Acupuncture for the Management of Chronic Low Back Pain: A Systematic Review of Randomized Controlled Trials

Abstract

Introduction: Chronic low back pain (CLBP) is a leading cause of disability worldwide, with substantial socioeconomic impact. Acupuncture is a frequently used complementary therapy for pain management, but its effectiveness for CLBP remains a subject of debate. This systematic review synthesizes the evidence from randomized controlled trials (RCTs) on the efficacy of acupuncture for CLBP.

Methods: We searched PubMed, CENTRAL, and Scopus databases from inception to October 2025 for RCTs comparing acupuncture with sham acupuncture, no treatment, or standard care for adults with CLBP lasting more than 12 weeks. Primary outcomes were pain intensity and back-specific disability. Risk of bias was assessed using the Cochrane tool.

Results: Twenty-four RCTs with 5,432 participants were included. The analysis revealed that acupuncture was significantly more effective than no treatment and standard care in reducing pain intensity and disability at the end of treatment. Compared to sham acupuncture, true acupuncture provided a small but statistically significant benefit for pain relief (Mean Difference: -5.3 mm on a 100 mm VAS; 95% CI: -8.9 to -1.7). These effects were sustained at 6-month follow-up.

Discussion: The evidence suggests that acupuncture is an effective treatment for CLBP, providing modest but clinically relevant benefits. The difference between true and sham acupuncture is small, which may indicate that non-specific effects (e.g., placebo, patient-practitioner interaction) play a significant role in the therapeutic outcome. The safety profile of acupuncture was excellent, with only minor adverse events reported.

Conclusion: Acupuncture is a safe and effective option for the management of chronic low back pain and should be considered as a component of a multidisciplinary care plan.