We are interested to read the latest “Effectiveness and Safety of Acupotomy on Lumbar Spinal Stenosis: A Pragmatic, Pilot, Randomized Controlled Trial”1 published by Jung Hee Lee et al in the Journal of Pain Research.

At present, acupotomy studies focuses on spinal and articular diseases, such as knee osteoarthritis, frozen shoulder, lumbar disc herniation, etc. However, the conclusions of these studies were unconvincing due to the poor methodological quality, especially in terms of lumbar Spinal Stenosis (LSS). Even though acupotomy is widely used in the clinical treatment of LSS, the clinical research is far from enough. This project is the first real-world study on the treatment of acupotomy for LSS, which will greatly promote the development of acupotomy in LSS.

The study may be improved by some minor changes. According to the epidemiological survey, the average age of patients with LSS is 62 years old. And the prevalence rate has no significant difference in gender.2 The World Health Organization considers people over the age of 75 to be vulnerable groups. Therefore, based on epidemiology and the Declaration of Helsinki, we suggest that the authors should include patients aged 50–75 in formal research and not limit gender in the inclusion criteria.

Secondly, this study is a pragmatic study, but it has 12 strict exclusion criteria, which will limit the extrapolation of conclusions. If a large number of people are screened out through strict exclusion criteria, the results may not meet the purpose of the real-world research. Thus, we suggest that the author should consider whether such strict exclusion criteria are needed.

In addition, the author mentioned that the results of research on chronic pain can change depending on the patient’s expectations, which may be related to the lack of blinding. We suggest that the author could add sham acupotomy in the control group, which may reduce the expectation bias of the participants in both groups. The specific design can refer to “Effect of acupotomy in knee osteoarthritis patients: study protocol for a randomized controlled trial” published by Danghan Xu et al.3

The authors declare no conflicts of interest in this communication.

1. Lee JH, Lee HJ, Woo SH, et al. Effectiveness and safety of acupotomy on lumbar spinal stenosis: a pragmatic, pilot, randomized controlled trial. J Pain Res. 2023;16:659–668. doi:10.2147/JPR.S399132

2. Jensen RK, Jensen TS, Koes B, Hartvigsen J. Prevalence of lumbar spinal stenosis in general and clinical populations: a systematic review and meta-analysis. Eur Spine J. 2020;29(9):2143–2163. PMID: 32095908. doi:10.1007/s00586-020-06339-1

3. Xu D, Lee M, Huang C, et al. Effect of acupotomy in knee osteoarthritis patients: study protocol for a randomized controlled trial. Trials. 2021;22(1):295. PMID: 33879221; PMCID: PMC8056725. doi:10.1186/s13063-021-05247-z