3.1.2. Acupuncture + Usual Conventional Therapy vs. Usual Conventional Therapy

The level of evidence and recommendations were derived based on 15 RCTs [20,36–49] that observed the combined effect of acupuncture and conventional treatment for LHIVD in terms of pain, function, and overall symptom improvement.

As a result of the meta-analysis, acupuncture combined with conventional treatments, such as moxibustion, herbal medicine, Western medicine, injection, and physical therapy, was more effective than usual conventional therapy in improving the overall symptoms (RR: 1.21, 95% CI: 1.16–1.28, *p* < 0.001), pain (MD, −1.03, 95% CI: −1.16–−0.90, *p* < 0.001), and function (ODI: MD, −3.27, 95% CI: −3.86–−2.68, *p* < 0.001; JOA: MD, 4.00, 95% CI: 3.48–4.52, *p* < 0.001). However, the heterogeneity (I2 = 80%) between studies was high; therefore, the level of evidence was evaluated at one level lower due to inconsistency.

Acupuncture has been reported to have a low clinical risk in safety-related studies [50] and in the utilization survey of experts, it has been shown to be a highly useful treatment method [51].

In conclusion, acupuncture in combination with conventional treatment is recommended for improving the overall symptoms of LHIVD (A/Moderate).
