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 (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 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.)
The American College of Physicians has developed a new guideline to present the evidence and provide clinical recommendations on non-invasive treatment of low back pain. The guideline is based on a systematic review of randomised, controlled trials and systematic reviews published up to April 2015, on non-invasive pharmacological and non-pharmacological treatments for lower back pain.
For chronic lower back pain, a strong recommendation is made to doctors and patients to initially try acupuncture among other treatments. Also recommended are exercise, tai chi and yoga.
(Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine, 4 April 2017.)
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, has compared the effectiveness of various treatments for sciatica. The conclusion is that acupuncture is effective for sciatica. The work was funded by the National Institute for Health Research.
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.)