OBJECTIVE: We briefly discuss the history of acupuncture and its postulated mechanisms of action, but our primary objective is to discuss the evidence for acupuncture's efficacy in low back pain as well as approaches of newer study protocols to define more clearly the true usefulness of this alternative modality in low back pain. METHODS: Pubmed online search of all articles and other literature in the past 50 years related to acupuncture efficacy in low back pain, including case reports, randomized controlled trials and meta-analyses.

RESULTS: Lower back pain and its associated incapacitating sequelae constitute an important healthcare and socioeconomic problem. There have been multiple, generally poor quality studies on the efficacy of acupuncture for thismulti-factorial pain condition. Although newer studies seem to show promise, effectiveness has not been clearly demonstrated.

CONCLUSIONS: There is a paucity of high-quality research assessing efficacy of acupuncture in the management of LBP. Nonetheless, it continues to play a significant role in our clinical practice, not as a sole therapeutic modality but rather as an adjunct to a multidisciplinary integrative approach of LBP management. Most of the published articles about acupuncture in the biomedical literature consist of case reports, case series, or intervention studies with designs inadequate to assess its efficacy. Thus it is imperative that further research be performed, both preclinical to help elucidate the mechanisms underlying acupuncture, and clinical to justify its clinical application.