{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,18]],"date-time":"2026-10-18T02:39:31Z","timestamp":1792291171353,"version":"4.4.0"},"reference-count":65,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n The study was carried out to inform Medicare acupuncture coverage decisions addressing the gap in evidence on acupuncture effectiveness, specifically for older adults with chronic low back pain (CLBP).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To determine the effectiveness of standard acupuncture (SA) or SA plus maintenance (enhanced acupuncture [EA]) to improve CLBP-related disability relative to usual medical care (UMC) at 3, 6, and 12 months after randomization.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n This multisite, 3-arm, parallel-group randomized clinical trial of older adults with CLBP collected data from 4 US health care systems in 3 geographic areas and compared SA and EA treatment with UMC only. Study enrollment was conducted from August 12, 2021, to October 27, 2022; follow-up concluded on November 7, 2023.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Both SA (8-15 treatment sessions over 12 weeks plus UMC) and EA (SA plus 4-6 maintenance sessions during the next 12 weeks) were provided by experienced, community-based licensed acupuncturists. Participants were randomized 1:1:1 to the 3 groups.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n The primary outcome was CLBP-related disability measured by a baseline-to-6-month change in the Roland-Morris Disability Questionnaire (RMDQ) score. Secondary outcomes included pain intensity and the percentage of participants with clinically meaningful (\u226530%) improvements.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The trial identified 800 individuals who were randomized to 3 groups (mean [SD] age, 73.6 [6.0] years; 496 females [62.0%]). At 6 months, RMDQ change scores were significantly better in both the SA and EA groups compared with the UMC only group (SA vs UMC: adjusted mean difference, \u22121.0 [95% CI, \u22121.9 to \u22120.1] and EA vs UMC: adjusted mean difference, \u22121.5 [95% CI, \u22122.5 to \u22120.6]). SA and EA change scores did not differ significantly from one another. The relative benefit of acupuncture compared with UMC on disability persisted at 12 months. Pain intensity exhibited a relative benefit of EA over SA at 6 months, and both acupuncture groups had significant improvement over UMC. The adjusted percentage with clinically meaningful improvements in RMDQ at 6 months was greater for SA (39.1% [95% CI, 33.1%-46.1%]; adjusted relative risk, 1.33 [95% CI, 1.04-1.70]) and for EA (43.8% [95% CI, 38.0%-50.4%]; adjusted relative risk, 1.49 [95% CI, 1.19-1.86]) compared with UMC (29.4% [95% CI, 24.3%-35.5%]) and persisted at 12 months. Rates of serious adverse events were low and similar among groups, with less than 1% that was possibly acupuncture-intervention related.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The findings of this randomized clinical trial of older adults with CLBP suggest that acupuncture needling provided greater improvements in back pain\u2013related disability at 6 months and at 12 months compared with UMC alone. These findings support acupuncture needling as an effective and safe treatment option for older adults with CLBP.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT04982315<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.31348","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T15:30:37Z","timestamp":1757691037000},"page":"e2531348","source":"Crossref","is-referenced-by-count":22,"title":["Acupuncture for Chronic Low Back Pain in Older Adults"],"prefix":"10.1001","volume":"8","author":[{"given":"Lynn L.","family":"DeBar","sequence":"first","affiliation":[{"name":"Kaiser Permanente Center for Health Research, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert D.","family":"Wellman","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Justice","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew L.","family":"Avins","sequence":"additional","affiliation":[{"name":"Division of Research, Kaiser Permanente Northern California, Oakland"},{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco"},{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Beyrouty","sequence":"additional","affiliation":[{"name":"The