A recent systematic review by Yuan et al concludes that “acupuncture versus no treatment, as an adjunct to conventional care should be advocated in the European Guidelines for the treatment of chronic low back pain.”1,2 We disagree, because: 1. More issues than just 1 systematic review on effec- tiveness should be taken into account to recom- mend a procedure (safety, standardization, indica- tion criteria, application conditions, etc.).2 2. Actual results from the review suggest that the ef- fect attributed to acupuncture derives from unspe- cific effects (placebo, more time and attention from therapists, etc.), or invalid comparison groups (procedures also lacking any evidence of effective- ness vs. placebo).1,3 3. The most consistent result in the review is that actual acupuncture has the same effect as sham acupuncture (“placebo”), which includes punctur- ing anywhere in the skin (not necessarily on acu- puncture points), or even just simulating doing so with a toothpick.4 Therefore, it would be more cost/effective and similarly (in) effective to recom- mend that LBP patients use toothpicks to press their skin anywhere they want. 4. It makes no sense to recommend the use of proce- dures that have consistently shown not to be better than placebo, especially when there is a need for cost containment.