Lynn DeBar

January 12, 2026: Enhanced Acupuncture Strategy Found to Be Cost-Saving in Older Adults With Chronic Low Back Pain

Posted on by Damon Seils

Logo for the BackInAction trialAn economic evaluation from the BackInAction trial found that an enhanced course of acupuncture for older adults with chronic low back pain was cost-saving from both the Medicare and healthcare sector perspectives.

The article appears in the upcoming issue of Spine.

In a previously published report, the BackInAction research team established that acupuncture significantly improved pain and disability in patients aged 65 years and older. The new analysis shows the treatment also provides significant value to the healthcare system.

The cost-effectiveness analysis, led by Patricia Herman of the RAND Corporation, analyzed data for 672 participants across 3 large healthcare systems. The study compared 3 treatment strategies: a standard 12 -week course of acupuncture plus usual medical care; standard acupuncture enhanced with up to 6 maintenance sessions plus usual care; and usual care alone.

The research team found that enhanced acupuncture reduced annual back pain–related healthcare costs by an average of $491 per participant and reduced Medicare-reimbursed costs by $421 per participant compared with usual care alone. The savings were primarily driven by a significant reduction in non-acupuncture healthcare utilization.

BackInAction, an NIH Collaboratory Trial, was led by co–principal investigators Lynn DeBar of the Kaiser Permanente Center for Health Research and Andrea Cook of the Kaiser Permanente Washington Health Research Institute.

Read the full report.

Beyond financial savings, participants in the enhanced acupuncture group experienced:

  • Significant gains in quality-adjusted life-years, a standard measure of health-related quality of life
  • An 18.5 percentage-point increase in the number of participants achieving a clinically meaningful improvement in their disability scores

While standard acupuncture was slightly more expensive than usual care, the strategy’s incremental cost-effectiveness ratio of approximately $53,000 per quality-adjusted life-year suggests it may be cost-effective from the perspectives of Medicare and the healthcare sector.

The BackInAction team’s findings are particularly relevant in the context of the Medicare program’s decision in 2020 to begin covering acupuncture for chronic low back pain. The study suggests that the current Medicare benefit, which includes maintenance sessions, aligns with the most cost-effective and beneficial care for this population.

By including a variety of healthcare settings and older adults with multiple medical conditions, this pragmatic clinical trial’s results are intended to be highly generalizable and to inform future treatment policies for the millions of older people in the United States who experience chronic pain.

BackInAction was supported within the NIH Pragmatic Trials Collaboratory through the NIH HEAL Initiative by a grant from the National Center for Complementary and Integrative Health. Learn more about BackInAction.

September 15, 2025: In BackInAction Pragmatic Trial, Acupuncture Improved Back Pain–Related Disability in Older Adults

Posted on by Damon Seils
Headshots of Dr. Lynn DeBar and Dr. Andrea Cook
Dr. Lynn DeBar and Dr. Andrea Cook, co–principal investigators for BackInAction

Older patients with chronic low back pain who receive acupuncture treatment have greater improvements in pain and disability compared with patients who receive usual care alone, according to the BackInAction trial.

The results of the study were published online in JAMA Network Open.

BackInAction, an NIH Collaboratory Trial, compared standard and enhanced courses of acupuncture with usual care alone in adults aged 65 years and older with chronic low back pain. Previous studies found acupuncture to be a safe and effective treatment for chronic low back pain in adults, and the American College of Physicians recommends the treatment as first-line therapy. However, few studies, and no large-scale randomized trials, have examined the safety and efficacy of acupuncture in older adults specifically.

“We worked hard to involve adults in multiple regions of the country so that participant demographics were consistent with the US census for older adults,” Lynn DeBar told the NIH. “And we worked with licensed acupuncturists in the community, who are most likely to deliver these services,” she said. DeBar is a senior investigator at the Kaiser Permanente Center for Health Research and a co–principal investigator for BackInAction.

The study team randomly assigned 800 patients to 1 of 3 groups: (1) a standard 12-week course of acupuncture plus usual medical care; (2) standard acupuncture enhanced with 4 to 6 maintenance sessions plus usual care; or (3) usual care alone. The study was conducted in 4 healthcare systems in the Pacific Northwest, Northern California, and New York, including a network of federally qualified health centers in an urban setting, 2 integrated health insurance and care delivery systems serving broad geographic regions, and a fee-for-service system serving a relatively urban and suburban population.

Logo for the BackInAction trial

At 6 months and 12 months after treatment, patients in both the standard and enhanced acupuncture groups experienced significantly greater reductions in pain and pain-related disability than patients in the usual care group. The improvements did not differ significantly between the standard and enhanced courses of acupuncture.

Read the full article.

“Older adults often are dealing with other medical problems in addition to back pain,” said co–principal investigator Andrea Cook, senior biostatistics investigator at the Kaiser Permanente Washington Health Research Institute. “Acupuncture offers a less invasive option that has a better safety profile than a lot of the common treatments for back pain in older adults,” she said.

BackInAction is supported within the NIH Pragmatic Trials Collaboratory through the NIH HEAL Initiative by a grant from the National Center for Complementary and Integrative Health. Learn more about BackInAction.

