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Category Archives: Back Pain & Sciatica
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.)
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.)