Effectiveness of Thread-Embedding Acupuncture at EX-B2 on the Oswestry Disability Index and Finger-to-Floor Distance in Chronic Low Back Pain

Universitas Indonesia32 enrolled

Overview

Chronic low back pain (CLBP) is a leading cause of disability worldwide and significantly impairs functional capacity and quality of life. Non-pharmacological therapies are recommended as first-line management, and acupuncture has demonstrated potential benefits in reducing pain and disability. Thread embedding acupuncture (TEA) is a modified acupuncture technique that provides prolonged stimulation through the implantation of absorbable polydioxanone (PDO) threads at acupuncture points. This randomized controlled trial aims to evaluate the effectiveness of TEA at the EX-B2 points compared with sham TEA in improving disability and lumbar flexibility in patients with chronic non-specific low back pain. Disability will be assessed using the Oswestry Disability Index (ODI), and lumbar flexibility will be measured using the Finger-to-Floor Distance (FFD) test over an 8-week follow-up period.

Chronic low back pain (CLBP) is a major contributor to global disability and reduced functional performance. Conventional management such as analgesics and physiotherapy often provides limited long-term functional improvement. Acupuncture has been recommended as a non-pharmacological treatment option for CLBP, and evidence suggests it can reduce pain and disability. Thread embedding acupuncture (TEA) is a modified acupuncture technique in which absorbable medical threads are implanted into specific acupuncture points, providing continuous stimulation over several weeks. This prolonged stimulation is believed to enhance neuromodulation, improve local microcirculation, and promote tissue repair, potentially leading to sustained clinical benefits. The EX-B2 points are located 0.5 cun lateral to the spinous processes from T1 to L5 and are anatomically close to the paraspinal muscles and posterior nerve roots. Stimulation of these points may modulate pain pathways and improve lumbar function. This study is designed as a randomized controlled trial comparing TEA at EX-B2 points with sham TEA in patients with chronic low back pain. The primary outcome is change in disability measured by the Oswestry Disability Index (ODI) at weeks 2, 4, 6, and 8 after intervention. The secondary outcome is change in lumbar flexibility measured by Finger-to-Floor Distance (FFD) at weeks 4 and 8. Adverse events related to the procedure will also be recorded to evaluate safety.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Interventions

Thread Embedding AcupunctureDEVICE

Participants will be randomly assigned in a 1:1 ratio to one of two parallel groups. The assigned procedures will be administered once, and outcomes will be evaluated over an 8-week follow-up period.

Sham Thread Embedding AcupunctureDEVICE

Participants will be randomly assigned in a 1:1 ratio to one of two parallel groups. The assigned procedures will be administered once, and outcomes will be evaluated over an 8-week follow-up period.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Male or female participants aged ≥ 18 years * Participants experiencing low back pain for at least 3 months (\>12 weeks) * Highest low back pain intensity within the past 2 weeks with a score of ≥ 3 on a 0-10 Numeric Pain Rating Scale (NPRS) * Receiving pharmacological therapy with a stable analgesic regimen for at least 2 weeks prior to enrollment * Presence of physical functional disability as indicated by an Oswestry Disability Index (ODI) score \> 20% * Willing and able to participate in the study until completion and to provide written informed consent Exclusion Criteria: * History of hypersensitivity reactions to acupuncture or thread embedding acupuncture, or known allergy to stainless steel or polydioxanone (PDO) threads * History of keloid formation * Presence of scars (cicatrices) or skin disorders at the thread embedding acupuncture insertion sites in the lower back area * Specific spinal pathology including fracture, tumor, infection, or severe lumbar spinal stenosis requiring surgical intervention * Structural spinal abnormalities (scoliosis or kyphosis) detected on physical examination * History of spinal surgery or indication for spinal surgery due to severe neurological deficits * Presence of cardiac disease, hematological disorders, or uncontrolled diabetes mellitus * Regular use of systemic steroids, nonsteroidal anti-inflammatory drugs (NSAIDs), antiplatelet agents, anticoagulants, or topical analgesic medications * Receipt of other treatments for low back pain, including dry needling, neuromuscular taping, spinal injections, or acupuncture within the past 2 weeks, or thread embedding acupuncture within the past 6 months * Severe cognitive impairment, severe psychiatric or psychological disorders, or history of alcohol or substance abuse * Pregnant or breastfeeding women, or women planning pregnancy within the next 6 months * Body mass index (BMI) \< 18 kg/m²

Outcomes

Primary Outcomes

Change in Oswestry Disability Index (ODI)

The Oswestry Disability Index (ODI) is a validated questionnaire assessing disability related to low back pain. Scores range from 0 to 100, with higher scores indicating greater disability and worse functional status. A decrease in ODI score represents improvement in functional disability.

Time frame: Baseline, Week 2, Week 4, Week 6, and Week 8

Secondary Outcomes

Change in Finger-to-Floor Distance (FFD)

The Finger-to-Floor Distance (FFD) assesses lumbar flexibility by measuring the distance (in centimeters) between the fingertips and the floor during maximal forward trunk flexion. Values range from 0 cm to higher positive values, with lower scores indicating better lumbar flexibility. A decrease in FFD represents improvement in lumbar flexibility.

Time frame: Baseline, Week 4, and Week 8