Table 1 Study population inclusion and exclusion criteria

• Age 60 years or older

• Able to read and write English

• cLBP that has persisted for at least 3 months and causes pain on at least half of the days for the previous 6 months [22]

• Average intensity of pain ≥ 4 on an 11-point numerical pain scale in the previous week

• Have intact cognition (Mini-mental State Examination, MMSE score > 24)

• Willing to commit to 4-weekly study visits and up to 12-months’ follow-up

• Able to apply pressure to the acupressure seeds using tapes on their ears

• Malignant or autoimmune diseases (e.g., rheumatoid arthritis)

• Known acute compression fractures caused by osteoporosis, spinal stenosis, spondylolysis, or spondylolisthesis because these conditions may confound treatment effects or the interpretation of results

• Sciatica with leg pain greater than back pain

• Allergy to the tape used

• Use of some types of hearing aids (size may obstruct the placement of the acupressure seeds)

• Pain in other parts of the body that is more severe than the cLBP and which occurs daily or almost every day with at least moderate intensity or acute pain; neurological disorders that could interfere with pain reporting or confound performance on the other outcomes, cerebral tumor, Alzheimer’s disease (or other cognitive illnesses), prior stroke, or multiple sclerosis

cLBP chronic low back pain