Traditional Chinese medicine therapies for chronic nonspecific low back pain: A systematic review and network meta-analysis

BackgroundChronic nonspecific low back pain (CNLBP) is a common clinical condition, and traditional Chinese medicine (TCM) therapies have been shown to effectively alleviate patient discomfort.ObjectiveTo evaluate and compare the efficacy of different TCM therapies in the treatment of CNLBP.MethodsA comprehensive search was performed in Web of Science, PubMed, Embase, and The Cochrane Library for randomized controlled trials on TCM therapies for CNLBP. A network meta-analysis was performed to compare the outcomes of various interventions, with therapeutic effects ranked by the surface under the cumulative ranking curve (SUCRA).ResultsMeta-analysis showed that for the Visual Analogue Scale, moxibustion (SMD = -2.08; 95% CI, -3.75 to -0.42; p = 0.0143), cupping (SMD = -5.69; 95% CI, -7.60 to -3.77; p < 0.00001), acupuncture (SMD = -0.94; 95% CI, -1.33 to -0.54; p < 0.00001), acupuncture combined with cupping(SMD = -6.65; 95% CI, -9.03 to -4.27; p < 0.0001), and traditional Chinese exercises (SMD = -1.86; 95% CI, -2.73 to -0.99; p < 0.00001) all showed significant effectiveness. The SUCRA ranking of effectiveness for these therapies was as follows: traditional Chinese exercises > moxibustion > acupuncture combined with cupping > acupuncture > cupping. Regarding the Roland-Morris Disability Questionnaire, both moxibustion (SMD = -1.54; 95% CI, -3.00 to -0.07; p = 0.0397) and acupuncture (SMD = -0.79; 95% CI, -1.27 to -0.31; p = 0.0013) showed significant therapeutic benefits. The SUCRA ranking for these treatments was: moxibustion > acupuncture. Regarding the Oswestry Disability Index, acupuncture (SMD = -1.40; 95% CI, -2.54 to -0.26; p = 0.0159) showed a significant advantage.ConclusionTCM can effectively alleviate symptoms in patients with CNLBP through multiple mechanisms. Among these interventions, traditional Chinese exercises have shown the greatest efficacy in pain relief, while acupuncture provides broader benefits across various outcome measures.