Various acupuncture therapies for managing nonspecific low back pain: a network Meta-analysis

doi:10.19852/j.cnki.jtcm.2025.05.002

Abstract

Abstract:

OBJECTIVE: To compare the therapeutic effects of nine acupuncture-related therapies (acupuncture, scrapping therapy, catgut embedding, blood-letting, electro-acupuncture, warm acupuncture, cupping, moxibustion, and needle knife) in the treatment of nonspecific low back pain (NLBP), providing evidence-based medical support for clinical treatment.

METHODS: Randomized controlled trials evaluating various acupuncture therapies for NLBP were screened from the China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, PubMed, Web of Science, Chinese Biomedical Literature Database, Embase, and the Cochrane Library. Methodological quality was assessed using the Cochrane 5.1.0 risk of bias assessment tool, and the data were analyzed using STATA 15.1.

RESULTS: This study included 19 randomized controlled trials involving 1356 participants and assessing pain using the visual analog scale (VAS), improvement in dysfunction using the oswestry disability index (ODI), and the effective rate. Blood-letting [surface under the cumulative ranking curve (SUCRA) = 81.4] exhibited a significant clinical effect in relieving NLBP in studies with the VAS score as the outcome indicator, followed by cupping (SUCRA = 70.4) and moxibustion (SUCRA = 58.5). Scrapping therapy (SUCRA = 77.7) had the most significant effect on improving NLBP-related functional impairment, followed by moxibustion (SUCRA = 59.8), and then bloodletting (SUCRA = 58.2). The effective rates of warm acupuncture (SUCRA = 78.0), scrapping therapy (SUCRA = 77.2) and blood-letting (SUCRA = 58.6) were better than those of acupuncture (SUCRA = 12.0), especially for cold and wet NLBP. These findings demonstrate the importance of syndrome differentiation during clinical decision making when determining diagnosis and treatment.

CONCLUSION: Blood-letting was the most effective treatment for relieving pain, and scrapping therapy was the most effective treatment for improving dysfunction. Warm acupuncture was the preferred treatment for cold and wet NLBP. However, further high-quality clinical studies are needed for validation.

Key words: nonspecific low back pain, acupuncture, randomized controlled trial, network Meta-analysis

GUO Jixing, JI Changchun, XIE Chaoju, RAO Xiang, SUN Zhangyin, XING Yu, ZHANG Rongni, QU Qiangqiang, DONG Youpeng, YANG Jinsheng. Various acupuncture therapies for managing nonspecific low back pain: a network Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2025, 45(5): 954-962.