Institute for Family Health, New York, New York"},{"name":"Alfred and Gail Engelberg Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carolyn M.","family":"Eng","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patricia M.","family":"Herman","sequence":"additional","affiliation":[{"name":"RAND, Santa Monica, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arya","family":"Nielsen","sequence":"additional","affiliation":[{"name":"The Institute for Family Health, New York, New York"},{"name":"Alfred and Gail Engelberg Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Pressman","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco"},{"name":"Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California"},{"name":"California Pacific Medical Center Research Institute, Sutter Health, San Francisco"},{"name":"Center for Health Systems Research, Sutter Health, Walnut Creek, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katie L.","family":"Stone","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco"},{"name":"California Pacific Medical Center Research Institute, Sutter Health, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond Y.","family":"Teets","sequence":"additional","affiliation":[{"name":"The Institute for Family Health, New York, New York"},{"name":"Alfred and Gail Engelberg Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea J.","family":"Cook","sequence":"additional","affiliation":[{"name":"Kaiser Permanente Washington Health Research Institute, Seattle"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2025,9,12]]},"reference":[{"issue":"6","key":"zoi250888r1","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1016\/S2665-9913(23)00098-X","article-title":"Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021.","volume":"5","author":"GBD 2021 Low Back Pain Collaborators","year":"2023","journal-title":"Lancet Rheumatol"},{"key":"zoi250888r2","doi-asserted-by":"publisher","DOI":"10.6061\/clinics\/2019\/e789","article-title":"Prevalence of low back pain in the elderly population: a systematic review.","volume":"74","author":"de Souza","year":"2019","journal-title":"Clinics (Sao Paulo)"},{"issue":"4","key":"zoi250888r3","doi-asserted-by":"publisher","first-page":"509","DOI":"10.1016\/j.jpain.2021.07.012","article-title":"Prevalence, incidence, and factors associated with non-specific chronic low back pain in community-dwelling older adults aged 60 years and older: a systematic review and meta-analysis.","volume":"23","author":"Wong","year":"2022","journal-title":"J Pain"},{"issue":"3","key":"zoi250888r4","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1111\/jgs.13241","article-title":"The clinical course of pain and function in older adults with a new primary care visit for back pain.","volume":"63","author":"Rundell","year":"2015","journal-title":"J Am Geriatr Soc"},{"issue":"9","key":"zoi250888r5","doi-asserted-by":"publisher","first-page":"863","DOI":"10.1001\/jama.2020.0734","article-title":"US health care spending by payer and health condition, 1996-2016.","volume":"323","author":"Dieleman","year":"2020","journal-title":"JAMA"},{"issue":"2","key":"zoi250888r6","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1177\/1077558717751209","article-title":"Treatments and health outcomes of Medicare patients with back pain.","volume":"77","author":"Mitchell","year":"2020","journal-title":"Med Care Res Rev"},{"issue":"23","key":"zoi250888r7","doi-asserted-by":"publisher","first-page":"2448","DOI":"10.1001\/jama.2018.18472","article-title":"Opioids for chronic noncancer pain: a systematic review and meta-analysis.","volume":"320","author":"Busse","year":"2018","journal-title":"JAMA"},{"issue":"13","key":"zoi250888r8","doi-asserted-by":"publisher","first-page":"1259","DOI":"10.1001\/jama.2010.338","article-title":"Trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults.","volume":"303","author":"Deyo","year":"2010","journal-title":"JAMA"},{"issue":"8","key":"zoi250888r9","doi-asserted-by":"publisher","first-page":"JC41","DOI":"10.7326\/ACPJ201904160-041","article-title":"Review: opioids improve chronic noncancer pain, but difference may not be clinically meaningful in most patients.","volume":"170","author":"Chou","year":"2019","journal-title":"Ann Intern