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Acupuncture and Low Back Pain first published July 2007
Back pain, particularly lower back pain, is considered to be one of the scourges of modern living, especially in the developed world. Millions of people suffer from it and most people will experience it during the course of their lifetime. So why should this be so? The problem is defined in medical terms as pain, muscle tension or stiffness below the ribs and above the top of the thighs, with or without leg pain (sciatica). It is described as chronic when it lasts for more than twelve weeks and low back pain is most common between the ages of 35 and 55 years.
There are many medical conditions which can result in people experiencing back pain and these include infections like TB (rare), tumours (very rare) and osteoporosis. It is always important to seek medical advice if the back pain fails to get better with time or with pain killers.
If the back pain results from moving a heavy object or from straining but does not affect the feeling in the legs then treatment with acupuncture may well help. Also, there is evidence that acupuncture helps to relieve pain in the lower back when used on its own and with conventional treatments such as painkillers and gentle exercise.
Many people ask if they can have an X-ray on their back on coming to my surgery with back pain but the problem normally is muscular where an X-ray will not help. This is because only bones show on X-rays and not inflamed muscles or tendons. Also having x-rays are not without risks and having just one X-ray on your lower spine exposes you to as much radiation as would normally be absorbed naturally from the atmosphere in one year. Several x-rays within a short period of time substantially increase the risk of radiation related problems, which is the reason why qualified medical staff avoid carrying out X-rays wherever possible. Blood tests can be carried out to help ascertain the problem, again, avoiding unnecessary X-rays but most adults over the age of forty will have signs of wear and tear in their spines which inevitably can cause discomfort and pain.
There are many ways to treat back pain beginning with gentle exercise to avoid stiffness and doctors now advocate a programme of movement rather than a period of lying flat on your back in bed which was the advice until recently. For severe spasm in the lower back, lying on a firm surface with the thighs bent at a right angle and the calves resting on a low stool, such as a dressing table stool, can also be very beneficial. However, gentle movement or massage is still the best thing for stiffness rather than acute pain.
Once the reason for the back pain has been diagnosed, I am, as a doctor, happy to advise patients to consider acupuncture for pain relief together with conventional painkillers and general exercise providing always, the reason for the pain is not caused by a condition such a prolapsed intervertebral disc ('slipped disc').
Prior to recommending acupuncture however, I always take a medical history, first to check all necessary tests have been done, and also to gain an understanding as to the level of pain killers needed by the patient. I also need to understand how restrictive their back pain is when looking at their day to day activities which helps me to monitor how well they are responding to the treatment they are currently receiving.
Having checked there are no reasons not to carry out acupuncture, I try to allay the natural fears of some patients with regard to the actual placing of the needles. Usually discomfort is an absolute minimum and once the patient is comfortably settled, the needles are normally left in place for about ten minutes on the first treatment and twenty minutes on second and subsequent treatments. Most patients tolerate the placing of the needles quite well but a few, a very few, may feel slightly faint. This is due to a drop in blood pressure but is only a temporary problem and not uncommon. Initially, treatments may be weekly but as the patient is the one experiencing the pain, most practitioners are guided by the patient themselves as to the number and frequency of treatments to achieve effective pain relief.
Acupuncture is an ancient art of healing, normally associated with the Chinese, who, by use of needles, treated pain. They did this by a series of meridian points which were considered to bring the body into balance from a condition of imbalance and hence pain. However, Western medicine has taken this further, identifying so called 'trigger points' on the body, which if treated with needles, help to relieve pain in a localised area. With trigger point acupuncture, the therapist concentrates on using acupuncture needles at tender points on the muscles which correspond to previously recorded points on the body but not necessarily traditional Chinese meridian points. The needles may be left in but are more usually held and rotated several times before removing. The area of tenderness, if the treatment is successful, becomes less painful, and the patient is able to inform the practitioner as to the effectiveness of the treatment. A trigger point in a muscle is tender when pressed and causes pain away from the area being pressed, as opposed to a tender point which has pain only in that area. Trigger point acupuncture is especially helpful if there is not much time for treatment or where the muscles are so tender that more conventional acupuncture causes too much discomfort.
Another technique found to be particularly useful for chronic low back pain is that of electroacupuncture. This uses a low voltage electric current and consists of placing two clips onto two needles spaced up to 5-6cm apart and the electricity vibrates the needles which acts in the same way as the practitioner twisting and twirling the needles by hand. This piece of equipment is common in NHS Pain Clinics across the UK which use acupuncture as part of their treatment regime.
Back pain is not funny and certainly not to be laughed at as portrayed in music hall satire and movies. It is wearing, debilitating and the sufferer feels thoroughly miserable and the pain can begin to dominate. Painkillers, of course, are the first resort, coupled with a sensible physical regime but for those people who do not respond, or are unable to get effective pain relief, then acupuncture is most certainly recommended.
Dr Jeni Worden
July 07
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