Back Pain


Parzin A., Calabasas, California, 2010. Bulging disc of Lumbar spine. 

Parzin , a 41 years old Ophthalmologist, suffered from lower back pain for 7 years. The pain was dull and intermittently presented. Long standing or sitting aggravate the pain. MRI showed bulging of disc at the level of L4-5, 8 mm posteriorly. He had received 5 epidural injections for his pain in the past, and effective maximally last for 6 months. He can’t take analgesics because they upset his stomach. Muscle in his back was quite tense with mildly tenderness at the lower back region. Myofacial band were detected on both side of his lower back at the level of L5-S1. Four treatments had been provided and the pain in his back was 95% less. Follow up for 4 months, he has no major pain recurred.

Margorie C., Tarzana, California, 2007. Pudendal nerve pinching.

Margorie, a 36 years old housewife, suffered from pain in the upper buttocks with groin radiation for 4 years.  Entrapment of the pudendal nerve was diagnosed and was operated at Central Hospital University in France on 6/21/2004 to release the compression. After surgery, her pain which was constantly presented while sitting, had released about 50%.  Physical therapy and local injection were given since then. But the pain still bothers her especially when she walks or sits. She came to our clinic for acupuncture on 12/8/2007. After 9 treatments were conducted, pain in the groin region was completely gone, and mild pain off and on still presented in her buttock particularly sitting for long time. She was satisfied to the treatment given and concluded on 1/28/08.  

Maryann P, Shermen Oaks, California, 2012. Subcostal neuritis.

Maryann, 88 years old, suffered with constantly moderated pain in her left side of upper body for 6 weeks.  Two chest x-ray examination were performed and no any positive findings were observed. She came to us on 6/22/12 and marked tenderness was detected at the territory of T12 spinal nerve from the mid back to the left flank. No any skin change was found. Movement of the upper body induced pain. Subcostal Neuritis was diagnosed and acupuncture was given. She started to feel better on the third treatments and progressively improving. Total six treatments had conducted and she was released with not pain.  

 

Herbert S., Encino, California, 2010.  Intervertebral disc protrusion and spinal stenosis. 

 

Herbert, an 83 years old retired attorney, presented with constantly severe pain in the lumbosacral area for years and weakness of right leg for about 5 months. He was a sufferer of leukemia for years and under control with medication. For more than 8 years, he suffered pain in the lower back due to multi-level of degeneration and protrusion of disc and spinal stenosis proved by MRI examination. In January of 2010 he sustained a car accident which caused him to be weakness of the right leg added to the existing pain in the back. Three epidural injections were given that provided slight effect to his condition. He took several Vicodins a day to ease his pain and used walker to support his standing and walking. We started regular acupuncture treatment on 10/13/2010 for his condition.  His condition was progressively improved with less pain and weakness. After 10 treatments he can walk with a can. He can walk by himself without a can after 17 treatments were provided. He still takes one Vicodin in the morning to control his back pain and dismissed on 12/31/2010.      

 

Back pain is ranked second only to headaches as the most frequent location of pain. Back pain has been estimated that up to 80% of the world’s population will suffer from back pain at some point in their lives. It can occur for no apparent reason and at any point on your spine. Due to the bearing of weight of the body, the most common site for pain is your lower back.  Although most lower back pain problems aren’t life threatening, and most of them last less than 2 weeks, but it usually provided an uncomfortable influence to the daily life. There are a dozen of causes to the lower back but injuries are one of the most common causes of disability. It were estimated that the total cost of back injuries to society of 20 to 50 billion dollars a year in the United States.   Research has shown that recurrence rates for low back pain can reach as high as 50% in the first few months following an initial episode. Surprisingly, many times low back pain can be managed by simple approach (hot compression, stretching or massage) or can be prevented (right posture of sitting and standing). But still there are a lot of people experienced intolerable or inexpedient to the pain particularly to the labor population.

Causes of back pain

The causes of back pain more than 80% are unknown. A number of things may contribute to back pain, including poor muscle tone, improper or heavy lifting, excess weight, and poor posture in sitting or standing. Researchers believe that back pain often begins with an injury.