Figures/Tables 3

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Number	Author	Number of people (T: experimental group C: control group) Total number/male/female	Mean age (years)	Disease course (month)	Intervention study		Sample size (example)		Treatment course (day)	Outcome indicator
1	Wang L 2013⁹	T: 39/15/24 C: 39/17/22	T: 40.203 (10.780) C: 39.072 (11.393)	T: 2.0726 (1.668) C: 1.6462 (1.077)	Scrapping therapy	Acupuncture	39	39	T: 35 C: 21	①②③
2	Liu Z et al 2013¹⁰	T: 43/25/18 C: 42/22/20	T: 42.37 (10.97) C: 40.34 (11.38)	T: 1.134 (1.419) C: 1.124 (0.535)	Scrapping therapy	Acupuncture	43	42	T: 35 C: 21	①②
3	Jin XL 2018¹¹	T: 24/13/11 C: 24/14/10	T: 50.46 (9.31) C: 51.12 (8.09)	T: 9.37 (4.79) C: 10.03 (5.17)	Catgut embedding	Acupuncture	24	24	60	②
4	Zhang F 2022¹²	T: 33/16/17 C: 33/18/15	T: 45 (7) C: 38 (7)	T: 5.5 (0.5) C: 4.25 (0.75)	Blood-letting	Acupuncture	33	33	14	①③
5	Wang Y, Chen Q 2020¹³	T: 40/17/23 C: 40/15/25	T: 51.73 (6.15) C: 50.46 (6.98)	T: 1.059 (0.657) C: 1.015 (0.609)	Blood-letting	Acupuncture	40	40	21	①②③
6	Pan L et al 2016¹⁴	T: 26/10/16 C: 27/12/15	T: 44 (8) C: 45 (7)	T: 21.04 (15.27) C: 21.41 (15.62)	Cupping	Bloodletting	26	27	NA	①②
7	Chao WM 2013¹⁵	T: 45/16/29 C: 45/13/32	T: 49.69 (10.475) C: 48.22 (11.417)	NA	Moxibustion	Acupuncture	45	45	21	①②③
8	Ren W et al 2017¹⁶	T: 38/15/23 C: 37/13/24	T: 52.4 (6.7) C: 53.0 (7.4)	T: 26.4 (3.6) C: 25.2 (6)	Needle-knife	Acupuncture	38	37	NA	①③
9	Qian H et al 2022¹⁷	T: 30/10/20 C: 30/12/18	T: 40.63 (10.71) C: 39.47（10.46)	T: 12.33 (5.90) C: 11.90 (4.69)	Acupuncture	Electroacupuncture	30	30	14	①③
10	Li JH 2017¹⁸	T: 30/18/12 C: 30/16/14	T: 42.1 (6.35) C: 41.9 (6.27)	T: 26.28 (16.44) C: 24.96 (15.96)	Acupuncture	Electroacupuncture	30	30	30	①②③
11	Chen ZX 2017¹⁹	T: 30/17/13 C: 30/16/14	T: 41 (5.46) C: 42 (7.13)	NA	Blood-letting	Acupuncture	30	30	56	①③
12	Liu GT 2019²⁰	T: 48/24/24 C: 48/25/23	T: 53.24 (3.42) C: 52.16 (3.25)	NA	Electroacupuncture	Acupuncture	48	48	20	①③
13	Zhao CH, Zhang T 2015²¹	T: 20/6/14 C: 20/8/12	T: 45.15 C: 49.55	NA	Moxibustion	Acupuncture	20	20	T: 60 C: 30	③
14	Jin YZ 2013²²	T: 30/17/13 C: 30/15/15	NA	T: 11.57 (5.49) C: 11.47 (4.77)	Warm acupuncture	Electroacupuncture	30	30	15	①③
15	Chen LD, Hou XP 2016²³	T: 58/28/30 C: 58/31/27	T: 49.5 (3.9) C: 50.3 (4.1)	T: 25.20 (9.60) C: 28.80 (8.40)	Warm acupuncture	Acupuncture	58	58	30	①③
16	Sun J, Zhao YX 2016²⁴	T: 35/18/17 C: 35/17/18	T: 39.4 (2.6) C: 40.4 (2.5)	NA	Warm acupuncture	Acupuncture	35	35	24	①③
17	Lyu ZL 2019²⁵	T: 49/26/23 C: 49/25/24	T: 55.98 (10.98) C: 56.15 (11.03)	T: 74.76 (28.92) C: 73.80 (28.68)	Warm acupuncture	Acupuncture	49	49	90	①③
18	Comachio J et al 2020²⁶	T: 33/14/19 C: 33/10/23	T: 46 (8.9) C: 49 (8.5)	T: 47 (28.6) C: 37 (32.2)	Electroacupuncture	Acupuncture	33	33	42	①
19	Comachio J et al 2015²⁷	T: 28/14/14 C: 27/8/19	T: 47.2 (10.5) C: 49.4 (9.9)	NA	Electroacupuncture	Acupuncture	28	27	42	①②

