Stimulated by DeBar et al 2025.[1]
cLBP – chronic low back pain
IF – impact factor
EA – enhanced acupuncture (rather confusing I’m afraid)
SA – standard electroacupuncture
UMC – usual medical care
RMDQ – Roland-Morris Disability Questionnaire
MCID – minimal clinically important difference
PEG – pain, enjoyment, and general activity (3 items, each on a 0 to 10 scale)
PGIC – patient global impression of change (a 7-point scale)
CI – confidence interval (in this case 95% CI)– key to acronyms
I was surprised to see this trial pop up at the top of an email alert from the journal JAMA Network Open (IF 9.7), rather than on my PubMed searches, where I usually see these things first. It is a very large pragmatic trial of manual acupuncture in cLBP in older adults (n=800).
Rather confusingly, it uses the acronym EA to mean enhanced acupuncture rather than the more familiar electroacupuncture. Enhanced refers to the addition of up to 6 top-up treatments following the main treatment course of 8 to 15 sessions over 12 weeks. The latter was referred to as SA or standard acupuncture. The third arm were randomised to UMC and asked to avoid acupuncture.
Patients were 65 years or older and suffered with non-specific cLBP with or without radicular symptoms.
The primary outcome was the RMDQ, a 24-item measure of disabilities related to back pain. Higher numbers indicate greater disability and the MCID is generally taken to be a change of 5 points or a 30% reduction from baseline. The latter was used in this trial. PEG and PGIC were secondary outcomes, and there were further
Outcomes were measured at baseline (apart from the PGIC of course), 3, 6 and 12 months. Acupuncture would have covered nearly 6 months in the EA group, 3 months in the SA group, and there was no acupuncture at all the UMC group (rather like the situation in the UK post-NG59).
Baseline RMDQ was just over 13, and this reduced by an average of 3.6 (CI 4.3 to 3.0) at 6 months, and 3.5 (CI 4.2 to 2.8) at 12 months in the EA group. So, whilst the mean change from baseline did not reach the MCID, the latter was achieved by just over 40% of the EA group and this was maintained at 12 months. The SA group came in at just under 40% and the UMC group was just under 30%.
As would be expected, the EA group were marginally ahead in most outcomes, but this did not reach statistical significance for most measures. Despite the difference between EA and UMC being small (mean 1.5 at 6 months and 1.7 at 12 months), this was statistically significant due to the large numbers in each group.
The authors conclude that their trial supports the use of acupuncture in older adults with cLBP. I tend to agree, but since the mean change from baseline did not reach the MCID, we would need to consider cost effectiveness within a publicly funded service.
My suspicion is that real EA (electroacupuncture) would be better, especially if performed in an enhanced manner.
References
1 DeBar LL, Wellman RD, Justice M, et al. Acupuncture for Chronic Low Back Pain in Older Adults: A Randomized Clinical Trial. JAMA Netw Open. 2025;8:e2531348. doi: 10.1001/jamanetworkopen.2025.31348
Declaration of interests MC
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