Back to Journals » Journal of Pain Research » Volume 17

Immediate Efficacy of Contralateral Acupuncture on SI3 Combined with Active Exercise for Acute Lumbar Sprains: Protocol for a Randomized Controlled Trial

Authors Tang X , Li Q , Huang G, Chen Z , Huang Y, Pei X, Zhao S, Liu Z , Guo T , Liang F 

Received 28 April 2024

Accepted for publication 10 June 2024

Published 13 June 2024 Volume 2024:17 Pages 2099—2110


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Houman Danesh

Xin Tang,1,* Qifu Li,1,* Gaoyangzi Huang,1 Ziwen Chen,2 Ya Huang,1 Xianmei Pei,1 Siwen Zhao,1 Zili Liu,1 Taipin Guo,1 Fanrong Liang2

1School of Second Clinical Medicine/The Second Affiliated Hospital, Yunnan University of Chinese Medicine, Kunming, People’s Republic of China; 2College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Taipin Guo, School of Second Clinical Medicine/The Second Affiliated Hospital, Kunming, People’s Republic of China, Email [email protected] Fanrong Liang, College of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People’s Republic of China, Email [email protected]

Purpose: Acute lumbar sprain (ALS) is a common clinical disease characterized by persistent intolerable low back pain and limitation of movement, and quick pain relief and restoration of mobility in a short time are the main needs of patients when they visit the clinic. This study aims to evaluate the immediate efficacy of contralateral acupuncture (CAT) on SI3 combined with active exercise in treating ALS.
Methods and Analysis: This study is a randomized controlled trial which will recruit 118 eligible participants aged 18 to 55 years with ALS at the Second Affiliated Hospital of Yunnan University of Chinese Medicine between March 2024 and December 2026. Participants will be randomly assigned to the acupuncture group or the sham-acupuncture group in a 1:1 ratio. The acupuncture group will receive a 10-minute acupuncture treatment combined with active exercise, while the sham-acupuncture group will receive a 10-minute sham acupuncture treatment combined with active exercise. Randomization will use a computer-generated sequence with allocation concealed in opaque envelopes. The primary outcome will be the pain visual analogue scale (VAS) scores after 10 minutes of treatment. Secondary outcomes will include the pain VAS scores at other time points (2, 4, 6, and 8 minutes post-treatment), the lumbar range of motion (ROM) scores at various time points, blinded assessment, the treatment effect expectancy scale, and the rescue analgesia rate. The analysis will follow the intention-to-treat principle. The primary outcome will be analyzed using ANCOVA, and secondary outcomes with repeated measures ANOVA. The rescue analgesia rate will be assessed using either the χ2 test or Fisher’s exact test.
Discussion: This study is the first randomized controlled trial to assess the immediate efficacy of CAT in combination with active exercise for ALS. This study will provide a simple, rapid, and effective treatment for the clinical management of ALS.

Keywords: acute lumbar sprain, immediate efficacy, contralateral acupuncture, active exercise, randomized controlled trial


Acute lumbar sprain (ALS) is defined as an acute rupture of the muscles, fascia, ligaments, and other soft tissues of the lower back, often caused by sudden and excessive external forces. It is a common form of low back pain, accounting for about 12% of all low such cases.1 Patients usually present with persistent intolerable low back pain and limitation of movement, which significantly affects their daily life and work.2 Therefore, quick pain relief and restoration of mobility in a short time are the main needs of patients when they visit the clinic.

The American College of Physicians Clinical Practice Guidelines recommends nonsteroidal anti-inflammatory drugs (NSAIDs) as the first-line treatment for pain in ALS patients.3,4 Previous studies have found that patients begin to experience pain relief on average about 30 minutes after taking NSAIDs, with significant pain relief averaging about two and a half hours.5–7 This indicates that even after taking the medication, patients still need to tolerate the pain for a prolonged period of time. Additionally, some patients report that their pain persists despite the use of medications.8,9 Furthermore, the use of NSAIDs may have side effects on the digestive and cardiovascular systems.10,11 Thus, complementary alternative therapies are considered advantageous treatments for improving ALS symptoms.12 Recent studies have also highlighted the benefits of manual therapy and exercise in reducing pain and disability in patients with low back pain.13,14

