Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis

Baroncini, Alice; Maffulli, Nicola; Eschweiler, Jörg; Molsberger, Friedrich; Klimuch, Alexandra; Migliorini, Filippo

doi:10.1186/s13018-022-03212-3

Journal of Orthopaedic Surgery and Research

Table 1 Generalities and patient baseline of the included studies

From: Acupuncture in chronic aspecific low back pain: a Bayesian network meta-analysis

Author, year	Journal	Treatment	Type of protocol	Patients (n)	Follow-up (months)	Mean age	Women (%)	Mean BMI
Brinkhaus et al. [15]	Arch Intern Med	Individualized	12 sessions of 30 min over 8 weeks (2 sessions in each of the first 4 weeks, followed by 1 session per week in the remaining 4 weeks)	147	13	59.1	64	26.7
		Sham		75		58.2	75	26.2
		Control	Patients in the waiting list group did not receive acupuncture treatment for 8 weeks after randomization	79		58.9	68	26.9
Camilotti et al. [16]	Fisioter. Mov	Physiotherapy/ Aquatic Therapy	Twice a week	15		61.7		27.8
		Auricular/scalp/standardized	Twice a week	15		57.3		27.6
		Control		14		61.2		28.7
Ceccherelli et al. [17]	The Clinical Journal of Pain	Standardized	8 sessions for 20 min; the first four sessions were carried out in 2 weeks, whereas the remaining four sessions were carried out once per week	21	3	41.7	24
Ceccherelli et al. [17]	The Clinical Journal of Pain	Individualized		21	3	41.6	33
Cherkin et al. [18]	Arch Intern Med	Individualized	Up to 10 massages or acupuncture treatments over 10 weeks were permitted	94	12	45.3	52
		Control		78		45.7	69
		Control		90		43.8	56
Cherkin et al. [19]	Arch Intern Med	Individualized	2 treatments weekly for 3 weeks; then once weekly for 4 weeks	157	13	47.0	68
		Standardized		158		49.0	56
		Sham		162		47.0	60
		Usual care	Patients received no study-related care; just the care, if any, they and their physicians chose (mostly medications, primary care, and physical therapy visits)	161		46.0	64
Cho et al. [20]	Spine	Individualized	12 acupuncture sessions (approximately 2 times a week for 6 weeks)	65	6	42.4	83	23.9
Cho et al. [20]	Spine	Sham		65	6	41.8	86	24.2
Comachio et al. [21]	Journal of Acupuncture and Meridian Studies	Individualized	1-h sessions, twice a week for 6 weeks	33	3	49.0	70	26.9
Comachio et al. [21]	Journal of Acupuncture and Meridian Studies	Electroacupuncture	1-h sessions, twice a week for 6 weeks	33	3	46.0	58	26.0
Di Cesare et al. [22]	Complementary Therapies in Medicine	Control	1 injection per week for 4 weeks	29	3	52.5	55
Di Cesare et al. [22]	Complementary Therapies in Medicine	Standardized	1 injection per week for 4 weeks	33	3	52.5	55
Giles et al. [23]	Journal of Manipulative and Physiological Therapeutics	Individualized	15- to 20-min appointments with subsequent low-volt electrical stimulation applied to the needles, 6 treatments applied in a 3- to 4-week period, (mean 6 treatments)	20	0	46.5	65
		Control	Pills given for the defined 3- to 4-week treatment period, (mean 2 prescriptions)	21		35.0	81
		Control	15 to 20-min appointments, 6 treatments applied in a 3- to 4-week period, (mean 6 treatments)	36		42.5	47
Giles et al. [24]	Spine	Standardized	20-min appointments, 2 treatments per week, maximum treatment duration of 9 weeks	36	12	37.5	44	25.8
		Control	Maximum treatment duration of 9 weeks	43		39.0	43	25.8
		Control	20-min appointments, 2 treatments per week, maximum treatment duration of 9 weeks	36		39.0	49	25.8
Grant et al. [25]	Pain	Individualized	2 sessions of manual acupuncture weekly for 4 weeks	30	3	75.0
Grant et al. [25]	Pain	TENS	2 sessions of manual acupuncture weekly for 4 weeks	27	3	72.0
Haake et al. [26]	Arch Intern Med	Individualized	Ten 30-min sessions, generally 2 sessions per week, and 5 additional sessions if, after the tenth session, patients experienced a 10% to 50% reduction in pain intensity	387	6	49.6	57	26.9
		Sham		387		49.2	64	26.5
		Control		388		51.3	58	26.3
Hasegawa et al. [27]	Acupunct Med	Standardized	5 sessions during 28 days	40	0	47.0	63
Hasegawa et al. [27]	Acupunct Med	Sham	5 sessions during 28 days	40	0	43.9	65
Hunter et al. [28]	Clin J Pain	Physiotherapy	Supervised group exercise session lasting for 1 h a week for 6 weeks	27	6	43.2	59
