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. Bear in mind the National Institute for Clinical Excellence (NICE), the independent body advising NHS doctors on best clinical practice, released new evidence-based guidelines in 2009, recommending acupuncture as one of the first line treatments for persistent, non-specific lower back pain.

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 in my practice, 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 constant, episodic, treatments tried), the nature and location of the pain (eg dull ache, sharper stabs), any accompanying symptoms (eg stiffness, pains down the legs), 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). 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 information on what to expect from your first consultation, but I hope this has told you more about treatment for back pain in particular. Below, you will find reports on some research conducted into back pain and acupuncture.

A pilot study looking at two different frequencies of treatment for chronic lower back pain, has found that improvements achieved within the first two weeks, were still present at one year follow-up.

Thirty participants with chronic lower back pain were randomly allocated to two groups to receive ten acupuncture treatments: the low frequency group received two treatments per week for five weeks, whilst the high frequency group received five treatments per week for two weeks. No significant differences were found between the groups in terms of measured outcomes, but clinically important improvements in pain, disability and quality of life, were achieved in both groups within the first fortnight, and were maintained at follow-up one year later.

(Different Frequencies of Acupuncture Treatment for Chronic Low Back Pain: An Assessor-Blinded Pilot Randomised Controlled Trial. Complementary Therapies in Medicine June 2009.)

Researchers in Japan have found acupuncture to be superior to the injection of local anaesthetic for the treatment of lower back pain. Twenty-six patients were randomly allocated to receive either acupuncture or local anaesthetic injection at two to five of the most painful points on the lower back, once per week for four weeks. Both groups experienced pain relief, but acupuncture provided significantly more pain relief at all time points measured, including at two and four weeks after completion of treatment.

(Comparison of the Effectiveness of Acupuncture Treatment and Local Anaesthetic Injection for Low Back Pain: A Randomised Controlled Clinical Trial. Acupunct Med Dec 2009.)

Japanese researchers have examined the effects of acupuncture on pain, mood disturbances and medical expenses related to lower back pain among employees of a steel firm.

Acupuncture was given once a week to 72 workers, averaging 53 years in age. After eight weeks of treatment, patients reported less pain and a significant decrease in mood disturbance. There were also significant reductions in the number of visits to hospital for conventional care, and in medical expenses related to lower back pain.

(Acupuncture Can Reduce Perceived Pain, Mood Disturbances and Medical Expenses Related to Low Back Pain among Factory Workers. Ind Health 2008 Aug).

An audit of almost 6000 patients who attended a pain clinic in Spain over a nine year period, revealed an average success rate of 79.7%. For the audit, “success” was defined as an improvement of at least 50% in five factors: pain intensity, pain frequency, consumption of painkillers, level of incapacity, and sleep disturbance.

The highest success rate (93%) was achieved in patients with headaches. The authors conclude acupuncture is effective, carries with it no severe adverse events, and considerably reduces the consumption of analgesic and anti-inflammatory drugs.

(Effectiveness of acupuncture and related techniques in treating nononcological pain in primary healthcare-an audit; Acupuncture Med June 2007)