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Acupuncture and dry-needling for low back pain

Thirty-five RCTs covering 2861 patients were included in this systematic review. There is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low-back pain. For chronic low-back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment, in measurements taken up to three months. The results also show that for chronic low-back pain, acupuncture is more effective for improving function than no treatment, in the short-term. Acupuncture is not more effective than other conventional and "alternative" treatments. When acupuncture is added to other conventional therapies, it relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain.

Massage for low-back pain

Low-back pain (LBP) is one of the most common and costly musculoskeletal problems in modern society. Seventy to 85% of the population will experience LBP at some time in their lives. Proponents of massage therapy claim it can minimize pain and disability, and speed return to normal function.

Massage in this review is defined as soft-tissue manipulation using hands or a mechanical device on any body part. Non-specific LBP indicates that no specific cause is detectable, such as infection, neoplasm, metastasis, osteoporosis, rheumatoid arthritis, fracture, inflammatory process or radicular syndrome (pain, tingling or numbnness spreading down the leg.

Thirteen randomized trials (1596 participants) assessing various types of massage therapy for low-back pain were included in this review. Eight had a high risk and five had a low risk of bias. Massage was more likely to work when combined with exercises (usually stretching) and education. The amount of benefit was more than that achieved by joint mobilization, relaxation, physical therapy, self-care education or acupuncture. It seems that acupressure or pressure point massage techniques provide more relief than classic (Swedish) massage, although more research is needed to confirm this.

No serious adverse events were reported by any patient in the included studies. However, some patients reported soreness during or shortly after the treatment. Some patients also reported an allergic reaction (e.g. rash or pimples) to the massage oil.

In summary, massage might be beneficial for patients with subacute (lasting four to 12 weeks) and chronic (lasting longer than 12 weeks) non-specific low-back pain, especially when combined with exercises and education.