Acupuncture, a traditional non-pharmacologic therapy, has potential advantages in the treatment of acute pain disorders.15–17 Clinical studies have indicated that acupuncture can alleviate pain and enhance mobility in ALS patients.18–20 Contralateral acupuncture (CAT) is a traditional acupuncture technique that has been used in China for more than 2000 years. It is characterized by selecting acupoints on the right (healthy side) for needling when the left (affected side) is diseased.21 This method is particularly effective in treating acute unilateral pain, such as acute migraine and shoulder pain.22,23 ALS often presents as unilateral low back pain, which is well-suited for CAT treatment.24 Additionally, exercise is a well-established adjunct therapy for acute mobility disorders, contributing to pain reduction and the improvement or restoration of functional activities.25 A recent study suggests that combining CAT with active exercise improves pain and dysfunction in patients with ALS in a short period, but with limitations such as small sample size and insufficient blinding.26 Therefore, the immediate efficacy of this combined therapy for ALS remains unclear, necessitating further validation.

The objective of this study is to evaluate the immediate efficacy of CAT on SI3 (Houxi acupoint) combined with active exercise in treating ALS. The findings of this research will provide high-quality evidence supporting the application of this combined therapy for ALS.

Methods and Analysis

Study Design and Setting

The study protocol is designed according to the standard protocol item: Recommendations for Interventional Trials 2013 Statement (SPIRIT 2013) (Supplementary Material 1) and followed the principles of the Declaration of Helsinki.27 This study has been approved by the Ethics Committee of the Second Affiliated Hospital of Yunnan University of Traditional Chinese Medicine (2023–007) and registered with the China Clinical Trial Registry (ChiCTR2400079752).

This study is a randomized controlled trial which will recruit 118 eligible participants aged 18 to 55 years with ALS at the Second Affiliated Hospital of Yunnan University of Chinese Medicine between March 2024 and December 2026. Participants will be randomly assigned to the acupuncture group or the sham-acupuncture group in a 1:1 ratio. All participants will be given a 10-minute treatment. The flowchart is shown in Figure 1. The schedule of enrollment, intervention, and assessment is detailed in Table 1.

Table 1 Study Schedule for Data Measurements

Figure 1 Flow diagram.


Recruitment of participants will mainly be through posting posters in the orthopaedic and acupuncture outpatient clinics of the Second Affiliated Hospital of Yunnan University of Chinese Medicine and in the Kunming community. Participants will be diagnosed by a licensed orthopaedic physician with at least five years of clinical experience, ensuring accurate diagnosis and eligibility for the study. Eligible participants will be required to provide written informed consent (Supplementary Material 2) before the randomization group. Participants will retain the right to withdraw from the study at any time.

Diagnostic Criteria

Refer to the diagnostic criteria for ALS as outlined in the “Clinical Diagnosis and Treatment Guidelines: Orthopedics” published by the Chinese Medical Association:

  1. History of ALS;
  2. Lumbar deformity, lumbar muscle spasm, and activity limitation;
  3. Obvious fixed pressure pain at the injury site;
  4. Lumbar spine X-ray without obvious positive features.28

Inclusion Criteria

Participants will be eligible if they meet all the following criteria:

  1. Conform to the diagnostic criteria of ALS;
  2. Unilateral low back pain, age 18–55 years old, male or female;
  3. Duration of the disease ≤ 3 days;
  4. Moderate to severe low back pain, with a visual analogue scale (VAS) between 4 and 8;
  5. Signed the informed consent form and voluntarily participated in this study.

Exclusion Criteria

Participants will be excluded with any of the following:

  1. Presence of concurrent lumbar spondylolisthesis, tuberculosis, tumors, fractures, or other spinal pathologies;
  2. Lumbar pain resulting from urinary system diseases, gynecological conditions or acute and chronic infections;
  3. Coexistence of severe cardiovascular, cerebrovascular, hepatic, renal, or coagulation system disorders;
  4. Combined serious mental illness or intellectual disability, rendering them unable to complete the questionnaire;
  5. Pregnant or breastfeeding women;
  6. Used other methods of pain relief within the past 6 hours.

Randomization and Blinding

Participants will be randomly assigned to the acupuncture group and the sham-acupuncture group in a 1:1 ratio. To minimize selection bias, an independent statistician will use SPSS 28.0 (IBM, Chicago, IL, license code: f56b44b8d8e3562ad8a2) to generate random numbers. These numbers will be enclosed in opaque envelopes. Participants will choose one of these envelopes after agreeing to the principle of random allocation, which will determine their group assignment and the corresponding intervention method. To further ensure research rigour, treatments will be administered in separate rooms to prevent participants from sharing information. Participants, outcome assessors, and statistical analysts will be blinded to group assignments. Although acupuncturists will be aware of the treatment allocations, they will not participate in the subsequent outcome assessment or data analysis.


