{"doi":"10.1001/jamanetworkopen.2025.31348","title":"Acupuncture for Chronic Low Back Pain in Older Adults","abstract":"Importance: The study was carried out to inform Medicare acupuncture coverage decisions addressing the gap in evidence on acupuncture effectiveness, specifically for older adults with chronic low back pain (CLBP). Objective: To determine the effectiveness of standard acupuncture (SA) or SA plus maintenance (enhanced acupuncture [EA]) to improve CLBP-related disability relative to usual medical care (UMC) at 3, 6, and 12 months after randomization. Design, Setting, and Participants: This multisite, 3-arm, parallel-group randomized clinical trial of older adults with CLBP collected data from 4 US health care systems in 3 geographic areas and compared SA and EA treatment with UMC only. Study enrollment was conducted from August 12, 2021, to October 27, 2022; follow-up concluded on November 7, 2023. Interventions: Both SA (8-15 treatment sessions over 12 weeks plus UMC) and EA (SA plus 4-6 maintenance sessions during the next 12 weeks) were provided by experienced, community-based licensed acupuncturists. Participants were randomized 1:1:1 to the 3 groups. Main Outcomes and Measures: The primary outcome was CLBP-related disability measured by a baseline-to-6-month change in the Roland-Morris Disability Questionnaire (RMDQ) score. Secondary outcomes included pain intensity and the percentage of participants with clinically meaningful (≥30%) improvements. Results: The trial identified 800 individuals who were randomized to 3 groups (mean [SD] age, 73.6 [6.0] years; 496 females [62.0%]). At 6 months, RMDQ change scores were significantly better in both the SA and EA groups compared with the UMC only group (SA vs UMC: adjusted mean difference, -1.0 [95% CI, -1.9 to -0.1] and EA vs UMC: adjusted mean difference, -1.5 [95% CI, -2.5 to -0.6]). SA and EA change scores did not differ significantly from one another. The relative benefit of acupuncture compared with UMC on disability persisted at 12 months. Pain intensity exhibited a relative benefit of EA over SA at 6 months, and both acupuncture groups had significant improvement over UMC. The adjusted percentage with clinically meaningful improvements in RMDQ at 6 months was greater for SA (39.1% [95% CI, 33.1%-46.1%]; adjusted relative risk, 1.33 [95% CI, 1.04-1.70]) and for EA (43.8% [95% CI, 38.0%-50.4%]; adjusted relative risk, 1.49 [95% CI, 1.19-1.86]) compared with UMC (29.4% [95% CI, 24.3%-35.5%]) and persisted at 12 months. Rates of serious adverse events were low and similar among groups, with less than 1% that was possibly acupuncture-intervention related. Conclusions and Relevance: The findings of this randomized clinical trial of older adults with CLBP suggest that acupuncture needling provided greater improvements in back pain-related disability at 6 months and at 12 months compared with UMC alone. These findings support acupuncture needling as an effective and safe treatment option for older adults with CLBP. Trial Registration: ClinicalTrials.gov Identifier: NCT04982315.","journal":"JAMA Network Open","year":2025,"id":512255,"datarank":0.4292093296339994,"base_score":2.639057329615259,"endowment":2.639057329615259,"self_citation_contribution":0.3958585994422889,"citation_network_contribution":0.03335073019171047,"self_endowment_contribution":0.3958585994422889,"citer_contribution":0.03335073019171047,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":11,"citers_with_citation_signal":1,"citers_with_endowment":1,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9158,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT04982315"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":797082,"name":"Robert Wellman","orcid":"0000-0002-1435-6134","position":1,"is_corresponding":false},{"id":1052531,"name":"Morgan Justice","orcid":null,"position":2,"is_corresponding":false},{"id":2143,"name":"Andrew L. Avins","orcid":"0000-0003-1723-7904","position":3,"is_corresponding":false},{"id":956118,"name":"Matthew Beyrouty","orcid":"0000-0001-6553-8344","position":4,"is_corresponding":false},{"id":1078971,"name":"Carolyn M. Eng","orcid":"0000-0002-1081-6463","position":5,"is_corresponding":false},{"id":723158,"name":"Patricia M. Herman","orcid":"0000-0001-5579-5654","position":6,"is_corresponding":false},{"id":856072,"name":"Arya Nielsen","orcid":"0000-0003-3370-9123","position":7,"is_corresponding":false},{"id":658999,"name":"Alice Pressman","orcid":"0000-0003-2775-3275","position":8,"is_corresponding":false},{"id":245151,"name":"Katie L. Stone","orcid":"0000-0003-2797-3171","position":9,"is_corresponding":false},{"id":1078973,"name":"Raymond Teets","orcid":"0000-0002-2527-5153","position":10,"is_corresponding":false},{"id":450997,"name":"Andrea J. Cook","orcid":"0000-0002-6848-5222","position":11,"is_corresponding":false},{"id":377020,"name":"Lynn DeBar","orcid":"0000-0001-9191-9706","position":0,"is_corresponding":true}],"reference_count":59,"raw_metadata":null,"created_at":"2026-07-19T02:48:06.263458Z","pmid":"40938602","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}