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Table 2 Acupuncture and related modalities for the treatment of CLBP

From: The role of chiropractic care in older adults

Modality Indications Contraindications (relative) Potential Adverse Effects
Traditional Chinese Acupuncture (TCA) Insufficient clinical trials evidence to recommend for older adults with CLBP • Bleeding diathesis
• Pacemaker (if leads cross chest when using electrical stimulation)
• Severely immune-compromised state
• Bleeding, bruising
• Infection (very rare)
• Transient pain flare
• Transient fatigue
• Vasovagal response
Percutaneous electrical nerve stimulation (PENS) CLBP in older adults; minimum effective dose of electrical stimulation unknown As with TCA As with TCA
Auricular acupuncture Insufficient clinical trials evidence to recommend for older adults with CLBP; theoretically useful for augmenting corporeal treatments. • Bleeding diathesis
• Cartilage disease (e.g., relapsing polychondritis)
As with TCA
Trigger point deactivation Myofascial pain; local twitch response is essential therapeutic element (ref). May be combined with other acupuncture modalities, e.g., following PENS for recalcitrant localized pain. As with TCA As with TCA; as compared with TCA and PENS, trigger point deactivation may be painful.
Deep intramuscular electrical stimulation Localized myofascial pathology (e.g., piriformis, erector spinae); may be performed in addition to TCA or PENS for recalcitrant localized myofascial pain. As with TCA As with TCA