The interventions in this study will adhere to the Comprehensive Standards for Trial Reporting and the Standards for Reporting Interventions in Acupuncture Clinical Trials.29,30 All participants will receive a single acupuncture session at the healthy side SI3 (on the back of the hand, in the depression between the red and white meatus proximal to the ulnar side of the 5th metacarpophalangeal joint).31 The location of SI3 is presented in Figure 2. Treatments in this study will be conducted by licensed acupuncturists with at least 5 years of experience. All acupuncturists will receive training to ensure that they are fully familiar with the treatment procedure at the beginning of the trial.

Figure 2 Location of acupoint.

Appliance Selection

Park Sham Acupuncture Device (PSD) (Figure 3): This device includes a transparent catheter (Φ4×20mm), double-sided tape (Φ1×15mm), and an opaque plastic base, It is manufactured by Suzhou Medical Supplies Factory Limited, with batch number: 210401.

Figure 3 Park Sham Acupuncture Device.

Acupuncture Needles: Huatuo brand disposable acupuncture needles will be used, produced by Suzhou Medical Supplies Factory Limited. The manufacturer holds license number Su Food and Drug Supervision and Mechanical Production Xu 2001–0020, and registration certificate number Su Food and Drug Supervision and Mechanical (Quasi) 24 No. 201622770970, with the specification of 0.25×40mm.

Blunt Needles: 0.25×40mm retractable stainless steel blunt-tipped needles, lot number 200304, manufactured by Suzhou Medical Supplies Limited, will be selected.

Protractor: Protractors made of stainless steel, measuring 90×155mm, produced by the company in Huzhou, Zhejiang, China, will be utilized.


Before the treatment, participants take a seated position, exposing the acupoint, and the acupuncturist will sterilize the surrounding skin.

Acupuncture Group

A PSD and an acupuncture needle will be selected. The tape on the skin side of the PSD will be removed, and then the needle will be inserted into the PSD with the needle tip exposed. Subsequently, the needle will be affixed to the SI3 on the healthy side and inserted perpendicularly towards the Hegu (LI 4) point to a depth of 20 to 30 mm.32 Large amplitude twisting techniques (180° to 360°) will be employed to elicit the “Deqi” sensation.33,34 Once achieved, the participant will be asked to stand. The doctor will stand behind the participant and support the participant’s lower back with both hands. Then, the participant will be instructed to perform slow movements including forward flexion, backward extension, lateral flexion, and rotation within their pain-tolerable range, as shown in Figure 4. The range and speed of these movements will increase gradually as pain decreases.

Figure 4 Lumbar exercises during acupuncture.

Participants in the acupuncture group will receive a single 10-minute session of acupuncture treatment.

Sham-Acupuncture Group

A PSD and a blunt needle will be used. The tape on the skin side of the PSD will be removed, and a retractable blunt needle will be inserted. The blunt needle will not pierce the skin, but the participant will feel a pinprick sensation. The subsequent steps will be the same as in the acupuncture group.

Participants in the sham-acupuncture group will receive a 10-minute session of sham-acupuncture treatment.

Emergency Treatment

In cases where a participant’s low back pain persists or worsens during the treatment, the intervention will be immediately discontinued, and emergency measures will be implemented. This includes administering NSAIDs and transporting participants to the emergency department for further evaluation and treatment if necessary. In addition, participants in the sham-acupuncture group whose symptom do not relieve will be offered real acupuncture treatment or other emergency interventions.


Primary Outcome

The primary outcome will be the pain VAS scores after 10 minutes of treatment.

Secondary Outcomes

Secondary outcomes will include the pain VAS scores at other time points (2, 4, 6, and 8 minutes post-treatment), the lumbar range of motion (ROM) scores at various time points, blinded assessment, the treatment effect expectancy scale, and the rescue analgesia rate.

Outcome Measurements

The VAS is a widely-recognized tool for evaluating pain, with scores ranging from 0 (no pain) to 10 (severe pain). Higher scores indicate more severe pain.35 The assessment will be conducted six times: at baseline, and 2, 4, 6, 8, and 10 minutes during the treatment process (Supplementary Material 3).

The ROM is a fundamental indicator of lumbar function. It can be quantified using a 5-point Likert scale. The scoring is as follows: A score of 0 is given when the participant can bend forward freely and touch the floor with the fingertips. A score of 1 is given if the participant can bend sufficiently to touch the knees with the hands. Bending beyond 70 degrees scores 2 points. A slight bend is scored as 3 points. If the participant is completely unable to bend forward, they receive 4 points. If the lumbar spine is unable to bend forwards, but instead shows reverse extension, this is scored 5.36 The scale will be measured at the same intervals as the VAS (Supplementary Material 4).

