Acupuncture at tender acupoints for chronic low back pain: a feasibility study investigating the impact of acupuncture on back pain and physical function.

There will be two groups, each group will use different acupuncture protocols. Experimental treatment will be simple acupuncture treatment on tender acupuncture points. Pain-sensitized points around bilateral BL 23, BL 25, BL 40 will be chosen as the main acupoints. In addition, up to two adjunct acupoints will be chosen from pain-sensitized sites around bilateral Jiaji Points along L1-L5 vertebrae. Treatment will be performed by a formally trained acupuncturist (H.T.), with 5 years' clinical experience. Patients will be asked to maintain a prone position for treatment. After disinfecting skin surface by alcohol swab, selected points will be stimulated by insertion of a sterile, single-use filiform acupuncture needle (Hwato needle, Suzhou, China; 25-40 mm in length; 0.25 mm in diameter). It is generally accepted that needles of 40 mm length should be used in the lumbar area, while needles of 25 mm should be placed in the extremities. Exceptionally, for underweight participants (BMI < 18.5 kg/m²), only 25 mm needles will be administered to ensure safety. After needling, the acupuncturist will continue stimulation to achieve Deqi sensation, which is a sensation of numbness, soreness and distension, indicating the stimulation is effective. Needles will be retained for 30 minutes, during which manual stimulation (lifting-thrusting, and twirling method) will be used every 10 minutes to maintain the sensation of Deqi. Each treatment session will take around 50 minutes. Treatment will be administered at an accredited acupuncture clinic in Dunedin for 8 sessions, twice per week, for four consecutive weeks. Treatment log will be filled by acupuncturist to monitor participants' adherence to the intervention.