Efficacy of Electroacupuncture Compared to Standard and Manual Needling Therapy for Nonspecific Low Back Pain: A Systematic Review and Meta-Analysis

Nonspecific low back pain is prevalent, and electroacupuncture is one potential treatment option. However, a focused evaluation of previous experimental studies is lacking. This systematic review and meta-analysis aimed to assess the efficacy of electroacupuncture for nonspecific low back pain in comparison to standard therapy and manual needling therapy. We systematically searched PubMed, Cochrane Library, and Embase up to December 1, 2023, for randomized controlled trials on electroacupuncture for nonspecific low back pain. Outcomes measured included the Visual Analog Scale and Numerical Rating Scale. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. 10 reports were included in the meta-analysis. Six studies used electroacpuncture with standard therapy compared to standard therapy alone. Four studies compared electroacupuncture with manual needling therapies. Compared to control groups, electroacupuncture with standard therapy resulted in a statistically significant large effect in reduction in pain (standardized mean difference (SMD) -0.83, 95% CI -1.22; -0.43, P < 0.0001) Electroacupuncture did not produce a statistically significant result compared to manual needling therapies (SMD 0, 95% CI -0.71; 0.71, P = 1.0) In terms of long-term analgesic effects, electroacupuncture with standard therapy versus standard therapy yielded a statistically significant large effect in reduction in pain at one month (SMD -0.84, 95% CI -1.30 to -0.37, P = 0.0004) and small effect at two months (SMD -0.40, 95% CI -0.65 to -0.16, P = 0.001) after treatment completion. Limitations, including small numbers of included studies and participants, the difficulty of blinding, and clinical heterogeneity among studies, were found. The certainty of evidence for these comparisons remained very low, which highlights the need for more robust studies. Compared to standard therapy alone, electroacupuncture used with standard therapy produced greater pain reduction for nonspecific low back pain in immediate effects and one month and two months after treatment completion. The findings suggest that electroacpuncture may provide sustained pain relief for nonspecific low back pain when combined with standard therapy.