Med"},{"issue":"10","key":"zoi250888r10","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1001\/jama.2011.1300","article-title":"Error in trends, major medical complications, and charges associated with surgery for lumbar spinal stenosis in older adults.","volume":"306","author":"Deyo","year":"2011","journal-title":"JAMA"},{"issue":"6","key":"zoi250888r11","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s11916-023-01201-7","article-title":"Acupuncture versus oral medications for acute\/subacute non-specific low back pain: a systematic review and meta-analysis.","volume":"28","author":"Lin","year":"2024","journal-title":"Curr Pain Headache Rep"},{"issue":"16","key":"zoi250888r12","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1001\/jamainternmed.2013.8725","article-title":"Major medical outcomes with spinal augmentation vs conservative therapy.","volume":"173","author":"McCullough","year":"2013","journal-title":"JAMA Intern Med"},{"issue":"9","key":"zoi250888r14","doi-asserted-by":"publisher","first-page":"1121","DOI":"10.1001\/jamainternmed.2024.2781","article-title":"Prescription medication use among older adults in the US.","volume":"184","author":"Innes","year":"2024","journal-title":"JAMA Intern Med"},{"issue":"7","key":"zoi250888r15","doi-asserted-by":"publisher","first-page":"524","DOI":"10.1001\/jama.2024.13387","article-title":"Study: polypharmacy nearly doubled in 20 years among older adults in US.","volume":"332","author":"Harris","year":"2024","journal-title":"JAMA"},{"issue":"2","key":"zoi250888r16","doi-asserted-by":"publisher","first-page":"S11","DOI":"10.1016\/j.pmn.2010.03.003","article-title":"Balancing analgesic efficacy with safety concerns in the older patient.","volume":"11","author":"Arnstein","year":"2010","journal-title":"Pain Manag Nurs"},{"issue":"1","key":"zoi250888r17","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1177\/2049463720976155","article-title":"Evidence-based clinical practice guidelines on the management of pain in older people\u2014a summary report.","volume":"16","author":"Schofield","year":"2022","journal-title":"Br J Pain"},{"issue":"3","key":"zoi250888r18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1003921","article-title":"Concurrent use of prescription gabapentinoids with opioids and risk for fall-related injury among older US Medicare beneficiaries with chronic noncancer pain: a population-based cohort study.","volume":"19","author":"Chen","year":"2022","journal-title":"PLoS Med"},{"key":"zoi250888r19","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1007\/s40266-019-00660-1","article-title":"Safety of oral non-selective non-steroidal anti-inflammatory drugs in osteoarthritis: what does the literature say?","volume":"36","author":"Cooper","year":"2019","journal-title":"Drugs Aging"},{"issue":"1","key":"zoi250888r20","doi-asserted-by":"publisher","first-page":"3313","DOI":"10.1038\/s41598-024-53728-3","article-title":"Impact of prescribed opioid use on development of dementia among patients with chronic non-cancer pain.","volume":"14","author":"Oh","year":"2024","journal-title":"Sci Rep"},{"issue":"4","key":"zoi250888r21","doi-asserted-by":"publisher","first-page":"905","DOI":"10.1142\/S0192415X2450037X","article-title":"The effectiveness of acupuncture for low back pain: an umbrella review and meta-analysis.","volume":"52","author":"Wu","year":"2024","journal-title":"Am J Chin Med"},{"issue":"3","key":"zoi250888r22","doi-asserted-by":"publisher","DOI":"10.1016\/j.imr.2023.100972","article-title":"Acupuncture as an alternative or in addition to conventional treatment for chronic non-specific low back pain: a systematic review and meta-analysis.","volume":"12","author":"Giovanardi","year":"2023","journal-title":"Integr Med Res"},{"issue":"5","key":"zoi250888r23","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1016\/j.jpain.2017.11.005","article-title":"Acupuncture for chronic pain: update of an individual patient data meta-analysis.","volume":"19","author":"Vickers","year":"2018","journal-title":"J Pain"},{"issue":"7","key":"zoi250888r24","doi-asserted-by":"publisher","first-page":"492","DOI":"10.7326\/0003-4819-147-7-200710020-00007","article-title":"Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society\/American College of Physicians clinical practice guideline.","volume":"147","author":"Chou","year":"2007","journal-title":"Ann