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.
View the British Acupuncture Council’s one minute video on lower back pain treatment.
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 (1) 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 systematic review by UK authors suggests that acupuncture represents a cost-effective and drug-free option for the treatment of lower back pain. Analysis of four studies showed that although acupuncture was associated with slightly increased costs, incremental cost-effectiveness ratios remained sufficiently low, and below the frequently used threshold value of £20 000 per quality-adjusted life year.
The National Institute for Health and Care Excellence (NICE) has selected this review for inclusion in NICE Evidence Search because it meets the definition of a reliable systematic review for this service.
(Cost-Effectiveness of Non-Invasive and Non-Pharmacological Interventions for Low Back Pain: a Systematic Literature Review. Applied Health Economics and Health Policy, 22 August 2016.)
A systematic review and network meta-analysis undertaken by researchers at the University of Huddersfield and funded by the National Institute for Health Research, has compared the effectiveness of various treatments for sciatica, and has come out in support of the use of acupuncture for this condition.
A total of 122 relevant studies, of which 90 were randomised controlled trials, covering 21 different treatment strategies were examined. Taking overall recovery as the main outcome criterion, and compared with inactive control or conventional care, there was found to be statistically significant improvement following acupuncture, disc surgery, epidural injections, non-opioid analgesia and manipulation.
(Comparative clinical effectiveness of management strategies for sciatica: systematic review and network meta-analyses. Spine Journal, October 2013.)
Researchers at the University of Westminster have shown that adding acupuncture to a self-care regime for lower back pain, can prove particularly helpful. Eighty chronic back pain patients, mean age 47, agreed to take part in a pilot service based in a primary and community care setting. Patients were referred by GPs, and by NHS physiotherapists and osteopaths. The service offered self-care advice, acupuncture, and information. Patients opting for acupuncture received up to six acupuncture sessions, on a weekly basis.
The results showed that service users experienced statistically significant improvements in pain, understanding of pain, quality of life, physical activity and relaxation. All of these improvements, with the exception of relaxation levels, were maintained at follow-up three months later. Patient satisfaction with the service was high, and particularly positive results were shown by those patients who had opted to include acupuncture within their care package.
(Patient outcomes and experiences of an acupuncture and self-care service for persistent low back pain in the NHS: a mixed methods approach. BMC Compl & Alter Medicine, November 2013.)
Researchers in Turkey have found that acupuncture is a promising treatment option for the management of radicular pain (pain radiating in recognised patterns through the body indicative of pressure on specific spinal nerves at intervertebral disc level). They concluded it is non-invasive and with minimal side-effects.
Eighty patients (43 women and 37 men) with acute radicular pain of either lumbar or cervical (neck) origin, were randomly assigned to receive either nonsteroidal anti-inflammatory drugs (NSAIDs), or acupuncture. Half the group had lumbar disc herniations and half had cervical disc herniations, all diagnosed by NMR or CT scan. The NSAID administered was Tenoxicam plus another drug to protect the stomach from possible side-effects of the NSAID.
The effects of acupuncture were similar to those of NSAIDs, although for the cervical group ie pain originating in the neck, acupuncture was significantly more effective than NSAIDs in the short term. The benefits of acupuncture were noticeable after four treatments in the neck pain cases and six treatments in the lumbar pain cases. All forty acupuncture patients completed the study, whereas eight of the NSAID patients dropped out, three due to gastric side-effects of the drug. Patients found acupuncture interesting, and some were unwilling to take medication long-term.
(Effectiveness of Acupuncture with NSAID Medication in the Management of Acute Discogenic Radicular Pain: A Randomised Controlled Trial. Journal of Anesthesia and Clinical Research, March 2012.)