Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Needling Therapies for Chronic Primary Low Back Pain in Adults.

81% of included trials were rated as having high risk of bias, and all outcomes were graded low or very low certainty. Only one trial included older adults (55 participants), so findings for that group rest on a single small study. Subgroup analyses were limited to 1 to 3 trials per group, making them imprecise and of limited use for clinical decision-making. 54 full-text records could not be retrieved, mainly due to restricted international access, so the review may have missed relevant trials. No trials assessed psychological outcomes (fear avoidance, catastrophizing, anxiety, self-efficacy), social participation including work, or changes in medication use and falls in older adults. Reporting of adverse events across studies was inadequate and inconsistent, limiting the ability to assess risks, particularly for older adults and those on anticoagulants.

Funded by the World Health Organization and the University of Zurich. No industry funder or commercial interest in needling therapies is named.

Do not read the larger pain and function improvements versus no treatment as proof that needling works. The sham comparison, which is the more rigorous test, showed a pain reduction below the minimally important difference. In addition, 81% of the included trials were rated as having high risk of bias, and every outcome was graded low or very low certainty.