The treatment effect expectation scale will be employed to assess anticipated treatment outcomes before the commencement of therapy (Supplementary Material 5).

To assess the success of blinding, patients will be asked at the end of their treatment if they believe they received true acupuncture therapy. Furthermore, they will be instructed to rate their certainty about their answer on a scale from 0 to 10, where 0 indicates complete uncertainty and 10 signifies absolute certainty (Supplementary Material 6).

The percentage of patients requiring additional analgesic medication will be counted at the end of the acupuncture treatment (Supplementary Material 7).

Sample Size

This study is designed as a superiority trial to assess whether acupuncture combined with exercise is more effective than sham-acupuncture combined with exercise in treating ALS. A previous clinical study has shown that acupuncture combined with exercise and sham-acupuncture combined with exercise in treating ALS for 10 minutes decreased VAS scores by 4.6±1.0 and 2.7±1.0, respectively.37 Based on this finding, we hypothesize that the change in VAS scores after 10 minutes of treatment will be 4.6±1.0 in the acupuncture group and 2.7±1.0 in the sham-acupuncture group, with α=0.025 (unilateral), β=0.1, Δ=1.3, and K=1.38 The sample size was calculated based on the following formula:

It was calculated that a minimum of 59 patients were needed in each group.39 Since only one treatment will be done, patient dropout will not be considered. A total of 118 patients will be recruited.

Statistical Analysis

SPSS 28.0 will be used to analyze all data in this study. When analyzing demographic characteristics, the normality of distribution will dictate the use of either independent samples t-tests or Wilcoxon rank-sum tests to evaluate continuous variables between two groups. For categorical variables in demographic characteristics, χ2 test or Fisher’s exact tests will be employed. Covariates such as age, gender, and baseline pain levels will be controlled through randomization. To control for potential confounding factors, significant differences in demographic characteristics emerge, these will be incorporated as covariates in subsequent efficacy analyses. Levene’s test for equality of variances will be used to assess the homogeneity of variances. The change in pain VAS score from baseline to 10 minutes into treatment will be analyzed using analysis of covariance (ANCOVA), with the treatment modality (acupuncture or sham-acupuncture) as the factor and baseline pain VAS score as the covariate. Differences in secondary outcomes at various time points will be examined using repeated measures analysis of variance (ANOVA). If these analyses do not meet the homogeneity of variance assumption, Welch’s ANOVA will be used. Evaluation of rescue analgesia rate using χ2 test or Fisher’s exact test. Adhering to the intention-to-treat (ITT) principle, our analyses will encompass all participants who received randomized treatment.

Data Management and Confidentiality

All raw clinical data will be detailed in a Case Report Form (CRF) and retained for at least five years after publication. The accuracy of these data will be monitored by two clinical research assistants. To protect the privacy of the subjects, only the outcome assessors will have access to the CRFs. The Ethics Committee will periodically review trial progress and CRF integrity, and it reserves the right to modify or terminate the trial. There is no conflict of interest between this committee and the research project. Throughout the study, all personal information relating to participants will be kept strictly confidential. Under no circumstances will this information be disclosed to any third party, individual or organization without the consent of the participant.

Adverse Events Report

Any adverse events (AEs) observed during treatment will be fully evaluated and documented on a CRF. These AEs may include acupuncture-related events like severe localized pain, subcutaneous congestion, hematoma, localized infections, syncope, nausea, and unrelated symptoms such as cough or headache. All AEs will be treated promptly.


ALS is a common acute pain disease characterized by intolerable pain and limitation of movement. Patients are urgently needing rapid relief of their symptoms. The result of this study is expected to provide a rapid, simple, and effective alternative treatment for ALS.

