Older adults with chronic low back pain (CLBP) had less pain and improved physical function using acupuncture compared to standard treatments, a National Institutes of Health (NIH)-funded clinical trial showed.

Approximately one-third of older Americans experience CLBP with typical treatment involving medications, surgery, or physical therapy. 

However, drug-based and invasive interventions have had “questionable impact” on this population who have an increased risk for adverse effects from opioids and comorbidities from polypharmacy, study investigators noted.

“We saw a decrease in pain-related disability. We saw improvements in physical functioning. We saw an impact on patient-reported anxiety. I think most interesting to me was that those effects sustained from three to nine months after the time that people received active treatment [suggesting] that a course of acupuncture can actually result in sustained benefit,” lead author Lynn DeBar, PhD, and distinguished investigator at Kaiser Permanente Center for Health Research in Portland, Oregon, told Medscape Medical News. 

The study was published online September 12 in JAMA Network Open.

Low Uptake 

Although non-opioid treatments like acupuncture are effective at relieving pain in the general adult population, a 2024 NIH study showed current national use remains low at about 2%. 

This randomized clinical trial was designed to fill a knowledge gap on the safety and effectiveness of acupuncture specifically for older Americans with CLBP to inform Medicare reimbursement. 

As previously reported by Medscape Medical News, Medicare made the decision to cover acupuncture for CLBP in 2020. 

Although the study did not launch until 2021, the Centers for Medicare & Medicaid Services decided to move ahead and reimburse acupuncture in the meantime, in part due to concerns about the risks of opioid therapy, DeBar explained 

The study included 800 older adults aged 65 and above (mean age, 73 years; 62% female) across four healthcare systems in multiple regions: Pacific Northwest, Northern California, and New York City. Study participants had experienced CLBP for 3 months or longer.

Participants were randomized in a 1:1:1 ratio to usual medical care treatment, standard acupuncture, or enhanced acupuncture groups.

The investigators only evaluated the effectiveness of needling and excluded other traditional East-Asian acupuncture techniques such as cupping or Gua sha. Acupuncturists were community-based and practiced independently to mimic everyday clinical practice.

Participants in the study’s usual care group did not receive acupuncture. Over 12 weeks, the standard acupuncture group received 8-15 sessions in addition to usual care, while the enhanced group received 4-6 extra sessions beyond the standard regimen. 

The study’s primary outcome of pain-related disability was evaluated by comparing scores from the Roland-Morris Disability Questionnaire (RMDQ). Secondary measures included using the PEG scale (questionnaire on pain intensity, enjoyment of life, and general activity) and the Patient Global Impression of Change to assess pain improvement. Participants self-assessed their pain and physical ailments at 3, 6, and 12 months.

Improved Physical Function, Less Intense Pain

After 6 months, both acupuncture groups had less intense pain and improved physical function compared to those in the usual care group. In addition, both acupuncture groups had decreased CLBP-related disability and less anxiety than the usual care group at 6 and 12 months.

At 6 months, the enhanced group showed a relative benefit over the standard group for reductions in pain intensity and for pain improvement.

“Rates of serious adverse events were low and similar among groups, with less than 1% that was possibly acupuncture-intervention related,” the investigators wrote.

Clinically meaningful improvements in RMDQ scores at 6 months was greater for the standard group (39.1%; 95% CI, 33.1%-46.1%) and the enhanced group (43.8%; 95% CI, 38.0%-50.4%) than usual care (29.4%; 95% CI, 24.3%-35.5%). These effects continued to the 12-month mark.

“It’s important to say [acupuncture] doesn’t take people’s pain away entirely and the effects are still modest, but it has a significant impact that looks to be every bit as good as any of those other modalities and have the same effect,” DeBar said.

The investigators noted that licensed acupuncturists can’t directly bill Medicare without a supervising Medicare-approved clinician and that eradicating this barrier could increase access.

“It’s abysmal. The access to acupuncture needs to be improved,” Richard Harris, PhD, co-president for the Society for Acupuncture Research and professor of anesthesiology and perioperative care at the University of California at Irvine, told Medscape Medical News. 

There aren’t enough acupuncturists and many pain clinics in the US don’t offer acupuncture, Harris said. 

A limitation of the study was there was no sham control. In addition, the study was conducted across four healthcare systems, two of which were not Kaiser Permanente. 

Although investigators could access records of dispensed medications within their own system, other systems relied on external pharmacy services. As a result, the impact of treatment on medication changes could not be fully assessed due to these data limitations.

“What’s interesting is this study showed nice effects with just needling alone. Had they also added things like cupping and Gua sha, the effects might have been even stronger,” Harris said. Future work should focus on who is most likely to benefit from acupuncture and how to integrate this treatment into conventional care, he said.

DeBar reported no disclosures. Harris reported he owns a freely available acupressure app called “MeTime PainRelief” and has also received NIH grant funding to research acupuncture.