Acupuncture for Chronic Non-specific Low Back Pain: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Chenlin Wang, Jian Ai, Xi Wang, Xujun Chen, Lianghua Chen, Yuan Lin, Dong LiBackground
This systematic review and meta-analysis evaluated the efficacy and safety of acupuncture for chronic non-specific low back pain (CNLBP).
Material and methods
We searched PubMed, Embase, Web of Science, EBSCO, and Cochrane Library for randomized controlled trials (RCTs) published from January 2000 to April 2025. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Random-effects meta-analyses and subgroup analyses were performed.
Results
Thirty-one RCTs were included: 27 trials (2779 participants) entered pooled analysis. Compared with controls, acupuncture significantly lowered Visual Analogue Scale (VAS) pain scores (MD = −1.36, 95% CI [−1.65, −1.07]) and Oswestry Disability Index (ODI) scores (MD = −6.70, 95% CI [−9.03, −4.38]). These improvements failed to reach the minimal clinically important difference (MCID). Potential publication bias was identified for the VAS outcome; in a trim-and-fill sensitivity analysis, the pooled effect was attenuated to MD = −0.68 (95% CI [−0.98, −0.38]) but remained statistically significant. Adverse-event risk did not differ significantly between groups. GRADE grading identified low to very low evidence quality due to methodological flaws and high cross-trial heterogeneity.
Conclusion
Acupuncture was associated with statistically detectable improvements in pain and functional impairment in patients with CNLBP and showed no clear increase in reported adverse events. However, its clinically meaningful advantages over active controls remain uncertain given the sub-MCID improvements. Given the substantial between-study heterogeneity, low certainty of evidence, and potential publication bias, these findings should be interpreted cautiously. Large, high-quality multicenter RCTs are needed to confirm its clinical efficacy and safety.