Number	Author	Number of people (T: experimental group C: control group) Total number/male/female	Mean age (years)	Disease course (month)	Intervention study		Sample size (example)		Treatment course (day)	Outcome indicator
1	Wang L 2013⁹	T: 39/15/24 C: 39/17/22	T: 40.203 (10.780) C: 39.072 (11.393)	T: 2.0726 (1.668) C: 1.6462 (1.077)	Scrapping therapy	Acupuncture	39	39	T: 35 C: 21	①②③
2	Liu Z et al 2013¹⁰	T: 43/25/18 C: 42/22/20	T: 42.37 (10.97) C: 40.34 (11.38)	T: 1.134 (1.419) C: 1.124 (0.535)	Scrapping therapy	Acupuncture	43	42	T: 35 C: 21	①②
3	Jin XL 2018¹¹	T: 24/13/11 C: 24/14/10	T: 50.46 (9.31) C: 51.12 (8.09)	T: 9.37 (4.79) C: 10.03 (5.17)	Catgut embedding	Acupuncture	24	24	60	②
4	Zhang F 2022¹²	T: 33/16/17 C: 33/18/15	T: 45 (7) C: 38 (7)	T: 5.5 (0.5) C: 4.25 (0.75)	Blood-letting	Acupuncture	33	33	14	①③
5	Wang Y, Chen Q 2020¹³	T: 40/17/23 C: 40/15/25	T: 51.73 (6.15) C: 50.46 (6.98)	T: 1.059 (0.657) C: 1.015 (0.609)	Blood-letting	Acupuncture	40	40	21	①②③
6	Pan L et al 2016¹⁴	T: 26/10/16 C: 27/12/15	T: 44 (8) C: 45 (7)	T: 21.04 (15.27) C: 21.41 (15.62)	Cupping	Bloodletting	26	27	NA	①②
7	Chao WM 2013¹⁵	T: 45/16/29 C: 45/13/32	T: 49.69 (10.475) C: 48.22 (11.417)	NA	Moxibustion	Acupuncture	45	45	21	①②③
8	Ren W et al 2017¹⁶	T: 38/15/23 C: 37/13/24	T: 52.4 (6.7) C: 53.0 (7.4)	T: 26.4 (3.6) C: 25.2 (6)	Needle-knife	Acupuncture	38	37	NA	①③
9	Qian H et al 2022¹⁷	T: 30/10/20 C: 30/12/18	T: 40.63 (10.71) C: 39.47（10.46)	T: 12.33 (5.90) C: 11.90 (4.69)	Acupuncture	Electroacupuncture	30	30	14	①③
10	Li JH 2017¹⁸	T: 30/18/12 C: 30/16/14	T: 42.1 (6.35) C: 41.9 (6.27)	T: 26.28 (16.44) C: 24.96 (15.96)	Acupuncture	Electroacupuncture	30	30	30	①②③
11	Chen ZX 2017¹⁹	T: 30/17/13 C: 30/16/14	T: 41 (5.46) C: 42 (7.13)	NA	Blood-letting	Acupuncture	30	30	56	①③
12	Liu GT 2019²⁰	T: 48/24/24 C: 48/25/23	T: 53.24 (3.42) C: 52.16 (3.25)	NA	Electroacupuncture	Acupuncture	48	48	20	①③
13	Zhao CH, Zhang T 2015²¹	T: 20/6/14 C: 20/8/12	T: 45.15 C: 49.55	NA	Moxibustion	Acupuncture	20	20	T: 60 C: 30	③
14	Jin YZ 2013²²	T: 30/17/13 C: 30/15/15	NA	T: 11.57 (5.49) C: 11.47 (4.77)	Warm acupuncture	Electroacupuncture	30	30	15	①③
15	Chen LD, Hou XP 2016²³	T: 58/28/30 C: 58/31/27	T: 49.5 (3.9) C: 50.3 (4.1)	T: 25.20 (9.60) C: 28.80 (8.40)	Warm acupuncture	Acupuncture	58	58	30	①③
16	Sun J, Zhao YX 2016²⁴	T: 35/18/17 C: 35/17/18	T: 39.4 (2.6) C: 40.4 (2.5)	NA	Warm acupuncture	Acupuncture	35	35	24	①③
17	Lyu ZL 2019²⁵	T: 49/26/23 C: 49/25/24	T: 55.98 (10.98) C: 56.15 (11.03)	T: 74.76 (28.92) C: 73.80 (28.68)	Warm acupuncture	Acupuncture	49	49	90	①③
18	Comachio J et al 2020²⁶	T: 33/14/19 C: 33/10/23	T: 46 (8.9) C: 49 (8.5)	T: 47 (28.6) C: 37 (32.2)	Electroacupuncture	Acupuncture	33	33	42	①
19	Comachio J et al 2015²⁷	T: 28/14/14 C: 27/8/19	T: 47.2 (10.5) C: 49.4 (9.9)	NA	Electroacupuncture	Acupuncture	28	27	42	①②

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