In clinical practice, the symptoms of ALS usually present unilaterally. Therefore, we opted for contralateral acupuncture, which is particularly effective in treating disorders characterized by unilateral pain.40,41 The main pathological features of ALS include aseptic inflammation and lumbar muscle spasms.42 Contemporary studies have shown that CAT is effective in reducing aseptic inflammation and relieving muscle spasms on the affected side, but further research is needed.43,44 Moreover, ALS is usually accompanied by subluxation of the small intervertebral joints and embedding of the surrounding joint capsule, which restricts lumbar mobility.45 During acupuncture, combined with exercise can promote the repositioning of slightly displaced lumbar intervertebral small joints and fascia, correct endogenous posterior joint disorders and imbalance of external motor structures, and restore normal motor function.46

When determining the timing for observations, we noted that previous studies on acute pain have typically involved treatment periods of 30 minutes or longer.47,48 However, recent evidence suggests that treatment of ALS can achieve significant efficacy in shorter periods (10 minutes).49 Considering that patients with ALS have severe pain and need immediate pain relief in the shortest possible time, our study adopted a 10-minute observation period, with assessments conducted every two minutes, to document in detail the immediate efficacy of the treatment. In addition, the short duration of treatment allowed us to use conventional medications promptly when acupuncture did not provide adequate pain relief. Considering that the operation needs to be simple, effective, and repeatable, and to minimize the discomfort of the patients during treatment, only one acupoint, SI3, is selected for treatment in this study. In Chinese medicine, the SI3 is esteemed as a critical point for treating low back pain and is extensively utilized in clinical practices for ALS.37,50 For measurement tools, we chose the VAS and ROM due to their relative objectivity and sensitivity, as well as the clarity and intuitive nature of the measurements.51,52 These tools facilitate rapid assessment and are directly related to the patient’s main symptoms, ensuring the validity and reliability of the results.37

Existing research indicates that sham-acupuncture, such as non-acupoint or superficial needling, can produce effective treatment effects.53,54 To reduce the impact of these non-specific effects, this study will use non-penetrating blunt needles for the control group.55 During treatment sessions, acupuncturists will ensure that these blunt needles make contact with the skin, inducing a mild tingling sensation. This approach aims to minimize differences in needling sensations between groups and to enhance the blinding effect of the trial. Previous studies have suggested that patients’ expectations of treatment efficacy may influence the outcomes of low back pain treatment, but no definitive conclusions have been reached.56,57 Therefore, we included an efficacy expectation scale to eliminate the potential influence of patients’ psychological expectations on the outcomes of acupuncture treatment.

This study is the first randomized controlled trial to assess the immediate efficacy of CAT in combination with active exercise for ALS. This study will provide a simple, rapid, and effective treatment for the clinical management of ALS. This study primarily observes the efficacy of acupuncture treatment, with medication administered only when acupuncture is not effective. This approach not only highlights the advantages of acupuncture, which has the potential to reduce the use of analgesic medications in the clinic, but also provides a basis for considering acupuncture as an initial treatment option for acute pain. However, some limitations of the study should also be recognized. Firstly, because of the specific characteristics of the acupuncture operation, the acupuncturists could not be blinded, which may affect the objectivity of the treatment results. To mitigate this bias, acupuncturists will not participate in outcome assessment or data analysis. Secondly, this is a single-centre study and its reproducibility needs to be further investigated. Thirdly, there is no follow-up in this study, thus there is a lack of knowledge about the long-term effects and durability of the treatment. These issues will be comprehensively explored in future studies.

In summary, this study aims to assess the immediate efficacy of CAT combined with active exercise for ALS. For researchers, this study will provide high-quality evidence on the immediate effects of this combined therapy approach. For clinicians and patients, the findings offer a simple and rapid alternative treatment protocol for managing ALS. The treatment duration of this study is only 10 minutes and the results will contribute significantly to understanding the efficacy of acupuncture in acute pain relief. Furthermore, the results of this study may also provide evidence to support the potential of acupuncture to reduce drug dependence.


ASL, acute lumbar sprain; VAS, visual analogue scale; ROM, range of motion; ITT, intention-to-treat; AEs, adverse events; CRF, case report form; PSD, Park Sham Acupuncture Device.

Trial Status

The trial is set to initiate recruitment and treatment on 1 March 2024 and is anticipated to be completed by 22 December 2026.

Ethics and Dissemination

This study was approved ethically by the Ethics Committee of the Second Affiliated Hospital of Yunnan University of Chinese Medicine on December 30, 2023, under document number 2023-007. It follows the principles of the Declaration of Helsinki. The results of the study will be published in a peer-reviewed journal and presented at a conference.

Patient Consent for Publication


Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.


This study is supported by the “Liang Fanrong Expert Workstation” of Yunnan Province-Yunnan Science and Technology Programme (202305AF150072), the Yunnan Ten Thousand Talents Plan Youth Project (YNWR-QNBJ-2019-257) and the “Liu Zili Famous Doctor” special talent program of the Yunnan Provincial Xing Dian Talent Support Program (Yunnan Party Talent Office 2022 No. 18).


