Low back pain in China and the role of traditional Chinese medicine: findings from the global burden of disease study 2021 and a meta-analysis

Introduction To quantify the burden of low back pain (LBP) and its risk factors in China from 1990 to 2021 and to assess the efficacy of traditional Chinese medicine (TCM) interventions. Methods The incidence, prevalence, and years lived with disability (YLDs) of LBP in China were searched. Trends from 1990 to 2021 were assessed using estimated annual percentage changes, stratified by age and sex, and joinpoint regression evaluated temporal patterns in LBP burden attributable to risk factors. Then, we searched ten electronic databases (up to April 2025) for randomized controlled trials (RCTs) of TCM interventions. The primary outcomes were pain intensity and physical function. Results In 2021, China had the highest absolute incidence, prevalence, and YLDs of LBP among G20 countries, although its age-standardized YLD rate had decreased significantly since 1990. An estimated 3.31 million YLDs (95% UI: 2.28, 4.53) were attributable to occupational ergonomic factors, 1.85 million (95% UI: 1.08, 2.70) to smoking, and 1.06 million (95% UI: 0.11, 2.23) to high body mass index. The systematic review identified 137 eligible trials involving 11 936 participants. Moderate-confidence evidence showed reduced post-intervention pain intensity with acupuncture plus physiotherapy care (standardized mean difference [SMD] = −1.59, 95% CI [−2.10, −1.09]), acupressure (SMD = −0.87, [−1.17, −0.57]), and acupuncture plus moxibustion (SMD = −2.44, [−2.72, −2.16]) versus physiotherapy care. Improved physical function had moderate-to-very-low confidence with acupuncture (SMD = −1.50, [−2.44, −0.57]) and Tai Chi (SMD = −1.84 [−2.30, −1.37]) compared with physiotherapy care and Western medicine. Conclusion Despite the decline in age-standardized YLD rates since 1990, the absolute burden remains substantial. Incorporating TCM into management may help address this burden but requires risk-stratified, large-scale, high-quality RCTs with extended follow-up. Registration: The study protocol was registered with the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO/, CRD420251054137).