ; Kim D; Ha IH (2024). Effectiveness of lumbar motion style acupuncture treatment on inpatients with acute low back pain: A pragmatic, randomized controlled trial Complementary therapies in medicine 82 :103035.

[15] Zhang DQ; Fu ZH; Sun J; Song YJ; Chiu PE; Chou LW (2024). Effects of Fu's subcutaneous needling on clinical efficacy and psychological cognitive characteristics in patients with chronic non-specific low back pain: A randomized controlled trial Complementary therapies in medicine 85 :103080.

[16] Li J; Sun Y; Zhang C; Thomas K; Lin W; Cheng C; Li H; Zhu Q; Ma S; Hua Q; Shi Q; Zheng X (2023). A randomized, controlled clinical trial of acupoint catgut embedding as an effective control of functional anorectal pain Medicine 102 (44) :e35462.

[17] Liu L; Skinner MA; McDonough SM; Baxter GD (2017). Acupuncture for chronic low back pain: a randomized controlled feasibility trial comparing treatment session numbers Clinical rehabilitation 31 (12) :1592-1603.

[18] Yang D; Huang H; Xu DD; Zhao Y (2023). Effects of Baduanjin exercise on patients with chronic nonspecific low back pain and surface electromyography signs of erector spinal muscle: A randomized controlled trial Medicine 102 (43) :e35590.

[19] Liu H; Li YP; Hou MJ; Huang WJ; Chen XL; Gao Z; Jiang Z (2023). Effect of trigger point acupuncture on pain and functional activity in patients with chronic non-specific low back pain: a randomised controlled trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 41 (3) :130-141.

[20] Park H; Lee H (2024). Effects of hand-press pellet on pain and daily life of elders with chronic lower back pain: randomized controlled trial BMC complementary medicine and therapies 24 (1) :182.

[21] Klassen E; Wiebelitz KR; Beer AM (2019). Classical Massage and Acupuncture in Chronic Back Pain - Non-Inferiority Randomised Trial Zeitschrift fur Orthopadie und Unfallchirurgie 157 (3) :263-269.

[22] Salemi MM; Gomes VMDSA; Bezerra LMR; Melo TMS; Alencar GG; Montenegro IHPM; Calado APM; Montenegro EJN; Siqueira GR (2021). Effect of Dry Cupping Therapy on Pain and Functional Disability in Persistent Non-Specific Low Back Pain: A Randomized Controlled Clinical Trial Journal of acupuncture and meridian studies 14 (6) :219-230.

[23] Clauw DJ; Harris RE (2006). Is acupuncture more effective than sham acupuncture in relieving pain in patients with low back pain? Nature clinical practice. Rheumatology 2 (7) :362-3.

[24] Minakawa Y; Miyazaki S; Waki H; Yoshida N; Iimura K; Itoh K (2022). Trigger Point Acupuncture and Exercise for Chronic Low Back Pain in Older Adult: a Preliminary Randomized Clinical Trial Journal of acupuncture and meridian studies 15 (2) :143-151.

[25] Yeh BY; Liu GH; Lee TY; Wong AM; Chang HH; Chen YS (2020). Efficacy of Electronic Acupuncture Shoes for Chronic Low Back Pain: Double-Blinded Randomized Controlled Trial Journal of medical Internet research 22 (10) :e22324.

[26] Arriaga-Pizano L; Gomez-Jimenez DC; Flores-Mejia LA; Perez-Cervera Y; Solorzano-Mata CJ; Lopez-Macias C; Isibasi A; Torres-Rosas R (2020). Low back pain in athletes can be controlled with acupuncture by a catecholaminergic pathway: clinical trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 38 (6) :388-395.

[27] Yun M; Shao Y; Zhang Y; He S; Xiong N; Zhang J; Guo M; Liu D; Luo Y; Guo L; Yan J (2012). Hegu acupuncture for chronic low-back pain: a randomized controlled trial Journal of alternative and complementary medicine (New York, N.Y.) 18 (2) :130-6.

