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

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.

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.

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.

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.