| Background: Low back pain (LBP) is one of the most common health problems in adults. The impact of
LBP on the individual can cause loss of health status and function related to pain in the back. To reduce
the impact of LBP on adults, drug therapy is the most frequently recommended intervention. But over the
last decade, a substantial number of randomized clinical trials of non-pharmacological intervention for
LBP have been published.
Objective: To determine the effectiveness of acupuncture, acupressure and chiropractic (non-pharmacological)
interventions on the treatment of chronic nonspecific low back pain in Iran.
Study design: Systematic review and meta-analysis.
Methods: A systematic literature search was completed without date restrictions up to May 2013 in five
major databases (Medline, CINAHL, Science Direct, CAJ Full-text Database, and Cochrane databases). Only
randomized controlled trials published in Persian (Farsi) or English languages were included. Two independent
reviewers extracted the data. The quality of the papers was assessed using the Cochrane Back
Review Risk of Bias criteria.
Results: Initial searches revealed 415 papers, 382 of which were excluded on the basis of abstract alone.
After excluding 23 papers due to duplication, the remaining 10 trial papers were subjected to a more
detailed analysis of the full text, which resulted in three being excluded. The seven remaining trials had a
lack of methodological and clinical homogeneity, precluding a meta-analysis. The trials used different
comparators with regards to the primary outcomes, the number of treatments, the duration of treatment
and the duration of follow-up.
Conclusion: This systematic review demonstrates that acupuncture, acupressure and chiropractic may
have a favorable effect on self-reported pain and functional limitations on NSCLBP. However, the results
should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity
in the study characteristics and the low methodological quality in many of the included studies. |