Novel avatar-based video-guided acupuncture imagery treatment for chronic low back pain: a randomised controlled trial in the USA.

Background: Chronic low back pain (cLBP) imposes a significant public health burden. Digital health interventions are increasingly used for chronic pain management, yet effective home-based therapies remain limited. We aimed to evaluate a novel, remotely delivered avatar-based video-guided acupuncture imagery treatment (AB-VGAIT) for cLBP. Methods: This parallel-group, randomised, controlled trial was performed at Massachusetts General Hospital (MA USA). Eligible participants, aged 18-75 years, had been experiencing cLBP for over six months and had at least 4/10 clinical pain on the low back pain numeric rating scale ranging from 0 to 10. Enrolled participants were randomly assigned (1:1) to either the AB-VGAIT or the avatar-based video-guided touch imagery treatment (AB-VGTIT; control) group. Participants underwent eight treatment sessions of either AB-VGAIT or AB-VGTIT over a 4-week period, wherein avatar-based, animated videos guided participants to imagine acupuncture (AB-VGAIT) or cotton stabs (AB-VGTIT) stimulation. Outcome evaluators and statisticians were blinded to group assignments, however participant blinding was not feasible due to the visual and interactive nature of the intervention. The primary outcome was the change from baseline in pain bothersomeness after 4 weeks of treatment. This study was registered with ClinicalTrials.gov, NCT03765879. Findings: Between June 22, 2021 and July 27, 2024, 60 participants were enrolled (n = 30 per group). Five (8.33%) participants did not complete the study, two (6.67%) in the AB-VGAIT group and three (10%) in the AB-VGTIT group. Although both groups demonstrated significant reductions in pain bothersomeness from baseline (AB-VGAIT: -1.71 [-2.38 to -1.04], Interpretation: Short duration, limited treatment frequency, and small sample size may restrict generalisability. No significant difference was observed between AB-VGAIT and AB-VGTIT; although both interventions yielded significant improvements in pain relief, suggesting each may offer a promising remote, self-administered digital intervention for cLBP. The scalable, non-invasive nature may help to bridge treatment gaps, particularly for individuals with limited access to in-person care. Future larger-scale trials are warranted to validate efficacy and generalisability. Funding: National Institutes of Health/National Center for Complementary and Integrative Health.