Hunter et al. [28]	Clin J Pain	Auricular	Manual AA for the first 6 weeks of the trial before each exercise session	24	6	42.4	67
Inoue et al. [29]	Acupunct Med	Individualized	Once	15		68.0	27
Inoue et al. [29]	Acupunct Med	Sham	Once	16		70.0	38
Itoh et al. [30]	Complementary Therapies in Clinical Practice	Standardized	1 weekly treatment over 5 weeks	7	2.5		63
		TENS		7
		Acupuncture and TENS		7
		Control	No specific treatment	7
Itoh et al. [31]	Acupunct Med	Individualized	2 phases of 3 weeks, 12 weeks in total. Each patient received a total of six 30 min treatments, one per week	9	2.75	70.1	71
		Individualized		9		71.9
		Standard		9		73.8
Itoh et al. [30]	Complementary Therapies in Clinical Practice	Standardized	5 treatments, once per week	8	2.5		63
		TENS		8
		Acupuncture and TENS		8
		Control		8
Kalauokalani et al. [32]	Spine	Control	Up to 10 treatments within 10 weeks		0
		Individualized	Up to 10 treatments within 10 weeks
		Control
		Control		66		45.0	70
		Control		69		43.0	57
Kennedy et al. [33]	Complementary Therapies in Medicine	Individualized	Once or twice a week; min 3 and max 12 treatments over 4–6 weeks	23	3	46.5	46
Kennedy et al. [33]	Complementary Therapies in Medicine	Sham		22	3	44.6	58
Kerr et al. [34]	Clin J Pain	Standard	The treatment program consisted of 6 of these sessions over a 6-week period. This reflected the routine pattern of attendance for outpatient physiotherapy. Patients were given a leaflet regarding their low back pain that included standardized advice and exercises	26	1.5	42.6	50
Kerr et al. [34]	Clin J Pain	Placebo-TENS		20	1.5	42.8	65
Leibing et al. [35]	Pain	Standardized	20 sessions (each 30 min) of traditional and standardized acupuncture over 12 weeks, plus active physiotherapy. In the first 2 weeks of treatment, acupuncture was done five times a week, and in the next 10 weeks once a week. Plus physiotherapy 26 sessions (each 30 min) over 12 weeks	40	13	47.9	55	26.1
		Sham	20 sessions (each 30 min) of minimal acupuncture over 12 weeks, plus active physiotherapy 26 sessions (each 30 min) over 12 weeks	45		49.0	60	25.9
		Control	Active physiotherapy with no other treatment 26 sessions (each 30 min) over 12 weeks	46		47.5	59	26.9
Liu et al. [36]	Clin Rehab	Standardized	Usual care + assigned acupuncture intervention according to group allocation. 30-min treatment sessions were administered twice weekly	15	3	30.0	60	23.9
		Standardized		15		37.1	60	27.0
		Standardized		15		30.8	73	27.4
Luo et al. [37]	Journal of traditional Chinese medicine	Auricular	18 treatments were provided over 7 weeks	54	6	39.0	20
		Standardized		50		36.0	24
		Control		48		37.0	19
Macdonald et al. [38]	Annals of the Royal College of Surgeons of England	Individualized	Over a short period of time once a week. The maximum number of treatments between the two assessments was arbitrarily defined as 10	8	0		75
Macdonald et al. [38]	Annals of the Royal College of Surgeons of England	Control		9	0		67
Mendelson et al. [39]	The American Journal of Medicine	Standardized	4 weeks of treatment, twice weekly	36	1	54.5	47
Mendelson et al. [39]	The American Journal of Medicine	Control	4 weeks of treatment, twice weekly	41	1	53.6	56
Meng et al. [40]	Rheumatology	Standardized	In addition to standard therapy, subjects in this group received acupuncture treatments twice a week for 5 weeks, for a total of 10 sessions	31	2.25	72.0	58
Meng et al. [40]	Rheumatology	Control	5 weeks	24	2.25	70.0	63
Miyazaki et al. [14]	Clin J Pain	Standardized	A washout period of at least 4 weeks took place between phases 1 and 2	42		20.8		22.7
Miyazaki et al. [14]	Clin J Pain	Control		39		21.0		25.1
Molsberger et al. [41]	Pain	Sham	In addition to the daily conservative orthopedic therapy, all patients received 12 sham treatments, (30 min, 3/ week)	61	3	50.0	46
		Standardized	In addition to the conventional conservative orthopedic therapy, 12 verum acupuncture treatments (30 min, 3/ week)	65		49.0	45
		Control	These patients received the daily conventional conservative orthopedic treatment over 4 weeks	60		49.0	53
Pach et al.[42]	Evidence-Based Complementary and Alternative Medicine	Standardized	2 treatment sessions per week had to be applied, with a maximum number of 10 to 15 sessions depending on the patient’s individual needs. The needle retention time was about 25 min	78	6.5	59.3	54	27.2