Intern Med"},{"issue":"7","key":"zoi250888r25","doi-asserted-by":"publisher","first-page":"514","DOI":"10.7326\/M16-2367","article-title":"Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians.","volume":"166","author":"Qaseem","year":"2017","journal-title":"Ann Intern Med"},{"issue":"9","key":"zoi250888r26","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-045961","article-title":"Acupuncture-related adverse events: systematic review and meta-analyses of prospective clinical studies.","volume":"11","author":"B\u00e4umler","year":"2021","journal-title":"BMJ Open"},{"issue":"2","key":"zoi250888r27","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1159\/000209315","article-title":"Safety of acupuncture: results of a prospective observational study with 229,230 patients and introduction of a medical information and consent form.","volume":"16","author":"Witt","year":"2009","journal-title":"Forsch Komplementmed"},{"key":"zoi250888r28","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.ctcp.2018.01.008","article-title":"Acupuncture and electroacupuncture for anxiety disorders: a systematic review of the clinical research.","volume":"31","author":"Amorim","year":"2018","journal-title":"Complement Ther Clin Pract"},{"key":"zoi250888r29","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/6617075","article-title":"Acupuncture for chronic pain-related depression: a systematic review and meta-analysis.","volume":"2021","author":"You","year":"2021","journal-title":"Pain Res Manag"},{"key":"zoi250888r30","doi-asserted-by":"publisher","DOI":"10.1016\/j.smrv.2023.101892","article-title":"Acupuncture for primary insomnia: effectiveness, safety, mechanisms and recommendations for clinical practice.","volume":"74","author":"Zhao","year":"2024","journal-title":"Sleep Med Rev"},{"key":"zoi250888r31","doi-asserted-by":"publisher","DOI":"10.1177\/27536130251340921","article-title":"Recruitment and retention for an acupuncture trial in an underrepresented 65 and older population with chronic low back pain.","volume":"14","author":"Teets","year":"2025","journal-title":"Glob Adv Integr Med Health"},{"issue":"2","key":"zoi250888r32","doi-asserted-by":"publisher","first-page":"87","DOI":"10.7812\/TPP\/22.172","article-title":"Comparing Kaiser Permanente members to the general population: implications for generalizability of research.","volume":"27","author":"Davis","year":"2023","journal-title":"Perm J"},{"key":"zoi250888r33","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2023.107166","article-title":"Acupuncture for chronic low back pain in older adults: design and protocol for the BackInAction pragmatic clinical trial.","volume":"128","author":"DeBar","year":"2023","journal-title":"Contemp Clin Trials"},{"issue":"6","key":"zoi250888r34","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1000261","article-title":"Revised Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA): extending the CONSORT statement.","volume":"7","author":"MacPherson","year":"2010","journal-title":"PLoS Med"},{"issue":"6","key":"zoi250888r35","doi-asserted-by":"publisher","first-page":"733","DOI":"10.1007\/s11606-009-0981-1","article-title":"Development and initial validation of the PEG, a three-item scale assessing pain intensity and interference.","volume":"24","author":"Krebs","year":"2009","journal-title":"J Gen Intern Med"},{"issue":"9","key":"zoi250888r36","doi-asserted-by":"publisher","first-page":"771","DOI":"10.1097\/00005650-200209000-00007","article-title":"Six-item screener to identify cognitive impairment among potential subjects for clinical research.","volume":"40","author":"Callahan","year":"2002","journal-title":"Med Care"},{"key":"zoi250888r38","doi-asserted-by":"publisher","DOI":"10.1177\/21649561211007091","article-title":"Acupuncture intervention protocol: consensus process for a pragmatic randomized controlled trial of acupuncture for management of chronic low back pain in older adults: an NIH HEAL Initiative funded project.","volume":"10","author":"Nielsen","year":"2021","journal-title":"Glob Adv Health Med"},{"issue":"7","key":"zoi250888r39","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s12603-012-0084-2","article-title":"A simple frailty questionnaire (FRAIL) predicts outcomes in middle aged African Americans.","volume":"16","author":"Morley","year":"2012","journal-title":"J