May 7, 2025: Results of BackInAction Pragmatic Trial of Acupuncture in Low Back Pain, in This Week’s PCT Grand Rounds

Posted on by Damon Seils
Headshots of Dr. Andrea Cook, Dr. Lynn DeBar, and Dr. Patricia Herman
Dr. Andrea Cook, Dr. Lynn DeBar, and Dr. Paricia Herman

In this Friday’s PCT Grand Rounds, Andrea Cook, Lynn DeBar, and Patricia Herman will present “A Policy-Relevant Pragmatic Trial on Acupuncture Effectiveness for Low Back Pain in Older Adults: Clinical and Cost Outcomes and Lessons Learned.”

The Grand Rounds session will be held on Friday, May 9, 2025, at 1:00 pm eastern.

The speakers will present the results of BackInAction, an NIH Collaboratory Trial. BackInAction compared standard and advanced courses of acupuncture with usual care for older adults with chronic low back pain.

Cook is a senior biostatistics investigator at the Kaiser Permanente Washington Health Research Institute; DeBar is a distinguished investigator at the Kaiser Permanente Center for Health Research; and Herman is a senior behavioral scientist at RAND, codirector of the RAND Research Across Complementary and Integrative Health Institutions (REACH) Center, and a professor of policy analysis at the RAND School of Public Policy.

Join the online meeting.

June 11, 2024: Many Older Participants in Acupuncture Research Have Prior Acupuncture Experience, BackInAction Data Suggest

Posted on by Damon Seils
Headshots of Dr. Andrea Cook and Dr. Lynn DeBar
Dr. Andrea Cook and Dr. Lynn DeBar, principal investigators of BackInAction

Many older adults who participate in acupuncture research may have prior experience with acupuncture, according to an analysis of data from the BackInAction trial. The finding has implications for the design and conduct of future pragmatic clinical trials involving acupuncture.

BackInAction, an NIH Collaboratory Trial, is testing strategies for the delivery of acupuncture to older patients with chronic low back pain. Learn more about BackInAction.

The researchers used data from baseline interviews at 1 of 4 trial sites to characterize participants’ prior experience with acupuncture and their views toward the practice. They also compared clinical and sociodemographic characteristics between participants who had acupuncture experience and those who did not.

Nearly two-thirds of the participants reported they had previously received acupuncture treatment, mostly for pain-related care. There were no significant differences in clinical and sociodemographic characteristics between participants with prior acupuncture and those without. The researchers concluded that it may be more feasible for future pragmatic trials to use an expanded definition of “acupuncture-naïve” in inclusion criteria.

Read the full report.

BackInAction is supported through the NIH HEAL Initiative by a grant administered by the National Center for Complementary and Integrative Health (NCCIH).

July 18, 2023: NIH Collaboratory Researchers Highlight Ethical Obligation, Value of Sharing Trial Results With Participants

Posted on by Hannah Webster
Headshots of Dr. Lynn DeBar and Dr. Natalia Morone
Dr. Lynn DeBar and Dr. Natalia Morone

In an interview at the annual NIH Pragmatic Trials Collaboratory Steering Committee meeting, Dr. Lynn DeBar and Dr. Natalia Morone had a conversation about sharing trial results with participant partners. Both also participated in a discussion session about the challenges and value of results dissemination. DeBar is a principal investigator of the BackInAction and PPACT NIH Collaboratory Trials, and Morone is the principal investigator of the OPTIMUM NIH Collaboratory Trial.

They described sharing results as important now more than ever. Dissemination can be a feasible and respectful way to keep patients involved in the study. It can also combat misinformation and promote trust.

An Ethical Obligation

DeBar and Morone said they are often surprised by the number of research participants, particularly older patients, who participate in trials based on altruism or with the goal of contributing to advancing science.

“We have done focus groups about why people participate in research, and many times it is the altruism,” Morone said. “People want to help others, and they very specifically said they want to know what’s going on with the study.”

In this case, there may especially be a moral obligation to share results with patients.

“I think it’s an obligation because they were generous in giving us their time, but also, they requested it,” DeBar said. “I think we have that responsibility.”

Engaging With Community Advisory Boards

Both researchers highlighted how valuable community stakeholder insight is in how to best communicate results with patients. Community advisory boards can provide a wealth of information.

“Having materials vetted by folks that represent your population is really valuable,” Morone said. “As a physician, I will start using medical language with my patients, and as a researcher, I may use research language. It’s just so automatic.”

That’s why removing jargon and making results accessible is so important, and community experts can provide that necessary insight, Morone explained. Stakeholder perspectives may also change over time, so research teams should be flexible.

Morone recalled an instance when community advisory board representatives requested testimonials from participants on the research project’s website.

“When you have someone with lived experienced sharing the results, it just carries a weight that I do not [as a researcher],” Morone said.

DeBar highlighted that results can and can be presented in creative and engaging ways. Lay summaries, videos, and graphics can help complicated research results be more accessible.

Communicating Results Over Time

Especially in the context of pragmatic trials, and when trials take place over many years, teams should not wait until the end of the study to share information, they said.

“If they are informed, participants can be better partners,” DeBar explained.

