Acupuncture Therapy Combined with Core Stability Training for Chronic Nonspecific Low Back Pain: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

Background: Chronic nonspecific low back pain (CNSLBP) is a common and disabling condition without identifiable specific pathoanatomical causes. Acupuncture therapy combined with core stability training (AT+CST) are widely used nonpharmacological interventions for CNSLBP. However, the effectiveness and safety of this combined intervention remains controversial. The present study conducted a network meta-analysis to rank the efficacy of different acupuncture modalities combined with core stability training and to identify the optimal treatment strategy, with the aim of informing health policy and guiding clinical practice. Methods: Randomized controlled trials(RCTs) published from database inception to March 7, 2025, were systematically searched in PubMed, Embase, the Cochrane Library, Web of Science, China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, WANFANG Database, and SinoMed. Manual searches and reference tracking were performed. Pairwise meta-analyses and network meta-analyses were conducted using RevMan and ADDIS software, respectively, and standardized mean differences (SMDs) were calculated. The primary outcome was the Visual Analog Scale (VAS) score. The secondary outcome was the Oswestry Disability Index (ODI) score. Safety was defined as the incidence of adverse events(AEs). Results: Thirty-two RCTs involving 2726 patients with CNSLBP were included. Available safety data suggested that reported AEs were generally mild, reversible, and infrequent; however, AE reporting was incomplete and heterogeneous across studies. Network meta-analysis indicated that moxibustion combined with unstable surface training ranked highly for reducing VAS scores, but this ranking was supported by limited evidence. Conclusion: This study suggests that AT+CST may be more effective than single interventions for CNSLBP. Moxibustion combined with unstable surface training may be the optimal strategy, with a favorable safety profile. However, given the methodological limitations and heterogeneity of the current evidence, these findings should be interpreted cautiously. Future high-quality, multicenter RCTs are needed to validate these results. Keywords: acupuncture therapy, core stability training, chronic nonspecific low back pain, network meta-analysis