Pach et al.[42]	Evidence-Based Complementary and Alternative Medicine	Individualized		72	6.5	56.1	63	27.0
Rajfur et al. [43]	Medical science monitor	TENS	A series of 15 treatments, 5 times a week (Monday to Friday) for a period of 3 weeks	20	0	50.2	55	26.7
		Acupuncture and TENS		20		52.1	60	27.0
		Control		19		47.8	58	26.3
		Control		21		48.7	62	26.1
		Control		22		52.1	59	25.9
		Control	Motor improvement exercises were used for 3 weeks, 5 times a week, from Monday to Friday	21		49.8	62	26.1
Sator-Katzenschlager [44]	Pain Medicine	Electroacupuncture	The acupuncture needles with the P-Stim™ devices were withdrawn 48 h after insertion in all cases and the acupuncture treatment was performed once a week for 48 h at home, for a total study period of 6 wk	61	1.5	54.1	71	26.6
Sator-Katzenschlager [44]	Pain Medicine	Acupuncture		61	1.5	53.1	71	25.3
Shankar et al. [45]	Indian Journal of Physiology and Pharmacology	Electroacupuncture	10 treatments over 3 weeks	30	0	36.2	53	22.9
		Control	10 days of Valdecoxib and 3 weeks of physiotherapy	30		34.5	80	22.0
		Control		30		35.9	57	23.3
Szczurko et al. [46]	PLoS ONE	Acupuncture	Twice per week to receive 24 treatments over a period of 12 weeks	39	3	45.3	56	28.7
Szczurko et al. [46]	PLoS ONE	Control	Participants randomized to the control group received an educational booklet (causes of back pain, prognosis, appropriate use of imaging studies and specialists, and exercises for promoting recovery and preventing recurrences)	36	3	48.0	44	27.7
Thomas et al. [47]	BMJ	Individualized	10 individualized treatment sessions over 3 months	159	24	42.0	62
Thomas et al. [47]	BMJ	Control	Patients in the usual care group received NHS treatment according to their general practitioner’s assessment of need	80	24	44.0	58
Witt et al. [48]	American J Epidemiology	Individualized	Maximum of 15 acupuncture sessions over 3 months	1451	6	53.1	58
Witt et al. [48]	American J Epidemiology	Control	Conventional therapy	1390	6	52.6	57
Yeung et al. [49]	Journal of Alternative and Complementary Medicine	Control	An hourly session each week for 4 consecutive weeks + daily 15 months of home exercise	26	3	55.6	81	24.2
Yeung et al. [49]	Journal of Alternative and Complementary Medicine	Standardized	EA three times/ week, 4 weeks	26	3	50.4	85	25.5
Tsui et al. [50]	The journal of alternative and complementary medicine	Electroacupuncture	Treatment for 20 min on a total of 6 acupuncture points. Treatment was delivered twice per week for 4 weeks (a total of 8 sessions)	14	1	39.7	76
		Electroacupuncture		14		39.1	71
		Control		14		40.9	62
Tsukayama et al. [51]	Acupuncture in medicine	Electroacupuncture	Twice a week for 2 weeks	10	0	47.0	89	22.5
Tsukayama et al. [51]	Acupuncture in medicine	TENS	Twice a week for 2 weeks	10	0	43.0	80	22.2
Weiß et al. [52]	The journal of alternative and complementary medicine	Standardized	21-day inpatient rehabilitation and acupuncture twice weekly	74	3	49.8	27	30.0
Weiß et al. [52]	The journal of alternative and complementary medicine	Control	21-day inpatient rehabilitation	69	3	51.7	39	28.8
Yoo et al. [53]	Journal of Korean Medicine Rehabilitation	Standardized	Treatment within 5 days. A total of 2 treatments	15	0	37.9		22.3
Yoo et al. [53]	Journal of Korean Medicine Rehabilitation	Sham	Treatment within 5 days. A total of 2 treatments	15	0	37.9		23.9
Yuan et al. [54]	Complementary Therapies in Medicine	Individualized	10 treatments; 2 times/week	15	12	43.5	40	27.0
Yuan et al. [54]	Complementary Therapies in Medicine	Individualized	10 treatments; 5 times/week	15	12	43.9	40	27.3
Yun et al. [55]	The Journal of Alternative and Complementary Medicine	Control	18 treatments were provided over 7 weeks, every other day for 3 weeks and then twice weekly for 4 weeks	64	11	35.0	22
		Individualized		60		34.0	27
		Control		63		33.0	19
Zaringhalam et al. [56]	Chinese Medicine Journal	Standardized	Twice a week for 5 weeks	20	2.5	54.2	0	32.5
		Control	daily	20		55.1		29.2
		Control	Twice a week for 5 weeks	20		54.2		30.3
		Control		20		54.3		31.0

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