Be Well

Millions of people suffer with low back pain. It is one of the top reasons people seek medical treatment. Back problems also are the primary reason for appointments with acupuncturists. But does acupuncture really help these patients? Researchers from the University of Maryland School of Medicine and the Peninsula Medical School, Plymouth, U.K., analyzed dozens of studies from around the world on acupuncture for low back pain.

"For people with chronic low back pain, this analysis shows that acupuncture is clearly effective in providing considerable pain relief. The research also showed that acupuncture provided true pain relief. The benefit was not just due to the placebo effect." Eric Manheimer
Study Author, Director of Database and Evaluation
University of Maryland Center for Integrative Medicine

Acupuncture is still considered an "alternative" treatment for low back pain in the U.S., but this is no longer the case in Germany. A study conducted by the Orthopaedic Department, University of Regensburg, Bad Abbach, Germany found; patients report more pain relief from acupuncture than conventional treatment. Read the WebMD article →

"Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy." German Acupuncture Trials (GERAC) for chronic low back pain →

Researchers from the University of Maryland School of Medicine and the Peninsula Medical School, Plymouth, U.K., also found:

"From our analysis, the message for people with chronic low back pain is that acupuncture is a truly effective therapy that provides significant pain relief. Patients with low back pain have many options for treatment including medication, chiropractic care, physical therapy and back exercises. However, these treatments do not always help, and scientific evidence indicates that they have only modest effectiveness." News release from University of Maryland Medical Center →

And this from a question-answer session with with Dr. Scott Fishman;

"Many patients advocate acupuncture as a very effective treatment for many different symptoms. These symptoms include pain from a variety of causes, as well as many other conditions including nausea, smoking cessation, problems with addiction, inflammatory conditions, possibly even anxiety and depression, to name just a few. There are many different forms of acupuncture. One form of acupuncture completed by one acupuncturist may be quite different than another, and any given practitioner may perform the acupuncture differently than another. Classically, acupuncture involves using a needle — although sometimes electricity is passed through the needle, and sometimes the burning of traditional Chinese herbs is employed as well. Burning these herbs is called "moxabustion."The points that are used for the needle insertions often are at a distance from the actual area of symptoms. So, if someone has pain in their back, they may be getting needles in their feet, their ears or somewhere else distant from the actual site of the pain.

Taken all together, acupuncture is an ancient, time-tested form of therapy that seems to have exceptionally few side effects and appears to be safe for pain management. At present, however, it continues to be of unproven value for pain management in scientific circles. In my experience, many patients have found relief from pain through acupuncture. For those of my patients who have not found relief with standard medical therapies, I am always open-minded to any kind of treatment that will help, particularly those that have the fewest side effects. Thus, I embrace acupuncture. I look forward to revelations through science that better explain how it works and how it may be best applied to fight the war on pain." Q & A with Dr. Scott Fishman →

Acupuncture can provide long-lasting relief for lower back pain, according to a recent U.K. study

When patients were treated with 10 sessions of acupuncture over the course of three months, they reported greatly reduced pain in the lower and mid backs. Patients were still reaping the benefits of reduced pain at a 24-month follow-up session with a physician.

Study co-author Hugh MacPherson, PhD believes that the ancient Chinese medical treatment – acupuncture – has proven its worth as an adjunct to traditional therapies for nonspecific back pain. "Acupuncture definitely has a role in the treatment of low back pain," said MacPherson. "And it seems to be associated with longer-term effects than anyone has realized."

The research team compared the impact of adding 10 acupuncture sessions over three months to the normal treatment for back pain, which includes physiotherapy, medication, and exercise.

The study concluded that, "Acupuncture care for patients with chronic conditions such as low back pain is likely to be a complex intervention that utilizes a number of patient-centered strategies to elicit long term therapeutic benefits."

A Japanese study found similar findings: Results suggest that acupuncture at the most painful point gives immediate relief of low back pain. Published the same year as the U.K. study, researchers at the Department of Acupuncture and Moxibustion found acupuncture to be effective in treating lower back pain.