The authors report no conflicts of interest in this work.


1. Hu Z, Yang Z, Wu Y, et al. A randomized controlled clinical study on immediate effect of long-needle penetration for acute lumbar sprain. Emerg Tradit Chin Med. 2020;29:1788–1790.

2. Shaoting X, Baofeng G, Shibi L. Practical Orthopaedics. Beijing: People’s Military Medical Publisher; 2012:2037–2038.

3. Chou R, Deyo R, Friedly J, et al. Systemic pharmacologic therapies for low back pain: a systematic review for an American college of physicians clinical practice guideline. Ann Intern Med. 2017;166:480–492. doi:10.7326/m16-2458

4. Chou R, Huffman LH. Medications for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147:505–514. doi:10.7326/0003-4819-147-7-200710020-00008

5. Desjardins PJ, Mehlisch DR, Chang DJ, et al. The time to onset and overall analgesic efficacy of rofecoxib 50 mg: a meta-analysis of 13 randomized clinical trials. Clin J Pain. 2005;21:241–250. doi:10.1097/00002508-200505000-00007

6. Girandola RN, Srivastava S, Loullis CC. A clinical trial comparing Lanconone® with ibuprofen for rapid relief in acute joint pain. Trials. 2016;17:189. doi:10.1186/s13063-016-1268-6

7. Manvelian G, Daniels S, Gibofsky A. A Phase 2 study evaluating the efficacy and safety of a novel, proprietary, nano-formulated, lower dose oral diclofenac. Pain Med. 2012;13:1491–1498. doi:10.1111/j.1526-4637.2012.01479.x

8. Moore RA, Derry S, McQuay HJ, et al. Single dose oral analgesics for acute postoperative pain in adults. Cochrane Database Syst Rev. 2011:Cd008659. doi:10.1002/14651858.CD008659.pub2

9. Friedman BW, O’Mahony S, Mulvey L, et al. One-week and 3-month outcomes after an emergency department visit for undifferentiated musculoskeletal low back pain. Ann Emerg Med. 2012;59:128–133.e123. doi:10.1016/j.annemergmed.2011.09.012

10. Harirforoosh S, Asghar W, Jamali F. Adverse effects of nonsteroidal antiinflammatory drugs: an update of gastrointestinal, cardiovascular and renal complications. J Pharm Pharm Sci. 2013;16(5):821–847. doi:10.18433/j3vw2f

11. Bindu S, Mazumder S, Bandyopadhyay U. Non-steroidal anti-inflammatory drugs (NSAIDs) and organ damage: a current perspective. Biochem Pharmacol. 2020;180:114147. doi:10.1016/j.bcp.2020.114147

12. Chou R, Deyo R, Friedly J, et al. Nonpharmacologic therapies for low back pain: a systematic review for an American college of physicians clinical practice guideline. Ann Internal Med. 2017;166(7):493–505. doi:10.7326/m16-2459

13. Martínez-Pozas O, Sánchez-Romero EA, Beltran-Alacreu H, et al. Effects of orthopedic manual therapy on pain sensitization in patients with chronic musculoskeletal pain: an umbrella review with meta-meta-analysis. American J Phy Med Rehabil. 2023;102(10):879–885. doi:10.1097/phm.0000000000002239

14. Cuenca-Zaldívar JN, Fernández-Carnero J, Sánchez-Romero EA, et al. Effects of a therapeutic exercise protocol for patients with chronic non-specific back pain in primary health care: a single-group retrospective cohort study. J Clin Med. 2023;12(20):6478. doi:10.3390/jcm12206478

15. Wu B, Yang L, Fu C, et al. Efficacy and safety of acupuncture in treating acute low back pain: a systematic review and Bayesian network meta-analysis. Ann Palliat Med. 2021;10(6):6156–6167. doi:10.21037/apm-21-551

16. Wang Y, Du R, Cui H, et al. Acupuncture for acute migraine attacks in adults: a systematic review and meta-analysis. BMJ Evid Based Med. 2023;28(4):228–240. doi:10.1136/bmjebm-2022-112135

17. Su X, Qian H, Chen B, et al. Acupuncture for acute low back pain: a systematic review and meta-analysis. Ann Palliat Med. 2021;10(4):3924–3936. doi:10.21037/apm-20-1998

18. Zhu B, Yuan X, Ye S, et al. Acupuncture at belt vessel for 38 cases of acute lumbar sprain. Zhongguo Zhen Jiu. 2022;42(08):871–872. doi:10.13703/j.0255-2930.20211004-k0002

19. Zhang L, Xu N. Clinical applications of shu points of the five shu points in acupuncture. Zhongguo Zhen Jiu. 2017;37(02):219–220. doi:10.13703/j.0255-2930.2017.02.034

20. Du J. Acupuncture treatment for acute lumbar sprain. Zhongguo Zhen Jiu. 2012;32(12):1098. doi:10.13703/j.0255-2930.2012.12.018

21. Sun R, Xu Y, Hu H, et al. Discussion on the mechanism, indications and applicable standard of contralateral channel needling. China J Tradit Chin Med Pharm. 2021;36:1972–1974.

