The Clinical Therapeutics review in this month’s NEJM looks at acupuncture for lower back pain. As always with the articles in this series, the authors start by describing an example patient and follow by summarising current evidence on treatment of the condition including the specific mode of therapy involved. Topics covered include:

• The clinical problem

• Pathophysiology and effect of therapy

• Clinical evidence

• Clinical use

• Adverse effects (which are few, but not nonexistent)

• Areas of uncertainty

• Guidelines (acupuncture is included in major US guidelines and in the UK NICE guideline on low back pain)

Finally, the authors summarise their recommendations for the patient presented. These include reassurance that no serious underlying pathology exists, advice on activity and exercise, and referral to a qualified acupuncture practitioner.