​Chronic Low Back Pain

Low back pain (LBP) is a common musculoskeletal disorder among adults and approximately 1 in 4 people seek medical attention in a 6-month period. 1 It has been estimated that around 50% of the population will experience LBP by the age of 30, whereas 70% of the population will experience LBP at one point in their adulthood. 1 The majority of symptoms resolve within 1 month, but between 10% and 40% of patients develop chronic symptoms lasting more than 6 weeks.1 In many cases the underlying cause of the pain is unknown, a condition referred to as non-specific chronic low back pain (NSCLBP).

A systematic review published in 2013 concluded: “Acupuncture may be effective for pain and functional limitation in chronic non-specific lower back pain”.1

In 2017, The American College of Physicians updated their clinical practice guidelines, making a strong recommendation for the use of acupuncture in both chronic and acute low back pain.2
Numerous systematic reviews on acupuncture for chronic low back pain have been conducted in USA by the Assessment of Health Research Quality (AHRQ)3, The Institute for Clinical and Economic Review (ICER)4, The American College of Physicians5, in Europe by The European Spine Society6 and in New Zealand by the Accident Compensation Corporation (ACC)7. Acupuncture has been consistently found to improve both pain and function in chronic low back pain, when used either alone or as an adjunct to conventional care. Acupuncture has been found to be a cost-effective treatment option8 and electroacupuncture has been found to be more cost effective than non-steroidal anti-inflammatory medications (NSAIDS).9 Acupuncture may also reduce the need for lumbar surgery.10

The U.S. Centers for Medicare & Medicaid Services is currently conducting a National Coverage Analysis for acupuncture in the treatment of chronic low back pain, to decide whether Medicare should cover acupuncture for chronic low back pain for 16 million US senior citizens. Their research found 8 systematic reviews/ meta-analyses undertaken in the previous five years studying acupuncture for chronic low back pain and all 8 found acupuncture to be effective. 11

References
1. Lam M, Galvin R, Curry P. Effectiveness of acupuncture for nonspecific chronic low back pain: a systematic review and meta-analysis. Spine (Phila Pa 1976). 2013;38(24):2124-38.
2. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine. 2017;166(7):514-30.
3. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. AHRQ Comparative Effectiveness Reviews. Noninvasive Treatments for Low Back Pain. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016.
4. Institute for Clinical and Economic Review (2017) Cognitive and Mind-Body Therapies for Chronic Low Back and Neck Pain: Effectiveness and Value – Final Evidence Report https://icerreview.org/wpcontent/uploads/2017/03/CTAF_LBNP_Final_Evidence_Report_110617.pdf
5. Chou R, Deyo R, Friedly J, Skelly A, Hashimoto R, Weimer M, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Annals of internal medicine. 2017;166(7):493-505.
6. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791-803.
7. The International Centre for Allied Health Evidence (2018). Effectiveness and Safety of Acupuncture Interventions for the Treatment of Musculoskeletal Conditions. Technical Report. Prepared for the Accident Compensation Corporation, New Zealand. https://www.acc.co.nz/assets/research/2b0c243f75/acupuncture-musculoskeletal-conditions-review.pdf
8. Andronis L, Kinghorn P, Qiao S, Whitehurst DG, Durrell S, McLeod H. Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Applied health economics and health policy. 2016.
9. Toroski M, Nikfar S, Mojahedian MM, Ayati MH. Comparison of the Cost-utility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugs in the Treatment of Chronic Low Back Pain. Journal of acupuncture and meridian studies. 2018;11(2):62-6.
10. Koh W, Kang K, Lee YJ, Kim MR, Shin JS, Lee J, et al. Impact of acupuncture treatment on the lumbar surgery rate for low back pain in Korea: A nationwide matched retrospective cohort study. PloS one. 2018;13(6):e0199042.
11. Centers for Medicare & Medicaid Services. Proposed National Coverage Determination for Acupuncture for Chronic Low Back Pain (CAG-00452N) July 15th, 2019. https://www.cms.gov/medicare-coverage-database/details/nca-proposed-decision-memo.aspx?NCAId=295