• Lili Zhu, Yuanjie Sun, Jing Kang, Jun Liang, Tongsheng Su, Wenbin Fu, Wei Zhang, Rongshui Dai, Yan Hou, Hong Zhao, Weina Peng, Weiming Wang, Jing Zhou, Ruimin Jiao, Biyun Sun, Yan Yan, Yan Liu, and Zhishun Liu.
• Department of Acupuncture and Moxibustion, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China (L.Z., Y.S., J.L., W.P., W.W., J.Z., R.J., B.S., Y.Y., Z.L.).
• Ann. Intern. Med. 2024 Aug 1; 177 (8): 104810571048-1057.

BackgroundAcupuncture may improve degenerative lumbar spinal stenosis (DLSS), but evidence is insufficient.ObjectiveTo investigate the effect of acupuncture for DLSS.DesignMulticenter randomized clinical trial. (ClinicalTrials.gov: NCT03784729).Setting5 hospitals in China.ParticipantsPatients with DLSS and predominantly neurogenic claudication pain symptoms.Intervention18 sessions of acupuncture or sham acupuncture (SA) over 6 weeks, with 24-week follow-up after treatment.MeasurementsThe primary outcome was change from baseline in the modified Roland-Morris Disability Questionnaire ([RMDQ] score range, 0 to 24; minimal clinically important difference [MCID], 2 to 3). Secondary outcomes were the proportion of participants achieving minimal (30% reduction from baseline) and substantial (50% reduction from baseline) clinically meaningful improvement per the modified RMDQ.ResultsA total of 196 participants (98 in each group) were enrolled. The mean modified RMDQ score was 12.6 (95% CI, 11.8 to 13.4) in the acupuncture group and 12.7 (CI, 12.0 to 13.3) in the SA group at baseline, and decreased to 8.1 (CI, 7.1 to 9.1) and 9.5 (CI, 8.6 to 10.4) at 6 weeks, with an adjusted difference in mean change of -1.3 (CI, -2.6 to -0.03; P = 0.044), indicating a 43.3% greater improvement compared with SA. The between-group difference in the proportion of participants achieving minimal and substantial clinically meaningful improvement was 16.0% (CI, 1.6% to 30.4%) and 12.6% (CI, -1.0% to 26.2%) at 6 weeks. Three cases of treatment-related adverse events were reported in the acupuncture group, and 3 were reported in the SA group. All events were mild and transient.LimitationThe SA could produce physiologic effects.ConclusionAcupuncture may relieve pain-specific disability among patients with DLSS and predominantly neurogenic claudication pain symptoms, although the difference with SA did not reach MCID. The effects may last 24 weeks after 6-week treatment.Primary Funding Source2019 National Administration of Traditional Chinese Medicine "Project of building evidence-based practice capacity for TCM-Project BEBPC-TCM" (NO. 2019XZZX-ZJ).

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