Acupuncture for Back Pain & Sciatica

Acupuncture in Exeter for back pain and 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 2013, Arthritis Research UK reported on the evidence for the effectiveness of twenty-five complementary therapies for 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.

The first differentiation 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, patients presenting with chronic back pain, will typically have had it for six months or more. Those with acute pain have most usually injured themselves in the past 72 hours, and can recall how it happened.

Chronic Pain

Acupuncture in Exeter for back pain: gardening can be hard on the back.

Chronic pain always involves quite a bit of delving. To formulate a diagnosis, I am interested in 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 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. I will also 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 progress. Lifestyle advice and exercises are likely to be an important component of your treatment.

Acute Pain

Acute cases are usually simpler, and two or three treatments in the first 10 to 14 days, can often be sufficient. If your injury, 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.

Electro-Acupuncture for Back Pain

Electro-acupuncture for back pain. Korean researchers studying the use of electro-acupuncture for back pain after surgery, have concluded that its use in addition to usual care, is more effective than usual care alone. A total of 108 participants with non-acute, post-surgical lower back pain, were randomised to receive either usual care alone, or usual care plus electro-acupuncture (EA). The latter was given twice a week for four weeks.

After four weeks, significant differences emerged between the groups, with greater pain reduction and functional improvement in the EA group. The researchers conclude that EA added to usual care, may be considered an effective, conservative treatment for patients with non-acute lower back pain after back surgery.

(Multicentre randomised controlled clinical trial of electroacupuncture with usual care for patients with non-acute pain after back surgery. British Journal of Anaesthesia, March 2021.)

Mechanisms Behind Acupuncture for Relief of Back Pain

Acupuncture benefits post-traumatic stress disorder. Researchers lead by Harvard Medical School in the US, have been studying the mechanisms behind acupuncture’s ability to relieve pain. A total of 79 patients aged 18 to 60, with chronic lower back pain were randomly assigned to four weeks of either real or sham acupuncture. Six treatments were given in total per patient. Resting state functional MRI scans were performed prior to the first treatment and after the last treatment.

Fifty patients completed the study. Reductions in the extent to which patients were troubled by their pain, were observed in both treatment groups, with significantly greater pain relief occurring in the real acupuncture group. Real acupuncture was found though to increase connectivity between the periaqueductal gray and ventral tegmental areas of the brain, with the amygdala.

The authors conclude that acupuncture may simultaneously modulate connectivity between key brain regions, linked via the amygdala, to block pain signals. The amygdala is not only involved in pain signal processing, but it also plays a role in negative emotion management. The authors also point out that the pain relief observed is consistent with findings from systematic reviews testing the efficacy of acupuncture for chronic lower back pain. These reviews found that although differences between real and sham acupuncture are relatively modest, acupuncture is superior to both a non-acupuncture control and sham acupuncture for the treatment of chronic pain.

(Acupuncture Treatment Modulates the Connectivity of Key Regions of the Descending Pain Modulation and Reward Systems in Patients with Chronic Low Back Pain. Journal of Clinical Medicine, 3 June 2020.)

Acupuncture for Spinal Pain

Acupuncture in Exeter: ear acupuncture for spinal pain. Brazilian university researchers studying acupuncture for spinal pain, have found that ear acupuncture reduces the degree of disability in sufferers. In a clinical trial, 110 people aged 18 to 80 were randomised into three groups: true acupuncture, placebo acupuncture and a no-treatment control group. Both treatment groups received five sessions, over six weeks.

Compared with initial assessment, the team observed a significant reduction in disability in the treatment and placebo groups, by one week after sessions ended, and again at 15 day follow-up. The true acupuncture group however, experienced a greater reduction in disability.

(Action of ear acupuncture in people with chronic pain in the spinal column: a randomized clinical trial. Revista Latino-Americana de Enfermagem, 3 September 2018.)

Acupuncture is Associated with Reduced Likelihood of Lower Back Surgery

Acupuncture in Exeter: acupuncture and lower back surgery. 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.

(Impact of acupuncture treatment on the lumbar surgery rate for low back pain in Korea: A nationwide matched retrospective cohort study. PLoS One, 12 June 2018.)