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Multimodal Interventions for Chronic Low Back Pain: A Pilot Randomized Trial of Acupuncture, Stretching, and Qigong
Spyridon Sotiropoulos1, Andreas Mavrogenis2, Maria Papandreou3
1Department of Physiotherapy, Musculoskeletal Physiotherapy Research Laboratory, University of West Attica (UNIWA), Athens, GRC.
Introduction:
Chronic low back pain (cLBP) is a leading cause of disability worldwide. Acupuncture has demonstrated benefits in cLBP management. Combining it with stretching or Qigong may enhance therapeutic outcomes. This pilot study assessed the feasibility and preliminary effects of acupuncture alone and in combination with stretching or Qigong.
Methods:
Thirty participants with cLBP were randomly assigned to receive (A) acupuncture only, (B) acupuncture plus static stretching, or (C) acupuncture plus modified Qigong, over eight weeks. The primary outcome was the pressure pain threshold (PPT). Secondary outcomes included pain intensity, disability, physical function, psychosocial measures, and quality of life. Outcomes were assessed at baseline, post-intervention, and two-month follow-up. Data were analysed using linear mixed-effects models. However, the study was not powered to detect between-group changes, as the aim of the study was to investigate the feasibility of the design, and the results need to be interpreted with caution.
Results:
All groups showed statistically significant improvements over time in PPT, pain intensity, disability, functional performance, psychosocial status, and physical quality of life (p < 0.001). No significant group-by-time interactions were observed. However, descriptive trends suggested greater improvements in the PPT and function in the combination therapy groups. Several outcomes exceeded minimal clinically important differences, and large effect sizes were observed for pain (d = -3.32), disability (d = -1.85), and psychosocial distress (d = -1.17). No adverse events occurred, and adherence was high.
Conclusions:
Acupuncture, alone and in combination with stretching or Qigong, resulted in clinically meaningful improvements in pain sensitivity, disability, and psychosocial outcomes. The protocol was feasible and well-tolerated. There are emerging indications from this study that combining acupuncture with other modalities may enhance therapeutic effects, highlighting the need for a larger sample to confirm these findings.
