Acupuncture therapy for chronic low back pain: protocol of a prospective, multi-center, registry study

Acupuncture Case Registry Study: Rationale, Implementations, and Achievements

The acupuncture case registry study is focusing on acupuncture therapy data from patient cases. The main objective is to collect real-world data and integrate clinically meaningful outcome evaluation indicators to uncover and evaluate real-world acupuncture efficacy and safety, explore factors affecting acupuncture efficacy, and provide real-world evidence to complement RCTs. Since the International Acupuncture Case Registry data collection system’s establishment in 2017, 16 projects have been underway, including two acupuncture specialty therapies and 15 diseases. Data from 3404 patients included extensive information on the diagnosis and treatment of acupuncture and the evaluation of its efficacy. In order to serve as a guide for future studies, this article discusses the value of and rationale for establishing acupuncture case registry studies, how to distinguish them from patient registries, and crucial techniques for implementing registry studies in terms of applications, patient recruitment, costakeholder collaboration, data collection and management, study quality control, and ethics.

Knowledge Mapping Analysis of International Research on Acupuncture for Low Back Pain Using Bibliometrics

Objective

Acupuncture has made recommendations to relieve low back pain (LBP) in a few guidelines. However, few articles focused on the papers published before, which may reflect the trend of study, main researchers, reciprocal collaboration, and other information in this field. In this study, we utilize the bibliometric analysis methods to objectively analyze the current trend and research hotspots about this field, aiming to provide a foundation and reference for future study.

Methods

The Web of Science database was searched for publications related to acupuncture therapy for treating low back pain between 1985 and 2021. VOSviewer and CiteSpace were used to analyze the annual publication, authors and co-cited authors and their countries (regions) and institutions, journals and co-cited journals, co-cited references, co-occurrence keywords, burst keywords, and the relevant centrality.

Results

A total of 1279 papers were retrieved from the database, and the trend of annual publications maintained growth. Article was the most document type (867). The USA (451) and the Kyung Hee University (49) were the most productive country (region) and institution, respectively, while the USA (0.37) and University of Maryland (0.13) had the highest centrality. MacPherson, Hugh and Sherman, Karen J. published the most papers in this field (32), and Ernst, Edzard became the most influential author (474 co-citations). Journal of Alternative and Complementary Medicine was the most productive journal (79), whereas SPINE was the most influential one (3111 co-citations). Haake's (2007) article had the most co-citation count (186), while Furlan's (2005) article had the highest centrality (0.23). The three frontier topics were pain management, disease, and protocol.

Conclusion

The present study investigated publications on acupuncture for treating low back pain using bibliometric analysis methods, which may help researchers explore the potential directions for the future.

Acupuncture is ineffective for chronic low back pain? A critical analysis and rethinking

Acupuncture is a promising treatment for relieving pain and improving lower back function in clinical practice. However, evidence from randomized clinical trials (RCTs) remains controversial. Most RCTs conclude that acupuncture procedures for chronic low back pain (CLBP) had no significant difference in efficacy and belonged to placebo. We carefully reviewed and analyzed the methodology and implementation of sham acupuncture in RCTs. Controversial evidence of acupuncture for CLBP is only a microcosm of the evaluation methodological limitation of acupuncture. Inappropriate selection of sham acupuncture controls, rigorous RCT research models, and incorrect interpretation of results may contribute to negative evidence. Evaluating and disregarding the holistic efficacy of acupuncture with an explanatory RCT model based on evaluation drugs may be unwise. Moreover, sham acupuncture is often proven to be non-inert, unreasonable, and with low fidelity. Pitfalls of the explanatory RCT model and sham acupuncture design should be avoided. Establishing a new evaluation system that is in line with the clinical characteristics of acupuncture and obtaining high-quality evidence are difficult but promising tasks.

Acupuncture for the Management of Low Back Pain

PURPOSE OF REVIEW

This evidence-based systematic review will focus on the use of acupuncture and its role in the treatment of low back pain to help better guide physicians in their practice. It will cover the background and the burden of low back pain and present the current options for treatment and weigh the evidence that is available to support acupuncture as a treatment modality for low back pain.

RECENT FINDINGS

Low back pain (LBP), defined as a disorder of the lumbosacral spine and categorized as acute, subacute, or chronic, can be a debilitating condition for many patients. Chronic LBP is more typically defined by its chronicity with pain persisting > 12 weeks in duration. Conventional treatment for chronic LBP includes both pharmacologic and non-pharmacologic options. First-line pharmacologic therapy involves the use of NSAIDs, then SNRI/TCA/skeletal muscle relaxants, and antiepileptics. Surgery is usually not recommended for chronic non-specific LBP patients. According to the 2016 CDC Guidelines for Prescribing Opioids for Chronic Pain and the 2017 American College of Physicians (ACP) clinical practice guidelines for chronic pain, non-pharmacologic interventions, acupuncture can be a first-line treatment for patients suffering from chronic low back pain. Many studies have been done, and most show promising results for acupuncture as an alternative treatment for low back pain. Due to non-standardized methods for acupuncture with many variations, standardization remains a challenge.