Introduction: Lower back pain (LBP) is the most prevalent form of chronic pain in active-duty military personnel worldwide. Electroacupuncture and neuromuscular electrical stimulation (NMES) are the two most widely used treatment methods in the military, while evidence for their benefits is lacking. The aim of this randomized clinical trial is to investigate the effectiveness of electroacupuncture vs. NMES in reducing pain intensity among active-duty navy personals with chronic lower back pain.
Methods: The study is designed as a single-center, randomized controlled trial. The primary outcome is a positive categorical response for treatment success in the first-time follow-up, which is predesignated as a two-point or greater decrease in the NRS score and combined with a score > 3 on the treatment satisfaction scale. The secondary outcomes include pain intensity, rate of treatment success, and Oswestry Disability Index (ODI) fear-avoidance beliefs questionnaire (FABQ) score along with muscular performance. The first follow-up starts on the first day after completing the last treatment session, and then the 4-weeks and 12-weeks follow-up are applied via telephone visit.
Results: Eighty-five subjects complete the treatment diagram and are included in the analysis. For the primary outcome, no difference has been found between electroacupuncture and NMES, with 65.1% (28 in 43) individuals reporting a positive response to electroacupuncture treatment, while 53.5% (23 in 43) in NMES. However, for longer follow-ups, superiority in positive response of electroacupuncture has been found in 4-weeks (26 in 39, 66.7% vs. 16 in 40, 40%; P = 0.018) and 12-weeks (24 in 36, 66.7% vs. 12 in 36, 33.3%; P = 0.005) follow-up.
In the regression analysis, baseline pain intensity and FABQ score are identified to be highly associated with positive treatment outcomes. Finally, the subgroup analysis suggests that electroacupuncture treatment is associated with better long-term outcomes in patients with lower back pain with a severe pain score (NRS score >4) and stronger fear-avoidance beliefs.
Conclusion: Both the electroacupuncture and NMES are associated with a positive response in treating military lower back pain, and the former offers lasting benefits in the later follow-ups. Thus, electroacupuncture is a more recommended treatment for military lower back pain.