Table 2.

Acupuncture and related modalities for the treatment of CLBP

Modality	Indications	Contraindications (relative)	Potential Adverse Effects
Traditional Chinese Acupuncture (TCA)	Insufficient clinical trials evidence to recommend for older adults with CLBP	• Bleeding diathesis • Pacemaker (if leads cross chest when using electrical stimulation) • Severely immune-compromised state	• Bleeding, bruising • Infection (very rare) • Transient pain flare • Transient fatigue • Vasovagal response
Percutaneous electrical nerve stimulation (PENS)	CLBP in older adults; minimum effective dose of electrical stimulation unknown	As with TCA	As with TCA
Auricular acupuncture	Insufficient clinical trials evidence to recommend for older adults with CLBP; theoretically useful for augmenting corporeal treatments.	• Bleeding diathesis • Cartilage disease (e.g., relapsing polychondritis)	As with TCA
Trigger point deactivation	Myofascial pain; local twitch response is essential therapeutic element (ref). May be combined with other acupuncture modalities, e.g., following PENS for recalcitrant localized pain.	As with TCA	As with TCA; as compared with TCA and PENS, trigger point deactivation may be painful.
Deep intramuscular electrical stimulation	Localized myofascial pathology (e.g., piriformis, erector spinae); may be performed in addition to TCA or PENS for recalcitrant localized myofascial pain.	As with TCA	As with TCA