[28] Yang HH; Chung YC; Szeto PP; Yeh ML; Lin JG (2023). Laser acupuncture combined with auricular acupressure improves low-back pain and quality of life in nurses: A randomized controlled trial Journal of integrative medicine 21 (1) :26-33.

[29] Zieger A; Kern A; Barth J; Witt CM (2022). Do patients' pre-treatment expectations about acupuncture effectiveness predict treatment outcome in patients with chronic low back pain? A secondary analysis of data from a randomised controlled clinical trial PloS one 17 (5) :e0268646.

[30] Park CH; Kang JH (2022). Efficacy and safety assessment of orthopedic device (LSM-01) for low back pain: A randomized, single-blinded, sham-controlled, parallel-group, pilot clinical trial Medicine 101 (43) :e31068.

[31] Won ES; Lee H; Kang JH (2022). Effectiveness and safety assessment of orthopedic device (LSM-01) for low back pain: A randomized, single-blinded, sham-controlled, parallel-group, pilot clinical trial Medicine 101 (3) :e28527.

[32] Xue K; Wang X; Xiao C; Zhang N; Liu M; Fu J; Cui J (2024). Clinical Efficacy and Safety of a Modified Moxibustion Therapy for Low Back Pain in Lumbar Disc Herniation: A Two-Center, Randomized, Controlled, Non-Inferiority Trial Journal of pain research 17 :1853-1865.

[33] Sun MM; Mao X; Liu JT; Lv T; Zhu PY (2022). [Head acupuncture combined with exercise therapy for nonspecific low back pain：a randomized controlled trial] Zhongguo zhen jiu = Chinese acupuncture & moxibustion 42 (5) :511-4.

[34] Namiranian P; Karimi M; Razavi SZE; Garoos AF; Ayati MH (2022). Comparison of an Iranian Traditional Massage (Fateh Method) with Physiotherapy and Acupuncture for Patients with Chronic Low Back Pain: a Randomized Controlled Trial Journal of acupuncture and meridian studies 15 (3) :163-173.

[35] Buyuksireci DE; Demirsoy N; Mit S; Gecioglu E; Onurlu I; Gunendi Z (2022). Comparison of the Effects of Myofascial Meridian Stretching Exercises and Acupuncture in Patients with Low Back Pain Journal of acupuncture and meridian studies 15 (6) :347-355.

[36] Johnston K; Bonjour T; Powell J; April MD (2021). Battlefield Acupuncture Versus Standard Pharmacologic Treatment of Low Back Pain in the Emergency Department: A Randomized Controlled Trial The Journal of emergency medicine 61 (4) :406-415.

[37] Seo BK; Han K; Kwon O; Jo DJ; Lee JH (2017). Efficacy of Bee Venom Acupuncture for Chronic Low Back Pain: A Randomized, Double-Blinded, Sham-Controlled Trial Toxins 9 (11).

[38] Lee HJ; Seo JC; Kwak MA; Park SH; Min BM; Cho MS; Shin I; Jung JY; Roh WS (2014). Acupuncture for low back pain due to spondylolisthesis: study protocol for a randomized controlled pilot trial Trials 15 :105.

[39] Hasegawa TM; Baptista AS; de Souza MC; Yoshizumi AM; Natour J (2014). Acupuncture for acute non-specific low back pain: a randomised, controlled, double-blind, placebo trial Acupuncture in medicine : journal of the British Medical Acupuncture Society 32 (2) :109-15.

[40] Schinhan M; Neubauer B; Pieber K; Gruber M; Kainberger F; Castellucci C; Olischar B; Maruna A; Windhager R; Sabeti-Aschraf M (2016). Climbing Has a Positive Impact on Low Back Pain: A Prospective Randomized Controlled Trial Clinical journal of sport medicine : official journal of the Canadian Academy of Sport Medicine 26 (3) :199-205.