  1. Muscle strains or spasms. These are common responses to injury.
  2. Herniated disc (slipped disc). The discs, which have a rigid outside rim and a soft gel-like center, act as shock absorbers and protect the spinal cord. Normal wear, tear, stress, or a mechanical problem in the spine can cause a spinal disc to bulge or rupture. The damaged disc may pinch or irritate a nerve root, causing pain on the back or leg.
  3. Osteoarthritis. As the body ages, past age 60, the discs in the spine dry out, the bones and ligaments become less flexible and thicken. The spurs (formed followed degeneration of bone) and the narrowing of the intervertebral space (formed followed disc thinning) caused nerve roots or spinal cord to be pinched or compressed.
  4. Sciatica. The sciatic nerve, composed of several lumbar nerve roots, is one of the nerves most likely to become irritated. Sciatic nerve travels through the pelvis and deep in the buttocks then down to the hip and along the back of the thigh to the foot. Sciatic nerve compressed by a disc causing pain the lower extremities.
  5. Osteoporosis. Osteoporosis is a condition of chronic losing of bony textures that cause a gradual weakness of bones. One in three women older than 50 is affected by painful vertebral compression fractures due to osteoporosis.
  6. Fibromyalgia. A multiple aching, tenderness and stiffness in muscles and body areas. The cause of fibromyalgia is still not well known.

 

The role of acupuncture in the treatment of back pain

While there is no definitive way to resolve lower back pain, the use of acupuncture to treat this condition has increased dramatically in the past few decades. In 1998, the National Institutes of Health concluded that acupuncture may help conditions that involve chronic pain, including low back pain. Many hospital clinics provide acupuncture treatment as one of the main methods of pain control. For example, the Mayo Pain clinic has used acupuncture since 1974 in some cases in which people don’t experience pain relief from medications or nerve blocks.

The principle of acupuncture treatment is based on the theory of Traditional Chinese Medicine (TCM). According to TCM, pain occurs when there is “obstruction” in the energy flow. The meaning of obstruction can be translated into modern concept which will be blockage of circulation, spasm of muscles, compression of nerve and stasis of lymphatic vessels. The acupuncture points used mostly are analgesic points, muscle relaxing points, mental clamming points and energy enhancing points. Needling areas are not only locally on the back, but also on the lower leg, arm and even on top of the head. When the flow of different energies are return to floating ahead, no more obstruction, pain will eventually disappeared. Since many low back pain conditions are exited for long time, thus treatment also need to apply for a rather longer period to heal. A persisted obvious result of treatment cannot be gained just by several treatments. A patient will be disappointed if he or she expects to have a good result by only a very briefly acupuncture treatment.

 

What we do

Standard steps we approach to patient with back pain:

1. Record detail history of illness to sort out the cause of the pain.

2. Review test data and imaging result (X-ray, CT scan, MRI).

3. Perform physical examination and movement test to picture the illness tissues.

4. Propose a treatment plan.

5. Common acupuncture points used include: Ear sympathetic, back pain, and kidney; para-spinal points according to the level of illness; Stomach and Liver channel points in the lower extremities; and distal analgesic points.

6. Add Electric stimulation or cupping as needed.

Demography of back pain patient and treatment results of our clinic

Study data draw from 2003 to 2007. Age: 45 to 80, average 63. Gender: F:M=3:1 

Diagnosis % of total pain patients % of Improvement % of marked improvement Average treatment
LBP 16.9 91.8 85.4 13
IVDD 7.96 91.8 85.4 18
Spondylosis 1.7 90 50 18
Spinal stenosis 8.3 62.5 41.7 16
Post-laminectomy 6.57 78.2 55.1 20
Osteoarthritis 1.73 80 60 11

Be noted that the result of treatment relate closely with many factors include age, gender, length of sickness, severity of sickness, treatment that have used and current combined therapy. Unfortunately, in United Stated many choose acupuncture treatment as the last resource. 

Literature review

Cho YJ, et. al. Acupuncture for Chronic Low Back Pain: A Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial. Spine (Phila Pa 1976) 2012 Sep 28.

Study design: Multicenter, Randomized, Patient-Assessor Blind, Sham-Controlled Clinical Trial. Low back pain is one of the main reasons of disability among adults of working age. Acupuncture is known as an effective treatment for chronic low back pain, but it remains still unclear whether acupuncture is superior to placebo. This study was to investigate the efficacy of acupuncture treatment with individualized setting for reduction of chronic low back pain (LBP). One hundred thirty adults aged 18-65 with non-specific LBP of lasting for at least the last 3 months was participated in the three Korean medical hospitals in Korea. Participants got individualized real acupuncture treatments or sham acupuncture treatments twice a week for over 6 weeks. One hundred sixteen participants finished the treatments and 3-, 6-month follow ups with fourteen subjects’ drop-out. Significant difference of discomfort and pain intensity of LBP between two groups has been found at the end of 8 weeks, and continuously until 3-month follow up.  Conclusion: This randomized sham-controlled trial suggests that acupuncture treatment show the better effects on the reduction of the discomfort and pain intensity than sham-control in participants with LBP.

