Acupuncture for Chronic Low Back Pain
Back pain is a huge problem in our society with an estimated 70% of persons in Western industrialized countries having back pain sometimes in their lives. Approximately 90% of acute episodes resolve within 6 weeks, but 25% or more of these patients will have recurrent pain within a year, and chronic low back develops on up to 7% of patients.
A 2008 meta analysis with 6359 patients showed that acupuncture was more effective than no treatment for chronic low back pain and that acupuncture can be a useful supplement to conventional therapy for low back pain. This conclusion was also supported by a subsequent meta-analysis from the Cochrane back review group.
In a German study of 1162 patients with chronic low back pain acupuncture was compared to sham acupuncture. At 6 months both real and sham acupuncture were significantly better than conventional therapy.
Another large German trial of 3093 patients with chronic low back pain were assigned to receive acupuncture or no acupuncture and back function was assessed with a score ranging from 0 to 100. At 3 months the mean back-function score in the acupuncture group had increased from 61.8 to 74.5, (increase of 12.1 points) whereas the control group only increased from 63.3 to 65.1 (2.7 points).
There have been several different mechanisms by which acupuncture is explained to work, one of which is acupuncture has been shown to induce the release of endogenous opioids in the brain stem, sub cortical and limbic structures. The reason I mention this one specifically is that the research for this was performed by Dr. Bruce Pomeranz. (check out an interview with Dr. Pomerenz here http://www.medicalacupuncture.org/acu_info/interviews/pomeranzart.html)
I am lucky enough to have regular discussions with Dr. Pomeranz as he uses my training facility and clinic in Toronto. He has also taken the time to give me some great advice with using acupuncture for my patients and has given me a copy of his textbook “Basics of Acupuncture”.
Dr. Pomeranz is adamant that to get the best treatment result, you must elicit “de qi”, for those unfamiliar with acupuncture when de qi occurs, patients usually feel an aching or heavy sensation in the area surrounding the acupuncture needle.
To really elicit de qi it requires the practitioner to twirl the needle once inserted, he stresses the importance of twirling the needle to adequately stimulate the muscle afferent fibers (types II and III) which in turn send messages to the brain to release neurochemicals such as endorphins.
As a practitioner the problem with this is that not all patients are going to like this feeling,
but this is necessary to have the treatment effect you are looking for.
Recommendations and Guidelines
The North American Spine Society has concluded that acupuncture provides better short-term pain relief and functional improvement than no treatment and that the addition of acupuncture to other treatments provides a greater benefit than other treatments alone.
The American College of Physicians and the American Pain Society have issued joint clinical practice guidelines recommending that clinicians consider acupuncture as a possible treatment option for patients with chronic low back pain who do not have a response to self care. Also the U.K. National Institute for Health and Clinical Excellence has recommended acupuncture as a treatment option for patients with low back pain.
There are many factors involved in chronic low back pain and it is a difficult condition to cure, but acupuncture provides a good drug free treatment option to help manage pain and improve function. These two factors can be extremely helpful as you provide the patient with symptomatic relief while progressing through an active rehabilitation process in an effort to move them out of chronic pain.
Dr. Mark Molloy
1. Berman BM, Langevin HH, Witt CM, Dubner R. Acupuncture
for chronic low back pain. N Engl J Med 2010;363:454-61.