Clinical Efficacy and Safety of Acupressure on Low Back Pain: A Systematic Review and Meta-Analysis

Abstract

Objectives. To evaluate the effectiveness and safety of acupressure on low back pain (LBP). Methods. We searched 7 electronic databases and 2 trial registries through December 28, 2020. Randomized controlled trials (RCTs) of acupressure on LBP were considered for meta-analysis with Revman 5.3 and Stata 15.0 software. Methodological quality was evaluated using the Cochrane Collaboration’s tool. Trial sequential analysis (TSA) was used to quantify the statistical reliability. HETRED analysis and GRADE were used to determine the heterogeneity and quality of the results, respectively. Results. Twenty-three RCTs representing 2400 participants were included. Acupressure was superior to tuina massage on response rate (RR 1.25; 95% CI, 1.16 to 1.35; P < 0.00001 ) and in the standardized mean difference (SMD) for pain reduction [SMD −1.92; 95% CI, −3.09 to −0.76; P = 0.001 ]. Likewise, acupressure was superior to physical therapy [SMD, −0.88; 95% CI, −1.10 to −0.65; P < 0.00001 ] and to usual care [SMD, −0.32; 95% CI, −0.61 to −0.02; P = 0.04 ] in pain reduction. The Oswestry Disability Index was significantly improved by acupressure compared with usual care [SMD, −0.55; 95% CI, −0.84 to −0.25; P = 0.0003 ]. The combination of acupressure with either manual acupuncture or electro-acupuncture showed significant improvements over the adjuvant therapies alone in response rate [RR 1.19; 95% CI, 1.13 to 1.26; P < 0.00001 ], pain reduction, and the Japanese Orthopedic Association score (JOA). However, each study displayed substantial heterogeneity. Through subgroup sensitivity analysis and -HETRED analysis, the heterogeneity of acupressure compared with manual acupuncture decreased while the results maintained significance with respect to pain reduction [SMD −0.9; 95% CI, −1.21 to −0.6; P < 0.00001 ] and JOA [SMD, 0.66; 95% CI, 0.33 to 0.98; P < 0.00001 ]. Similar results were obtained comparing acupressure with electro-acupuncture with respect to pain [SMD, −1.07; 95% CI, −1.33 to −0.81; P < 0.00001 ] and JOA [SMD, 0.89; 95% CI, 0.51 to 1.27, P < 0.00001 ]. TSA demonstrated the effectiveness of acupressure as a standalone or as a combinative treatment (with manual acupuncture or electro-acupuncture) for LBP. Conclusion. Acupressure is an effective treatment for LBP. However, GRADE assessments downgraded the evidence in the trials, indicating that additional investigations are needed to confirm these observations.

Acupressure for Managing Osteoarthritis: A Systematic Review and Meta-Analysis

“…Currently, there is no systematic review on acupressure for OA. In comparison to prior systematic reviews on acupressure for musculoskeletal conditions including low back pain [10,12], neck pain syndrome [16], and musculoskeletal pain [46], our results are found to be only partially consistent with their findings on acupressure showing positive effect in pain reduction. Our pooled results showed that acupressure has superior effects in reducing pain as a complementary intervention to conventional intervention, but not as sole intervention.…”

“…Acupressure has been used for various purposes. Previous systematic reviews have investigated the efficacy or the impact of acupressure as a sole intervention on pain [11], low back pain [10,12], labor or labor pain [13][14][15], neck pain syndrome [16], sleep quality, or sleep disorders [17][18][19], promoting the health of older adults [20], respiratory allergic diseases [21], postoperative gastrointestinal symptoms [22], chemotherapy-induced nausea and vomiting [23], primary dysmenorrhea [24][25][26], anxiety [27], neurological disorders [28], and symptom management [29][30][31]; and other reviews considered acupressure as a complementary intervention with acupuncture on cancer pain [32], cancer-related fatigue [33], weight reduction [34], uremic pruritus [35], premenstrual syndrome [36], and labor pain [37].…”

Comparative Effectiveness of Western and Eastern Manual Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis

“…In this review, manual therapies that showed significant improvement in some outcomes of the quality of life in COPD patients were acupressure and tuina belonging to Eastern manual therapy. These therapies may not only affect lung function or exercise capacity in COPD patients but may also help improve other disturbing symptoms, including pain [ 49 ], insomnia [ 50 , 51 ], and fatigue [ 50 ], as seen in previously published studies, thereby contributing to the improvement in the quality of life of COPD patients.…”

Manual therapy regulates oxidative stress in aging rat lumbar intervertebral discs through the SIRT1/FOXO1 pathway

“…As a widely used complementary and alternative therapy, manual therapy (MT) is performed by the hands on external areas of the body, which can affect the internal physiological state [26]. In China, Tuina is a traditional style of MT that involves pressing, pinching, and kneading the body [27] and has demonstrated positive effects for treating LBP in clinical practice [28][29][30]. However, there have been few studies on the effects of MT on tissue degeneration beyond pain relief, although an association has been shown between LBP and age-related IVD degeneration [31].…”