Effect of Electroacupuncture on pain and functional disability in individuals with chronic Low back pain: A Systematic Review of Randomized Controlled Trials

Background Low back pain (LBP) remains one of the most prevalent and disabling musculoskeletal conditions globally, imposing a substantial socioeconomic burden on healthcare systems. Electroacupuncture (EA), a contemporary modification of traditional acupuncture integrating electrical stimulation, has gained attention as a promising adjunctive therapy. However, A comparative efficacy of EA versus manual acupuncture and other physical therapy–based interventions remain uncertain across clinical contexts. This systematic review aims to critically evaluate and compare the therapeutic efficacy of electroacupuncture on pain and functional disability in adults with chronic low back pain. Methods A systematic search was conducted in PubMed/MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and ClinicalTrials.gov up to November 2025 using Medical Subject Headings (MeSH) and free-text terms combining “low back pain,” “electroacupuncture,” and “physical therapy modalities.” Only randomized controlled trials (RCTs) were included. Data on pain intensity and functional disability were extracted and synthesized narratively. Methodological quality was assessed according to the Cochrane Risk of Bias 2 tool (RoB-2). Results Twelve RCTs, encompassing approximately 850 participants, met the inclusion criteria. Across most trials, EA significantly reduced pain and improved function compared with sham or usual care interventions (p < 0.05). When compared with manual acupuncture, however, the superiority of EA was generally not statistically significant (p > 0.05) . Combined regimens, such as EA plus exercise therapy or usual care, yielded more consistent improvements in both pain relief and disability reduction. Evidence heterogeneity and a moderate risk of bias were observed across studies. Conclusion Electroacupuncture appears to be an effective adjunct for managing chronic low back pain, particularly when integrated into multimodal rehabilitation programs. Nevertheless, its superiority over manual acupuncture remains inconclusive due to limited high-quality evidence. Future large-scale, standardized RCTs are warranted to optimize stimulation parameters and evaluate long-term effects.