Nutr Health Aging"},{"issue":"1","key":"zoi250888r40","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1016\/j.jclinepi.2014.09.010","article-title":"A systematic review identifies valid comorbidity indices derived from administrative health data.","volume":"68","author":"Yurkovich","year":"2015","journal-title":"J Clin Epidemiol"},{"issue":"24","key":"zoi250888r41","doi-asserted-by":"publisher","first-page":"3115","DOI":"10.1097\/00007632-200012150-00006","article-title":"The Roland\u2013Morris Disability Questionnaire and the Oswestry Disability Questionnaire.","volume":"25","author":"Roland","year":"2000","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"zoi250888r42","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1097\/BRS.0b013e31815e3a10","article-title":"Interpreting change scores for pain and functional status in low back pain: towards international consensus regarding minimal important change.","volume":"33","author":"Ostelo","year":"2008","journal-title":"Spine (Phila Pa 1976)"},{"issue":"1","key":"zoi250888r44","doi-asserted-by":"publisher","first-page":"6","DOI":"10.1080\/15402002.2012.636266","article-title":"Development of short forms from the PROMIS\u2122 sleep disturbance and Sleep-Related Impairment item banks.","volume":"10","author":"Yu","year":"2011","journal-title":"Behav Sleep Med"},{"key":"zoi250888r45","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1016\/j.jclinepi.2015.08.038","article-title":"PROMIS measures of pain, fatigue, negative affect, physical function, and social function demonstrated clinical validity across a range of chronic conditions.","volume":"73","author":"Cook","year":"2016","journal-title":"J Clin Epidemiol"},{"issue":"11","key":"zoi250888r46","doi-asserted-by":"publisher","first-page":"1284","DOI":"10.1097\/01.MLR.0000093487.78664.3C","article-title":"The Patient Health Questionnaire-2: validity of a two-item depression screener.","volume":"41","author":"Kroenke","year":"2003","journal-title":"Med Care"},{"issue":"5","key":"zoi250888r47","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1136\/ebm.12.5.149","article-title":"The 2-item Generalized Anxiety Disorder scale had high sensitivity and specificity for detecting GAD in primary care.","volume":"12","author":"Skapinakis","year":"2007","journal-title":"Evid Based Med"},{"issue":"9","key":"zoi250888r48","doi-asserted-by":"publisher","first-page":"858","DOI":"10.1001\/archinternmed.2009.65","article-title":"A randomized trial comparing acupuncture, simulated acupuncture, and usual care for chronic low back pain.","volume":"169","author":"Cherkin","year":"2009","journal-title":"Arch Intern Med"},{"issue":"1","key":"zoi250888r49","doi-asserted-by":"publisher","first-page":"1","DOI":"10.7326\/0003-4819-155-1-201107050-00002","article-title":"A comparison of the effects of 2 types of massage and usual care on chronic low back pain: a randomized, controlled trial.","volume":"155","author":"Cherkin","year":"2011","journal-title":"Ann Intern Med"},{"issue":"12","key":"zoi250888r50","doi-asserted-by":"publisher","first-page":"849","DOI":"10.7326\/0003-4819-143-12-200512200-00003","article-title":"Comparing yoga, exercise, and a self-care book for chronic low back pain: a randomized, controlled trial.","volume":"143","author":"Sherman","year":"2005","journal-title":"Ann Intern Med"},{"issue":"4","key":"zoi250888r51","doi-asserted-by":"publisher","first-page":"253","DOI":"10.1002\/pst.210","article-title":"A note on the power of Fisher\u2019s least significant difference procedure.","volume":"5","author":"Meier","year":"2006","journal-title":"Pharm Stat"},{"issue":"1","key":"zoi250888r52","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1093\/biomet\/73.1.13","article-title":"Longitudinal data analysis using generalized linear models.","volume":"73","author":"Liang","year":"1986","journal-title":"Biometrika"},{"issue":"7","key":"zoi250888r53","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1093\/aje\/kwh090","article-title":"A modified Poisson regression approach to prospective studies with binary data.","volume":"159","author":"Zou","year":"2004","journal-title":"Am J Epidemiol"},{"key":"zoi250888r54","doi-asserted-by":"publisher","DOI":"10.1016\/j.cct.2025.107981","article-title":"Baseline sample characteristics