Pilot edition of international acupuncture guidelines for non-specific low back pain

Non-specific low back pain is a significant global health problem, with 90~95% of patients suffering from non-specific low back pain (NSLBP). Clinical practice has shown that acupuncture and moxibustion therapy have positive efficacy with fewer side effects, making it a more efficient treatment option.

To boost efforts in the field, a team of researchers in China established a set of guidelines to provide more comprehensive scientific, patient-centered clinical practice recommendations.

"Referencing the WHO guideline development process, clinical questions were initially investigated and collected from the perspectives of guideline users in different identities and regions,” shares leader of the guideline working group, Tao Yang, a professor of acupuncture at the China Academy of Chinese Medical Sciences. “Combined with multidisciplinary expert interviews and the use of a modified Delphi method, we formed a structured clinical question that reached expert consensus.”

Subsequently, evidence was gathered to construct the set of guidelines. Participants in the survey for the clinical questions and members of the guidelines development expert panel come from different countries and regions, making this set of guidelines more internationally representative and its clinical applicability more extensive.

The set of guidelines, published in the World Journal of Acupuncture – Moxibustion, provides seven recommendations for 10 clinical questions. The main recommendations are:

1. For patients with acute/subacute NSLBP, compared with oral administration of Western medicine (non-steroidal anti-inflammatory drugs, muscle relaxants) or other non-pharmacological treatments (physical therapy, bed rest, tuina), filiform needle therapy (acupuncture or electroacupuncture) or comprehensive therapy of acupuncture therapy (acupuncture plus moxibustion, acupuncture plus cupping, acupuncture plus moxibustion and cupping) is prioritized.
2. For patients with chronic non-specific low back pain, the degree of recommendations for therapy ranges from high to low : the comprehensive therapy of acupuncture therapy >  filiform needle therapy >  other non-pharmacological treatments (tuina, physical therapy plus exercise, and core stability training).
3. For pregnant women with NSLBP, acupuncture should be delivered with caution, and the risk of safety may be induced if the acupoints are not appropriately selected or manipulated.

The clinical questions in the set of guidelines were formulated in the form of questionnaires, and the quality of the evidence from the included studies was found to be low.

“Notably, there was a lack of high-quality literature references. Therefore, higher quality clinical studies should be conducted on these clinical questions to provide more evidence-based references for subsequent clinical work,” adds Yang.

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Contact author:  Tao YANG, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing100053, China ,bjytyangtao@163.com