Although lower back pain is the leading cause of disability worldwide, most treatments offer limited relief. One of the most divisive is acupuncture. A recent study has now examined whether it truly helps.
In The Conversation, Kieran O’Sullivan writes that the research found that acupuncture – recommended in American guidelines for lower back pain but not in the United Kingdom – does provide some relief for people with lower back pain, but the benefit was modest.
Having additional maintenance sessions did not boost the effect either.
More significantly, the improvement was smaller than that seen in studies using different approaches from Australia and the US.
Although acupuncture is unlikely to be the best treatment for lower back pain, the fact that it helps at all reveals something important about the condition and how people can find relief.
The study included 800 older adults who were randomly assigned to “usual care” or one of two acupuncture plans. The standard programme involved 11 sessions over 12 weeks, while the enhanced version added five more maintenance sessions over the following 12 weeks.
The trial took place with 55 acupuncturists in different parts of the US and focused on older adults.
After six and 12 months, both acupuncture groups had similar results, so the extra follow-up sessions didn’t help. Both acupuncture groups had less pain and disability after six months than those who received usual care – and about 40% improved by at least 30%.
These improvements persisted until the 12-month evaluation, and no major safety concerns emerged.
These findings align with large reviews of lower back pain treatments focusing on acupuncture or all non-drug and non-surgical approaches. Overall, acupuncture performs somewhat better than no treatment or usual care at improving pain and disability, though this benefit is typically small.
More tellingly, reviews show that any benefit from acupuncture appears even smaller when compared with sham or placebo treatments. This means some of the benefit may come from the experience of being treated, not the acupuncture itself.
What patients expect can affect how much they say they improve, which is important in all studies that rely on self-reported pain.
This makes it crucial to consider what comparison treatment was used when any study claims acupuncture helps, as usual-care groups – who typically receive less time and attention – are easiest to outperform.
Better options exist
Some people might say that any relief from lower back pain is worth celebrating or even paying for. But it’s also important to think about whether safer and cheaper options are available.
The benefits of different mind-body treatments for lower back pain studied in Australia and the US are worth considering, as they appear to offer greater reductions in pain and disability without increasing costs or risks.
The Australian study showed much greater reductions in disability and pain (using the same outcome measures) through a rehabilitation programme delivered by physiotherapists that addressed both physical and psychological aspects of back pain.
Even more importantly, the economic analysis revealed significant cost savings.
The US study involved teaching people that back pain comes from their brain being overprotective, rather than actual damage to their back. It used talk therapy techniques to help the participants think about and respond to pain differently. As with the Australian study, the US study also demonstrated much larger reductions in pain and disability than those seen with acupuncture – albeit using slightly different measures.
The fact that these holistic, mind-body rehabilitation programmes outperform acupuncture – and other relatively basic interventions such as massage and medication – reflects the emerging international consensus that comprehensive approaches help people manage their lower back pain.
Effective help for people with lower back pain exists; the challenge is ensuring healthcare professionals are properly trained to deliver these treatments, and that sufferers are aware of the available approaches.
Without accessible alternatives, people with lower back pain will understandably continue seeking treatments such as acupuncture which they know about, can access and provide some modest symptom relief. It is hard to fault them when alternatives that are both accessible and affordable are not available.
Kieran O’Sullivan – Professor, Physiotherapy, University of Limerick
Study details
Acupuncture for Chronic Low Back Pain in Older Adults: A Randomised Clinical Trial
Lynn DeBar, Robert Wellman, Morgan Justice et al.
Published in JAMA Network on 12 September 2025
Key Points
Question Is acupuncture needling (both a standard acupuncture course and additional maintenance sessions) an effective treatment for older adults with chronic low back pain (CLBP)?
Findings In this randomised clinical trial that included 800 older adults with CLBP, acupuncture needling (both a standard course and additional maintenance sessions) improved pain-related disability with CLBP at six months and 12 months, with no statistically discernible benefit of additional maintenance sessions.
Meaning These findings suggest that acupuncture needling is an effective and safe treatment option for older adults with CLBP.
Abstract
Importance
The study was carried out to inform Medicare acupuncture coverage decisions addressing the gap in evidence on acupuncture effectiveness, specifically for older adults with chronic low back pain (CLBP).
Objective
To determine the effectiveness of standard acupuncture (SA) or SA plus maintenance (enhanced acupuncture [EA]) to improve CLBP-related disability relative to usual medical care (UMC) at three, six, and 12 months after randomisation.
Design, Setting, and Participants
This multisite, three-arm, parallel-group randomised clinical trial of older adults with CLBP collected data from four US health care systems in three geographic areas and compared SA and EA treatment with UMC only. Study enrolment was conducted from 12 August 2021 to 27 October 2022; follow-up concluded on 7 November 2023.
Interventions
Both SA (eight-15 treatment sessions over 12 weeks plus UMC) and EA (SA plus four-six maintenance sessions during the next 12 weeks) were provided by experienced, community-based licensed acupuncturists. Participants were randomised 1:1:1 to the 3 groups.
Main Outcomes and Measures
The primary outcome was CLBP-related disability measured by a baseline-to-six-month change in the Roland-Morris Disability Questionnaire (RMDQ) score. Secondary outcomes included pain intensity and the percentage of participants with clinically meaningful (≥30%) improvements.
Results
The trial identified 800 individuals who were randomised to three groups (mean [SD] age, 73.6 [6.0] years; 496 females [62.0%]). At six months, RMDQ change scores were significantly better in both the SA and EA groups compared with the UMC only group (SA vs UMC: adjusted mean difference, −1.0 [95% CI, −1.9 to −0.1] and EA vs UMC: adjusted mean difference, −1.5 [95% CI, −2.5 to −0.6]). SA and EA change scores did not differ significantly from one another. The relative benefit of acupuncture compared with UMC on disability persisted at 12 months. Pain intensity exhibited a relative benefit of EA over SA at six months, and both acupuncture groups had significant improvement over UMC. The adjusted percentage with clinically meaningful improvements in RMDQ at six months was greater for SA (39.1% [95% CI, 33.1%-46.1%]; adjusted relative risk, 1.33 [95% CI, 1.04-1.70]) and for EA (43.8% [95% CI, 38.0%-50.4%]; adjusted relative risk, 1.49 [95% CI, 1.19-1.86]) compared with UMC (29.4% [95% CI, 24.3%-35.5%]) and persisted at 12 months. Rates of serious adverse events were low and similar among groups, with less than 1% that was possibly acupuncture-intervention related.
Conclusions and Relevance
The findings of this randomised clinical trial of older adults with CLBP suggest that acupuncture needling provided greater improvements in back pain–related disability at six months and at 12 months compared with UMC alone. These findings support acupuncture needling as an effective and safe treatment option for older adults with CLBP.
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Only 10% of non-surgical treatments kill backache – Australian review
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