Abstract

Background: Chronic low back pain (CLBP), with or without central sensitization (CS), is a common musculoskeletal condition that impairs quality of life and daily function. While standard physiotherapy is widely used, adjunctive therapies such as Transcutaneous Electrical Nerve Stimulation (TENS) and acupuncture are gaining recognition for their potential benefits. However, limited research has directly compared their effectiveness alongside physiotherapy, particularly in patients with or without CS. Objective: To compare the effectiveness of TENS and acupuncture as adjuncts to standard physiotherapy in improving pain intensity, functional impairment, central sensitization, and quality of life in patients with CLBP. Methodology: A clinical trial involving 52 CLBP patients was randomly assigned to two groups: Group A received TENS with physiotherapy, and Group B received acupuncture with physiotherapy. Interventions lasted six weeks, with assessments at baseline, three weeks, and six weeks. The primary outcomes included the Numerical Pain Rating Scale (NPRS) and Oswestry Disability Index-Gujarati (ODI-G), and the secondary outcomes were the Central Sensitization InventoryGujarati (CSI-G) and Short Form-12 (SF-12). Results: Both groups showed significant improvements; however, acupuncture yielded superior results. At six week s, acupuncture showed greater reductions in NPRS (1.31 ± 1.19 vs. 3.04 ± 1.43), ODI-G (3.15 ± 2.31 vs. 8.88 ± 5.43), and CSI-G (6.81 ± 5.33 vs. 16.81 ± 12.25) (p < 0.05). Quality of life improved in both groups, with acupuncture offering faster benefits. Subgroup analysis revealed greater CS reduction with acupuncture.

• 1.   Coates G., Clewes P., Lohan C., Stevenson H., Wood R., Tritton T., et al. Chronic Low Back Pain with and without Concomitant Osteoarthritis: A Retrospective, Longitudinal Cohort Study of Patients in England. International journal of clinical practice. 2023;2023:5105810.
• 2.   Rubin D.I. Epidemiology and risk factors for spine pain. Neurologic clinics. 2007; 25(2): 353-71. 3. Koes B.W., van Tulder M.W., Ostelo R., Kim Burton A., Waddell G. Clinical guidelines for the management of low back pain in primary care: An international comparison. Spine. 2001; 26(22): 2504-13; discussion 13-4.
• 4.   Mikhail H., Reda N., Shahaly M., Nour-Eldein H. Predictors of fear-avoidance belief, pain, and disability index in patients with chronic low back pain attending rheumatology outpatient clinics. Journal of Public Health. 2022; 30.
• 5.   Picavet H.S., Vlaeyen J.W., Schouten J.S. Pain catastrophizing and kinesiophobia: predictors of chronic low back pain. American journal of epidemiology. 2002; 156(11): 1028-34.
• 6.   Stewart W.F., Ricci J.A., Chee E., Morganstein D., Lipton R. Lost productive time and cost due to common pain conditions in the US workforce. Jama. 2003; 290(18): 2443-54.
• 7.   Fatoye F., Gebrye T., Odeyemi I. Real-world incidence and prevalence of low back pain using routinely collected data. Rheumatology international. 2019; 39(4): 619-26.
• 8.   Ito T., Shirado O., Suzuki H., Takahashi M., Kaneda K., Strax T.E. Lumbar trunk muscle endurance testing: an inexpensive alternative to a machine for evaluation. Archives of physical medicine and rehabilitation. 1996; 77(1): 75-9.
• 9.   Meucci R.D., Fassa A.G., Faria N.M. Prevalence of chronic low back pain: systematic review. Revista de saude publica. 2015; 49:1.
• 10.   Wall P.D., McMahon S.B., Koltzenburg M. Wall and Melzack’s Textbook of Pain: Elsevier/ Churchill Livingstone; 2006.
• 11.   Khadilkar A., Odebiyi D.O., Brosseau L., Wells G.A. Transcutaneous electrical nerve stimulation (TENS) versus placebo for chronic low-back pain. The Cochrane database of systematic reviews. 2008; 2008(4): Cd003008.
• 12.   Milne S., Welch V., Brosseau L., Saginur M., Shea B., Tugwell P., et al. Transcutaneous electrical nerve stimulation (TENS) for chronic low back pain. The Cochrane database of systematic reviews. 2001(2): Cd003008.
• 13.   Berman B.M., Langevin H.M., Witt C.M., Dubner R. Acupuncture for chronic low back pain. The New England journal of medicine. 2010; 363(5): 454-61.
• 14.   Carlsson C.P., Sjölund B.H. Acupuncture for chronic low back pain: a randomized placebocontrolled study with long-term follow-up. The Clinical journal of pain. 2001; 17(4): 296- 305.
• 15.   Sudhakaran P. Acupuncture for Low-Back Pain. Medical acupuncture. 2021; 33(3): 219-25.
• 16.   Lai H.C., Lin Y.W., Hsieh C.L. AcupunctureAnalgesia-Mediated Alleviation of Central Sensitization. Evidence-based complementary and alternative medicine: eCAM. 2019; 2019: 6173412.
• 17.   Zheng X., Reneman M.F., Echeita J.A., Schiphorst Preuper R.H., Kruitbosch H., Otten E, et al. Association between central sensitization and gait in chronic low back pain:
• 18.   Zheng X., Lamoth C.J., Timmerman H., Otten E., Reneman M.F. Establishing central
• 19.   Haake M., Müller H.H., Schade-Brittinger C, Basler H.D., Schäfer H., Maier C., et al. German
• 20.   Foster N.E., Bishop A, Bartlam B., Ogollah R., Barlas P., Holden M., et al. Evaluating
• 21.   Mu J., Furlan A.D., Lam W.Y., Hsu M.Y., Ning Z., Lao L. Acupuncture for chronic nonspecific low back pain. The Cochrane database of Kalauokalani D., Cherkin D.C., Sherman K.J.,
• 23.   Hutchinson A.J., Ball S., Andrews J.C., Jones G.G. The effectiveness of acupuncture in treating chronic non-specific low back pain: a systematic review of the literature. Journal of orthopaedic surgery and research. 2012; 7: 36.
• 24.   Yan W.X., Lin H.Z., Wang X., Zhang W., Liu L.P., Yu J.N., et al. Acupuncture for Low Back Pain: Reevaluation of Systematic Reviews and Meta-analyses. Current pain and headache reports. 2023; 27(9): 351-69.
• 25.   Fox E.J., Melzack R. Transcutaneous electrical stimulation and acupuncture: comparison of treatment for low-back pain. Pain. 1976; 2(2): 141-8.
• 26.   Simon C.B., Riley J.L., 3rd, Fillingim R.B., Bishop

Data Sharing Statement

Funding