PURPOSE: To systematically review clinical trials assessing the efficacy of acupuncture treatment of chronic low-back pain. OBJECTIVES: The goals of this critical review of the literature include: (1) to determine how strong the research evidence is for acupuncture as a treatment for chronic low-back pain; (2) to evaluate if the research is of an acceptable standard; and (3) to propose a research design to evaluate acupuncture management in the treatment of chronic low-back pain. SUMMARY OF BACKGROUND DATA: Chronic low-back pain is a very common condition for which no universally accepted treatment exists. Acupuncture is a commonly used therapy to treat chronic pain. DATA SOURCES: A computer-aided search of medical indexes for papers published between 1978, and 1998 was conducted. The indices included Medline, CINAHL, MANTIS, AMED, AMI, and the internet using the terms: acupuncture, low back pain, and Chinese Medicine. STUDY SELECTION: Four peer-reviewed literature articles were identified. DATA EXTRACTION: Scores were given for quality based on the following categories: study population, quality of intervention, effect measurement, and data presentation and analysis. RESULTS: The methods scored in the trials ranged from 20 to 46 points (out of a possible total of 100), indicating that all the trials were of poor quality. Three studies showed a favourable result for acupuncture. CONCLUSIONS: There are flaws in the design of all four studies. The efficacy of acupuncture for patients with chronic low-back pain has not been demonstrated with sound randomised controlled clinical trials. One cannot necessarily conclude from this review whether acupuncture is an effective treatment due to the poor design and/or methodology of the trials. This paper suggests an alternate design and methodology to evaluate the efficacy of acupuncture in the management of chronic low-back pain.

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A brief summary and a critical assessment of this review may be available at DARE