22. Zhang S, Wang X, Yan CQ, et al. Different mechanisms of contralateral- or ipsilateral-acupuncture to modulate the brain activity in patients with unilateral chronic shoulder pain: a pilot fMRI study. J Pain Res. 2018;11:505–514. doi:10.2147/jpr.S152550

23. Li Q, Zhang X, Zhao S, et al. Treatment of 55 patients with acute migraine without aura by sequential triple acupuncture. Zhongguo Zhen Jiu. 2023;43:23–24. doi:10.13703/j.0255-2930.20220113-0003

24. Liu H, He J, Yan M, et al. Clinical application research of contralateral acupuncture method based on data mining. Lishizhen Med Materia Medica Res. 2018;29:3042–3044.

25. Hwang DW, Yoo DH, Bae IS, et al. Effectiveness of motion style acupuncture treatment for patients with shoulder disorders: a prospective observational study. Explore. 2023;19:832–841. doi:10.1016/j.explore.2023.04.011

26. Zhang Z, Wang Y, Li W, et al. Clinical observation of contralateral acupuncture therapy for acute lumbar sprain. Res Integ Tradit Chin Western Med. 2024;16(02):102–104.

27. Chan AW, Tetzlaff JM, Gøtzsche PC, et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ. 2013;346:e7586. doi:10.1136/bmj.e7586

28. Association CM. Clinical Diagnosis and Treatment Guidelines Orthopedics Fascicle. Beijing: People’s Medical Publishing House; 2009:108.

29. Schulz KF, Altman DG, Moher D. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18. doi:10.1186/1741-7015-8-18

30. MacPherson H, White A, Cummings M, et al. Standards for reporting interventions in controlled trials of acupuncture: the STRICTA recommendations. J Altern Complement Med. 2002;8:85–89. doi:10.1089/107555302753507212

31. Pacific WROft W. WHO Standard Acupuncture Point Locations in the Western Pacific Region. Manila: World Health Organization; 2008.

32. Fan Y, Wu Y. Effect of electroacupuncture on muscle state and infrared thermogram changes in patients with acute lumbar muscle sprain. J tradit Chin med. 2015;35(5):499–506. doi:10.1016/s0254-6272(15)30131-x

33. Li B, Huang M, Shang X, et al. Clinical efficacy of acupuncture combined with tuina for treating levator scapulae muscle Injury-type acute torticollis: a randomized controlled trial. Zhongguo Zhen Jiu. 2024:1–9. doi:10.13703/j.0255-2930.20231206-k0007

34. Yuan HW, Ma LX, Qi DD, et al. The historical development of deqi concept from classics of traditional Chinese medicine to modern research: exploitation of the connotation of deqi in Chinese medicine. Evid Based Complement Alternat Med. 2013;2013:639302. doi:10.1155/2013/639302

35. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain. 2016;13:67–75. doi:10.1016/j.sjpain.2016.06.012

36. Thomas E, Bianco A, Paoli A, et al. The relation between stretching typology and stretching duration: the effects on range of motion. Int J Sports Med. 2018;39:243–254. doi:10.1055/s-0044-101146

37. Lin R, Zhu N, Liu J, et al. Acupuncture-movement therapy for acute lumbar sprain: a randomized controlled clinical trial. J tradit Chin med. 2016;36(1):19–25. doi:10.1016/s0254-6272(16)30003-6

38. Gallagher EJ, Liebman M, Bijur PE. Prospective validation of clinically important changes in pain severity measured on a visual analog scale. Ann Emerg Med. 2001;38:633–638. doi:10.1067/mem.2001.118863

39. Hu J, Li B, Zhang H, et al. Sample size estimation in acupuncture and moxibustion clinical trials. Zhongguo Zhen Jiu. 2021;41:1147–1152. doi:10.13703/j.0255-2930.20201020-0002

40. Ran M, Zhao C, Zhao H. Clinical observation of immediate effect of contralateral Meridian needling combined movement on scapulohumeral periarthritis. Modern J Integ Trad Chin West Med. 2014;23:2056–2058.

