Table 2 Acupuncture and related modalities for the treatment of CLBP
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 |