STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs). OBJECTIVE: To evaluate the totality of evidence in relation to the effectiveness of acupuncture for nonspecific chronic low back pain (NSCLBP). SUMMARY OF BACKGROUND DATA: Acupuncture has become a popular alternative for treating clinical symptoms of NSCLBP. A number of RCTs have examined the effectiveness of acupuncture in the treatment of NSCLBP. METHODS: A systematic literature search was completed without date or language restrictions up to May 2012. Studies included in the review were RCTs that examined all forms of acupuncture that adhered to the Traditional Acupuncture Theory for treating NSCLBP. Outcome measures included impairment, activity limitation, and participation restriction. The methodological quality of the studies was examined using the Cochrane risk of bias tool. RESULTS: Thirty-two studies were included in the systematic review, of which 25 studies presented relevant data for the meta-analysis. Acupuncture had a clinically meaningful reduction in levels of self-reported pain (mean difference =-16.76 [95% confidence interval, -33.33 to -0.19], P = 0.05, I = 90%) when compared with sham, and improved function (standard mean difference =-0.94 [95% confidence interval, -1.41 to -0.47], P < 0.00, I = 78%) when compared with no treatment immediately postintervention. Levels of function also clinically improved when acupuncture in addition to usual care, or electroacupuncture was compared with usual care alone. When acupuncture was compared with medications (NSAIDs, muscle relaxants, and analgesics) and usual care, there were statistically significant differences between the control and the intervention groups but these differences were too small to be of any clinical significance. There was no evidence in support of acupuncture over transcutaneous electrical nerve stimulation. CONCLUSION: This systematic review demonstrates that acupuncture may have a favorable effect on self-reported pain and functional limitations on NSCLBP. However, the results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies. LEVEL OF EVIDENCE: 1.STUDY DESIGN: A systematic review and meta-analysis of randomized controlled trials (RCTs). OBJECTIVE: To evaluate the totality of evidence in relation to the effectiveness of acupuncture for nonspecific chronic low back pain (NSCLBP). SUMMARY OF BACKGROUND DATA: Acupuncture has become a popular alternative for treating clinical symptoms of NSCLBP. A number of RCTs have examined the effectiveness of acupuncture in the treatment of NSCLBP. METHODS: A systematic literature search was completed without date or language restrictions up to May 2012. Studies included in the review were RCTs that examined all forms of acupuncture that adhered to the Traditional Acupuncture Theory for treating NSCLBP. Outcome measures included impairment, activity limitation, and participation restriction. The methodological quality of the studies was examined using the Cochrane risk of bias tool. RESULTS: Thirty-two studies were included in the systematic review, of which 25 studies presented relevant data for the meta-analysis. Acupuncture had a clinically meaningful reduction in levels of self-reported pain (mean difference =-16.76 [95% confidence interval, -33.33 to -0.19], P = 0.05, I = 90%) when compared with sham, and improved function (standard mean difference =-0.94 [95% confidence interval, -1.41 to -0.47], P < 0.00, I = 78%) when compared with no treatment immediately postintervention. Levels of function also clinically improved when acupuncture in addition to usual care, or electroacupuncture was compared with usual care alone. When acupuncture was compared with medications (NSAIDs, muscle relaxants, and analgesics) and usual care, there were statistically significant differences between the control and the intervention groups but these differences were too small to be of any clinical significance. There was no evidence in support of acupuncture over transcutaneous electrical nerve stimulation. CONCLUSION: This systematic review demonstrates that acupuncture may have a favorable effect on self-reported pain and functional limitations on NSCLBP. However, the results should be interpreted in the context of the limitations identified, particularly in relation to the heterogeneity in the study characteristics and the low methodological quality in many of the included studies. LEVEL OF EVIDENCE: 1.