41. Yang T, Wan Q. Clinical observation of opposing needling motor therapy in treatment of PHS. Acta Chin Med Pharmacol. 2022;50:78–81. doi:10.19664/j.cnki.1002-2392.220255

42. Li Y, Chen X, Li L, et al. Effect of acupuncture along meridians on pain degree and treatment of acute lumbar sprain. Dis Markers. 2022;2022:5497805. doi:10.1155/2022/5497805

43. Wang J, Du N. The impact of the juci method on pain and interleukin-6 in cervical radiculopathy. Henan Tradit Chin Med. 2014;34:2479–2480. doi:10.16367/j.issn.1003-5028.2014.12.024

44. Zhu G, Bao Y, Zeng Y, et al. Effect of balance needle on median nerve’s f-response in patients of spastic upper limb after stoke. Chin Archives of Tradit Chin Med. 2008:2185–2187. doi:10.13193/j.archtcm.2008.10.106.zhugx.019

45. Hong X, Zhao J, Fan Z, et al. Discussion on lin’s bone-setting technique for acute lumbar sprain based on “bone dislocation, tendons out of groove”. World Chin Med. 2022;17:3070–3073.

46. Gao T, Zheng Q, Zhang S, et al. Clinical application and mechanism of motion style acupuncture treatment for pain. Liaoning J Tradit Chin Med. 2019;46:1523–1526. doi:10.13192/j.issn.1000-1719.2019.07.052

47. Cohen M, Parker S, Taylor D, et al. Acupuncture as analgesia for low back pain, ankle sprain and migraine in emergency departments: study protocol for a randomized controlled trial. Trials. 2011;12:241. doi:10.1186/1745-6215-12-241

48. Kim KH, Ryu JH, Park MR, et al. Acupuncture as analgesia for non-emergent acute non-specific neck pain, ankle sprain and primary headache in an emergency department setting: a protocol for a parallel group, randomised, controlled pilot trial. BMJ Open. 2014;4:e004994. doi:10.1136/bmjopen-2014-004994

49. Zhang Y, Chen S, Luo Z, et al. Clinical efficacy and time-effect relationship of dynamic qi acupuncture for acute lumbar sprain. Zhongguo Zhen Jiu. 2022;42:1368–1372. doi:10.13703/j.0255-2930.20220117-0001

50. Wu Y, Zhang B, Wang C, et al. Observation on short-term and long-term therapeutic effects of electroacupuncture at Houxi (SI 3) on acute lumbar sprain. Zhongguo Zhen Jiu. 2007;3:3–5.

51. Shafshak TS, Elnemr R. The visual analogue scale versus numerical rating scale in measuring pain severity and predicting disability in low back pain. J Clin Rheumatol. 2021;27(7):282–285. doi:10.1097/rhu.0000000000001320

52. Ng JK, Kippers V, Richardson CA, et al. Range of motion and lordosis of the lumbar spine: reliability of measurement and normative values. Spine. 2001;26(1):53–60. doi:10.1097/00007632-200101010-00011

53. Linde K, Niemann K, Schneider A, et al. How large are the nonspecific effects of acupuncture? A meta-analysis of randomized controlled trials. BMC Med. 2010;8:75. doi:10.1186/1741-7015-8-75

54. Birch S. A review and analysis of placebo treatments, placebo effects, and placebo controls in trials of medical procedures when sham is not inert. J Altern Complement Med. 2006;12:303–310. doi:10.1089/acm.2006.12.303

55. Dos Santos Maciel LY, Dos Santos Leite PM, Neto ML, et al. Comparison of the placebo effect between different non-penetrating acupuncture devices and real acupuncture in healthy subjects: a randomized clinical trial. BMC Complement Altern Med. 2016;16:518. doi:10.1186/s12906-016-1477-2

56. Sherriff B, Clark C, Killingback C, et al. Impact of contextual factors on patient outcomes following conservative low back pain treatment: systematic review. Chiropractic Manual Ther. 2022;30(1):20. doi:10.1186/s12998-022-00430-8

57. Sánchez Romero EA, Lim T, Villafañe JH, et al. The influence of verbal suggestion on post-needling soreness and pain processing after dry needling treatment: an experimental study. Int J Environ Res Public Health. 2021;18(8):4206. doi:10.3390/ijerph18084206

Creative Commons License © 2024 The Author(s). This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.