Sharing results over the course of the study can be a mechanism for engaging participants. Even if individual data can’t be shared, aggregate data provides insight.

“We aren’t waiting to the end of the study. We are updating our website, and we send them newsletters with information because they ask us for it,” Morone said.

She noted that when patients are engaged and treated as partners in research, they will often be part of the dissemination efforts.

DeBar highlighted that sharing anecdotes, when they align with data, can be a powerful way to communicate results with participant partners.

“I like the phrase fact-congruent stories,” she said. “Those are the things that are really compelling to people. You definitely need the results of the study, but if it can be packaged in ways that really bring that to life, it makes a big difference.”

June 30, 2022: BackInAction Is Back on Track After COVID-19 Delays

Posted on by Elizabeth Mccamic

Karen J. Sherman, PhD, MPH
Dr. Karen Sherman

In connection with the NIH Pragmatic Trials Collaboratory Steering Committee meeting and 10th anniversary celebration, we sat down for an interview with Drs. Karen Sherman and Lynn DeBar to get an update on the Pragmatic Trial of Acupuncture for Chronic Low Back Pain in Older Adults (BackInAction) NIH Collaboratory Trial. BackInAction is a pragmatic randomized trial to evaluate the safety and effectiveness of treatments for older adults with chronic low back pain. The study team is conducting a 3-arm trial of adults 65 years or older with low back pain to evaluate acupuncture vs usual care.

What is the current status of the BackInAction trial?
BackInAction has recruited about two-thirds of its participants and is on track to complete recruitment next fall. We also are providing acupuncture and doing follow-up interviews, so the trial is in the “ongoing phase.”

What challenges have you faced, and how have you dealt with them?
Our biggest challenges have been associated with COVID-19 impacts. Given the higher risk and vulnerability for our older adult target population and the requirement for in-person treatment (acupuncture), we delayed the start of recruitment by many months to ensure that those outreached had ample opportunity to be vaccinated beforehand and have also paused recruitment commensurate with regional surges of COVID variants at one or more of our clinical sites as needed. We also vetted the community acupuncturists who provide acupuncture to our study participants to ensure adequate COVID-safe office practices.

Lynn DeBar, PhD, MPH
Dr. Lynn DeBar

Unrelated to COVID-19, escalating thresholds for regulatory and security features resulted in a previously approved event tracking and recruitment and assessment software system not passing the Technology Resource Office (TRO) review at multiple clinical sites and the consequent need to align data collection and aggregation from site-specific systems. TRO reviews established for clinical care software and processes for our healthcare systems increasingly restrict clinical research practices as well.

What impact do you hope your trial will have on real-world healthcare?
The grant was funded as part of the NIH HEAL Initiative's PRISM program, and the specific funding opportunity announcement was issued because Medicare was interested in additional nonpharmacological treatment options for older adults with chronic low back pain. We had thought that they would be using data from the trial for a coverage decision, since few data on acupuncture existed for older adults. We hope that the trial results will assist the Centers for Medicare & Medicaid Services in any further refinements related to coverage of acupuncture for older adults with chronic low back pain.

How has being part of the NIH Pragmatic Trials Collaboratory shaped your project?
It’s helpful to have the sounding board of regular contact with principal investigators and research teams grappling with often similar issues that arise in implementing pragmatic trials (Steering Committee meetings, annual meetings, and Core Working Groups). Feedback from the Biostatistics and Study Design Core has been particularly helpful, as has the PRISM-wide help selecting and coordinating an appropriate data repository for required HEAL common data elements. Although there have been a few instances when we’ve been surprised by and needed to correct study-specific information included in cross-site dissemination products (always given ample opportunity to do so), we’re very aware and grateful for the functionality of the program’s Coordinating Center and infrastructure in contrast to some of the more recently established Coordinating Center infrastructures for related NIH sub-initiatives. The NIH Pragmatic Trials Collaboratory is much more an aid than a hindrance!

December 1, 2021: PCT Grand Rounds to Highlight Primary Results of PPACT Study

Posted on by Damon Seils

Head shot of Dr. Lynn DeBar
Dr. Lynn DeBar, principal investigator of PPACT

In this Friday’s PCT Grand Rounds, the principal investigator of the PPACT study, an NIH Collaboratory Trial, will announce the study’s primary results.

Principal investigator Dr. Lynn DeBar of the Kaiser Permanente Washington Health Research Institute, will present “Primary Care-Based Behavioral Treatment for Long Term Opioid Users With Chronic Pain: Primary Results and Lessons Learned From the PPACT Pragmatic Trial.” The Grand Rounds session will be held on Friday, December 3, at 1:00 pm eastern.

PPACT, or the Collaborative Care for Chronic Pain in Primary Care study, was a pragmatic, cluster randomized trial that enrolled 850 patients who were receiving long-term opioid therapy for chronic pain. Patients in the intervention group participated in weekly group sessions that taught a variety of pain self-management techniques. The strategy was compared with usual care.

Join the online meeting.

PPACT was supported within the NIH Collaboratory by the NIH Common Fund and by cooperative agreements from the National Institute of Neurological Disorders and Stroke.