Acupuncture vs usual care for chronic low back pain: a systematic review and meta-analysis of immediate and intermediate effects

Introduction: Chronic low back pain (CLBP) is a leading global cause of disability. Acupuncture is increasingly integrated into its management, yet its standalone effectiveness compared to usual care remains uncertain. This review aimed to assess the immediate (≤2 weeks) and intermediate (2 weeks–6 months) effects of acupuncture versus usual care on pain and disability in adults with CLBP. Methods: A systematic review and meta-analysis of randomized controlled trials was conducted, searching MEDLINE, CENTRAL, Scopus, and PEDro through November 2024. Eligible studies compared acupuncture (body, electroacupuncture, scalp) to usual care (physiotherapy, education, medication, and exercise) in adults with CLBP. Outcomes included pain and disability at immediate and intermediate follow-up. Data were pooled using a random-effects model. Risk of bias was assessed with the PEDro scale, and GRADE was used to evaluate evidence certainty. Sensitivity and subgroup analyses were conducted to explore clinical and methodological heterogeneity and test the reliability of findings. Results: A total of 2.956 records were identified, and 8 RCTs (n = 1,123 participants) were included in this study. Acupuncture significantly reduced pain at both immediate (SMD = –0.73, 95% CI –1.04 to –0.42) and intermediate (SMD = –1.13, 95% CI –1.82 to –0.43) timepoints. Disability also improved at both follow-ups (immediate: SMD = –0.49, 95% CI –0.68 to –0.30 and intermediate: SMD = –0.79, 95% CI –1.18 to –0.41). Sensitivity analyses confirmed effect robustness, especially in electroacupuncture subgroups. Certainty of evidence ranged from low to very low due to risk of bias, inconsistency, and suspected publication bias. Discussion: Acupuncture appears more effective than usual care for reducing pain and disability in adults with CLBP, but the certainty of evidence is low, warranting cautious interpretation.