for the BackInAction pragmatic trial of acupuncture for chronic low back pain in older adults.","author":"Justice","journal-title":"Contemp Clin Trials"},{"issue":"10398","key":"zoi250888r57","doi-asserted-by":"publisher","first-page":"304","DOI":"10.1016\/S0140-6736(23)00404-X","article-title":"Opioid analgesia for acute low back pain and neck pain (the OPAL trial): a randomised placebo-controlled trial.","volume":"402","author":"Jones","year":"2023","journal-title":"Lancet"},{"issue":"1","key":"zoi250888r59","doi-asserted-by":"publisher","DOI":"10.1016\/j.imr.2025.101122","article-title":"Concerns about the use of verum acupuncture points in sham acupuncture studies for pain conditions: findings and insights from network meta-analysis.","volume":"14","author":"Lee","year":"2025","journal-title":"Integr Med Res"},{"key":"zoi250888r60","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1016\/j.jclinepi.2019.02.011","article-title":"The selection of comparators for randomized controlled trials of health-related behavioral interventions: recommendations of an NIH expert panel.","volume":"110","author":"Freedland","year":"2019","journal-title":"J Clin Epidemiol"},{"issue":"11","key":"zoi250888r61","doi-asserted-by":"publisher","first-page":"1205","DOI":"10.1001\/jama.2016.11409","article-title":"Pragmatic trials: practical answers to \u201creal world\u201d questions.","volume":"316","author":"Sox","year":"2016","journal-title":"JAMA"},{"key":"zoi250888r62","doi-asserted-by":"publisher","first-page":"92","DOI":"10.1016\/j.jclinepi.2017.07.001","article-title":"Series: pragmatic trials and real world evidence: paper 5. Usual care and real life comparators.","volume":"90","author":"Zuidgeest","year":"2017","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"zoi250888r63","doi-asserted-by":"publisher","DOI":"10.1016\/j.imr.2025.101195","article-title":"Cochrane reviews of acupuncture are dated, do not account for the specific effects of sham controls and likely underestimate the efficacy of acupuncture therapy.","volume":"14","author":"Nielsen","year":"2025","journal-title":"Integr Med Res"},{"issue":"2","key":"zoi250888r64","doi-asserted-by":"publisher","first-page":"527","DOI":"10.1007\/s11606-020-05871-6","article-title":"Medicare coverage of acupuncture for chronic low back pain: does it move the needle on the opioid crisis?","volume":"36","author":"Liou","year":"2021","journal-title":"J Gen Intern Med"},{"key":"zoi250888r13","doi-asserted-by":"crossref","DOI":"10.23970\/AHRQEPCCER228","volume-title":"Nonopioid Pharmacologic Treatments for Chronic Pain.","author":"McDonagh","year":"2020"},{"key":"zoi250888r43","author":"Guy","year":"1976"},{"key":"zoi250888r55","volume-title":"Systematic Review on Noninvasive Nonpharmacological Treatment for Chronic Pain: Surveillance Report 2: Literature Update Period: October 2021 through December 2021.","author":"Skelly","year":"2019"},{"key":"zoi250888r56","volume-title":"Systematic Review on Noninvasive Nonpharmacological Treatment for Chronic Pain: Surveillance Report 3: Literature Update Period: January 2021 through March 2022","author":"Skelly","year":"2022"},{"key":"zoi250888r37","unstructured":"National Coverage Determination. Acupuncture for chronic lower back pain (cLBP). Centers for Medicare & Medicaid Services. 2020. Accessed February 7, 2025. https:\/\/www.cms.gov\/medicare-coverage-database\/view\/ncd.aspx?NCDId=373"},{"key":"#cr-split#-zoi250888r58.1","unstructured":"Caplan? Z, Rabe? M. The older population: 2020. 2020 Census Briefs. C2020BR-07. US Census Bureau, US Department of Commerce"},{"key":"#cr-split#-zoi250888r58.2","unstructured":"May 2023. Accessed December 16, 2024. https:\/\/www2.census.gov\/library\/publications\/decennial\/2020\/census-briefs\/c2020br-07.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2838793\/debar_2025_oi_250888_1757082875.66506.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T15:30:39Z","timestamp":1757691039000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2838793"}},"subtitle":["A Randomized Clinical Trial"],"short-title":[],"issued":{"date-parts":[[2025,9,12]]},"references-count":65,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,9,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.31348","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,12]]}}}