References:
MacPherson, H., Thorpe, L., Thomas, K. “Beyond needling—therapeutic processes in acupuncture care: a qualitative study nested within a low-back pain trial.” Journal of Alternative Complementary Medicine. 2006 Nov;12(9):873-80.
Inoue, M., et al. “Relief of low back pain immediately after acupuncture treatment – a randomized, placebo controlled trial.” Acupunct Med. 2006 Sept.;24(3):103-8.

The School of Health and Related Research, University of Sheffield, U.K. analylized the longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Here are some of their findings;

• Traditional acupuncture care delivered in a primary care setting was safe and acceptable to patients with non-specific low back pain.
• Acupuncture care and usual care were both associated with clinically significant improvement at 12- and 24-month follow-up.
• Acupuncture care was significantly more effective in reducing bodily pain than usual care at 24-month follow-up.
• GP referral to a service providing traditional acupuncture care offers a cost-effective intervention for reducing low back pain over a 2-year period. PubMed: Study abstract →

Because research has shown that acupuncture is safer, more effective and less expensive for treating back pain than conventional methods, the National Health Service (NHS) will now be paying for acupuncture for back pain. According the the NHS:

"Tens of millions of pounds are being wasted by the NHS on useless treatments for back pain, money that should be diverted to alternative therapies such as acupuncture and spinal manipulation. From among 200 treatments and devices claimed to help a bad back, the National Institute for Clinical Excellence (NICE) has passed judgement on what works and what doesn't. X-rays, ultrasound and steroid injections are out and acupuncture, osteopathy and chiropractic are in.

Back pain is among the most common reasons for visits to family doctors (after colds and flu). It affects one in three adults in the UK each year, with an estimated 2.5 million people seeking help from their GP. The NHS spends £1.5bn on treating the condition, and much of that is wasted on worthless treatments, according to Nice.

The new guideline applies to people with "persistent" low back pain which has lasted for at least six weeks. They should be offered three options: an exercise programme, a course of manual therapy including manipulation or a course of acupuncture. If one treatment option does not work, patients may be offered a second.

The 13-strong NICE panel that drew up the guideline expects acupuncture to be the most popular option." Full article →

How is Oriental medicine used to treat sciatica?

"It is best to approach sciatica using combination style treatment.  An effective therapy many include acupuncture, Tui Na (Chinese medical massage,) cupping, electric stimulation, and stretching.  The back, hip, and pelvis are very interconnected and the treatment should incorporate all of them. Overall, the treatment should relax and stretch the tendons and fascia while strengthening the muscles.  This will help release the spastic muscles and strengthen them, allowing the back to naturally heal. It can even encourage an out of place disc to go back into place, depending on severity.

Acupuncture will help to reprogram the muscles to stay relaxed. In effect, this is working to help the body heal itself.  Chinese massage, or tui na, works to foster the acupuncture by releasing any extra tension in the fascia and connective tissue around the muscles. The technique called rolling is very important to deeply relax the muscles and improve circulation at the same time.

After the pain is gone, it is important for you to keep up you own back.  Stretching is essential.  Stretching will help keep the muscles healthy and relaxed.  And it is the best way for you to maintain your own back.  Also, doing tai chi, the Chinese exercise and meditation, is very effective to strengthen the lower back and relax it."

Sciatica Treatment with Acupuncture, by: Joseph Alban, L.Ac. →

Joseph Alban, L.Ac., is a New York State licensed acupuncturist practicing in New York City. Alban Acupuncture (website)

Treating Chronic Low Back Pain

Chronic low back pain is clinically complex, and exacts a huge cost on society. Patients with chronic pain are typically treated by their primary care physician or a specialist; orthopedist, physiatrist (rehabilitation physician), neurologists. A smaller number of patients are referred to pain specialists.

Pain specialists start with a comprehensive assessment. Based on the assessment, one or more therapeutic approaches may be selected. Many patients benefit from a multimodality strategy that looks to reduce or eliminate the underlying causes of pain, improve comfort, enhance function and quality of life. More and more people now seek integrative care themselves — because it works for them.

Low Back Pain: Integrative Pain Therapy

The healingchronicpain.org website site offers lots of great information to help educate patients about the range of therapies that might be used for chronic low back pain. Healing Chronic Pain (website).