Table 6.

Acupuncture for acute LBP: SRs with/without meta-analysis

Authors, Year	Modality	SR	Meta-Analysis	Setting/Condition	Outcomes/Comparators	Results	Quality and Recommendation
Lee et al. 2013 [82]	Acupuncture 8/11 manual, EA, modern, wrist ankle	11 RCTs	7 RCTs	Outpatient, acute LBP, n = 1,139	3 acupuncture vs nonpenetrating sham 7 acupuncture vs NSAID medication 2/7 acupuncture, acupuncture+ meds vs meds alone 1 acupuncture + meds vs meds alone 6 “cured, improved, or failed” scale 6 NRS or VAS 4 function, 2 physical exam, 2 analgesic use	Acupuncture may be more effective than NSAIDs for global assessment, but effect is small. Acupuncture more effective than sham in reducing acute pain but not so for function or subacute pain. Acupuncture plus meds more effective for pain relief and overall function than meds alone. Fewer side effects than NSAIDs.	Quality mixed and needs consistency. Evidence shows potential for acupuncture, but further study needed to establish whether benefit compared with NSAIDs reflects evidence of equivalence. More research needed to establish optimal dose and frequency of acupuncture.
Chou et al. 2017 [81]	Nonpharm including acupuncture	11 RCTs of Lee et al. plus 2 RCTs	NA	n = 1,163 acute LBP (actually 1,139)	Acupuncture vs no acupuncture Acupuncture vs sham Acupuncture vs meds Acupuncture vs acupuncture plus meds vs meds Pain and function measures	Acupuncture decreased pain intensity more than sham, no clear impact on function. Greater likelihood of improvement compared to NSAIDs at end of tx.	SOE low to moderate for chronic LBP; SOE low for acute LBP. There is limited evidence that acupuncture is effective for acute LBP in short term (less than 3 months) and on a small to moderate magnitude. More evidence needed for acute LBP, to understand incremental benefits of combining and sequencing interventions.
Xiang et al. 2020 [95]	Acupuncture 4/14: 1 scalp acupuncture, 3 body acupuncture	14 RCTs n = 2,110 4 trials (sub) acute LBP (<12 weeks)	9 RCTs	4 acute LBP in outpatient setting (n = 753)	Acupuncture vs sham vs placebo vs UC Acupuncture vs sham	Moderate evidence of efficacy for acupuncture in terms of pain reduction immediately after tx for NSLBP ([sub]acute and chronic) when compared with sham or placebo acupuncture. Only minor AE.	Quality moderate. Need for research on specific techniques used, including needle placement, stimulation, needle depth, and the experience of the acupuncturists. Recommends standardization of the outcome measures and focus on duration/frequency of acupuncture sessions in future studies.
Su et al. 2021 [96]	Manual acupuncture, EA, AA	13 RCTs n = 899	13 RCTs n = 899	Settings not described. Acute LBP	Acupuncture (manual acupuncture, EA, ear acupuncture) vs drugs or sham acupuncture	Acupuncture significantly benefits VAS score (pain), ODI score, and NOP. Effect on RMDQ equal to controls.	Quality moderate. Acupuncture significantly benefits acute LBP symptoms, including reduction in analgesic medication. Heterogeneity of trials contributes to cautious recommendation of acupuncture for acute LBP. More research is needed.

EA = electroacupuncture; NA = not applicable; nonpharm = nonpharmacologic; NOP = number of pills; NRS = numerical rating scale; NSLBP = nonspecific low back pain; ODI = Owestry Disability Index; RMDQ = Rowland-Morris Disability Questionnaire; SOE = strength of evidence; tx= treatment; UC= usual care; VAS = visual analog scale.