Furlan AD, et al. A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain. Evid Based Complement Alternat Med.  2012;2012:953139. Epub 2011 Nov 24. 

To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Records from various databases up to February 2010. The efficacy outcomes of interest were pain intensity and disability. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically non-significant results. Conclusions: CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment.

Ernst E, White AR, Wider B. Acupuncture for back pain: meta-analysis of randomized controlled trials and an update with data from the most recent studies. Shmerz 2002 Apr;16(2):129-39

A systematic literature search was conducted to retrieve all randomized controlled trials of any form of acupuncture for any type of back pain in humans. The main outcome measure for the meta-analysis was numbers of subjects who were improved at the end of treatment.

12 studies were included of which 9 presented data suitable for meta-analysis. The odds ratio of improvement with acupuncture compared with control intervention was 2.30. For sham-controlled, evaluator-blinded studies, the odds ratio was 1.37. The results from the majority of the most recent studies also support the effectiveness of acupuncture in the treatment of back pain. CONCLUSIONS: Collectively, these data imply that acupuncture is superior to various control interventions.

Carlsson CP, Sjolund BH. Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Clin. J. Pain 2001 Dec.;17(4):296-305

Dr. Carlsson and associates use a blinded placebo-controlled study with an independent observer to determine whether a series of acupuncture treatments produced long-term relief of chronic low back pain. Fifty consecutive patients (33 women, 17 men with a mean age of 49.8) with chronic low back pain (mean pain duration 9.5 years) and without rhizopathy or history of acupuncture treatments were included in the study.

The patients were randomized to receive manual acupuncture, electroacupuncture, or active placebo (mock transcutaneous electrical nerve stimulation). Treatments were given once per week for 8 weeks. Two further treatments were given during the follow-up assessment period of 6 months or longer. Patients were examined and monitored by an investigator who was blinded to the treatment given. The observer made a global assessment of the patients 1, 3 and 6 months after treatment. The patients kept pain diaries to score pain intensity twice daily, analgesic intake and quality of sleep daily, and activity level weekly.

At the one-month assessment, 16 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo groups showed improvement (p<0.05). At the 6-month follow-up assessment, 14 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement (p<0.05), A significant decrease in pain intensities occurred at 1 & 3 months in the acupuncture groups compared with the placebo group. There was a significant improvement in return to work, quality of sleep, and analgesic intake in subjects treated with acupuncture.

CONCLUSIONS: The result of this study demonstrated a long-term pain-relieving effect of needle acupuncture compared with true placebo in a great percentage of patients with chronic nociceptive low back pain.

Leibing E, Leonhardt U,Koster G,Gierkutz A,Rosenfeldt JA, Hilgers R,Ramadori G. Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled trial with 9-month follow up. Pain 2002 Mar;96(1-2):189-96

Since there is some evidence for the efficacy of acupuncture in chronic low back pain (LBP), but it remains unclear whether acupuncture is superior to placebo. This study is designed to evaluate the effect of traditional acupuncture in chronic low back pain.

A total 131 consecutive out-patients of the Department of Orthopedics, University Goettingen (mean age of 48.1, 58.5% female, duration of pain 9.6 years) with non-radiating LBP for at least 6 months and a normal neurological examination were randomized to one of three groups over 12 weeks. Each group received active physiotherapy over 12 weeks. The control group (n=46) received no further treatment, the acupuncture group (n=40) received 20 sessions of traditional acupuncture and the sham-acupuncture group (n=45) 20 sessions of minimal acupuncture.

Changes from baseline to the end of treatment and to 9-month follow-up were assessed in pain intensity and in pain disability, and secondary in psychological distress and in spine flexion, compared by intervention groups. At the end of treatment acupuncture was superior to the control condition regarding pain intensity (p=0.000), pain disability (p=0.00), and psychological distress (p=0.020). Compared to sham-acupuncture, acupuncture reduced psychological distress (p=0.040) only. At 9-month follow up, the superiority of acupuncture compared to the control condition became less and acupuncture was not different to sham-acupuncture. CONCLUSIONS: A significant improvement by traditional acupuncture in chronic LBP compared to routine care with physiotherapy but not compared to sham-acupuncture.