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Category Archives: Back Pain & Sciatica
This is one of a series of short articles in which I outline for you, how I approach a particular condition. People can come along with pain in any area of the back, but I shall write with a special emphasis on lower back pain, since it is the most common category.
The American College of Physicians has in its 2017 guidelines, recommended acupuncture as a first-line treatment for lower back pain, finding it more effective for pain relief than medication. The German state healthcare system, has provided acupuncture for back pain since 2006. In January 2013, medical research charity Arthritis Research UK, published a report looking at the evidence for the effectiveness and safety of twenty-five complementary therapies commonly used by people with musculoskeletal pain. Acupuncture scored highly for treating lower back pain. In 2015, a meta-analysis comparing 21 different therapies for sciatica rated acupuncture as the second-best therapy in terms of pain intensity and overall effect. It was clearly superior to exercise therapy and radio frequency treatment.
The first differentiation I always make, is whether your pain is chronic or acute: chronic means you have had it for upwards of a few weeks, whilst acute means it only started in recent days. To give you an idea, I find patients presenting with chronic back pain, will typically have had it for six months or more. Those with acute back pain have most usually injured themselves in the past 48 hours, and can recall accurately how it happened.
Chronic pain always involves quite a bit of delving, and so in order to formulate a diagnosis, I am interested in answers to such questions as: when the problem began (eg pregnancy, a fall, gradual onset), its history (eg is the pain constant or episodic, has it changed over time, what treatments have you tried), the nature and location of the pain (eg dull ache, sharper stabs), any accompanying symptoms (eg early morning stiffness, difficulty putting on socks, pains down the legs / sciatica), any weather or seasonal variations (eg worse for cold/damp, better in summer), any relevant occupational factors (eg lots of sitting, driving, bending, lifting), and any aggravating factors (eg tiredness, stress, standing too long, gardening, DIY).
We will then go on to cover your health and wellbeing in a wider sense, to see whether there is anything else I might connect with your back pain, and I will examine your back and range of movement. I normally offer treatment for chronic back pain, weekly for a set period, after which we will review your progress. Lifestyle advice and exercises are likely to be an important component of your treatment.
Acute cases are usually simpler, and after establishing what has happened, I find up to three or four treatments in the first 10 to 14 days, can often be sufficient. If the injury, subsequent back examination or on-going occupational factors suggest it would be useful, then I might offer some follow-up treatment to reduce the likelihood of a recurrence.
Elsewhere on my website you will find more general information on what to expect from your first consultation, but I hope this has told you more about acupuncture for back pain and sciatica in particular. Below, you will find reports on some research conducted into back pain and acupuncture.
A large matched cohort study undertaken in Korea, suggests that having acupuncture treatment for lower back pain is associated with less likelihood of eventually needing lower back surgery. Using a nationwide insurance database, researchers identified all newly-diagnosed cases of lower back pain over a six year period, and separated out the subset who had had a course of acupuncture. After matching, over 130 000 patients were included in each of an acupuncture and non-acupuncture group. The lumbar surgery rate in the two years following a first acupuncture session was calculated.
Rates of lumbar surgery were significantly lower in the acupuncture group for all age ranges, except patients in their twenties, and across all income groups. More intensive acupuncture was associated with further reductions in lumbar surgery rates, as was being an older patient. The authors point out that this was acupuncture delivered by experienced practitioners in real-world clinical settings, unlike the strictly-controlled acupuncture sometimes applied in medical trials.
Authors of a study in Japan looking at acupuncture for spinal stenosis of the lumbar region, have concluded that it is more effective than either medication or physical exercise. A total of 109 patients with L5 root radiculopathy associated with lumbar spinal stenosis, visiting Iwai Orthopaedic Medical Hospital for surgical treatment, were assigned to receive either paracetamol (900mg three times a day), exercise therapy, or acupuncture (five sessions) over a period of four weeks. All groups were permitted to use additional non-steroidal anti-inflammatory drugs as required for pain control.
Symptom severity scores improved significantly in all three groups, but physical function scores improved only in the acupuncture group. Treatment satisfaction was significantly greater for the acupuncture group compared with the medication group.
(A comparative study of three conservative treatments in patients with lumbar spinal stenosis: lumbar spinal stenosis with acupuncture & physical therapy study (LAP study). BMC Complementary & Alternative Medicine, 19 January 2018.)
Clinicians in Berlin, Germany have shown that cupping for lower back pain, combined with analgesics, is more effective than analgesics alone. In the four week study they performed, 110 patients aged 18 to 65 were randomised to receive either eight sessions of cupping, plus paracetamol as required, or low suction cupping plus paracetamol as required, or paracetamol alone as required.
Compared with medication only, cupping plus paracetamol was a more effective treatment. At four weeks, both forms of cupping were comparable. However at twelve week follow-up, stronger cupping proved a superior option relative to controls. The researchers say that although the mechanism of cupping remains unclear, as it is a non-pharmacological and comparably safe therapy, it may be of use in clinical care independent of mechanisms.
(Pulsatile dry cupping in chronic low back pain – a randomized three-armed controlled clinical trial. BMC Complementary & Alternative Medicine, 2 April 2018.)
A small UK-New Zealand exploratory study suggests a trend of increased benefits after ten sessions of adjunctive acupuncture for lower back pain of a chronic nature. A total of 45 patients were randomly allocated to receive usual care plus either four, seven or ten acupuncture treatments. Outcome measures including back function, pain and disability, suggested that at the 12 week point, the 10 session group experienced most benefit. Over 90% of the study participants felt “very satisfied” &/or “extremely satisfied” with acupuncture treatment.
(Acupuncture for chronic low back pain: a randomized controlled feasibility trial comparing treatment session numbers. Clinical Rehabilitation, 1 April 2017.)