Lower back pain is a common ailment that places a considerable burden on society in terms of reduced quality of life and lost productivity.1 In this week's BMJ an economic evaluation by Ratcliffe and colleagues shows that acupuncture is relatively cost effective as an adjunct to usual care for patients with persistent non-specific lower back pain.2 The study is based on a well conducted pragmatic randomised controlled trial, which is also published this week.3 The trial showed a modest but statistically significant reduction in back pain and increase in health related quality of life compared with usual care.

The addition of acupuncture to usual care for low back pain raised health service costs by £140 (€207; $265) per patient, but this increase was small relative to the health gain. At £4000 per quality adjusted life year (QALY) gained, this is well below the lower NHS funding threshold used by the United Kingdom's National Institute for Health and Clinical Excellence (NICE) …