Back Pain and Acupuncture

Treating back pain is a substantial part of my day at the clinic, constituting around 15% of a typical day's patient load. I realized that I had given short shrift to this topic when three back pain patients who read this blog regularly asked why so many of the topics covered by this site deal with internal medicine-related issues like fertility or immunity and not musculo-skeletal pain. The reason is simple, and perhaps wrong-headed of me: I have always presumed that most people already are aware of the dramatic effect that acupuncture can have on back pain and it's multiple causes but less knowledgeable about it's many other uses.

 

Back pain can have an astonishing number of origins, in broad brush these range from muscular to spinal with many types of pain originating from an interplay between both the muscles and the nerves exiting the spine.The most frequent types of back pain that we see in the clinic are from herniation, spinal stenosis and muscular impingement on spinal nerves. In clinic, the most rapid response to acupuncture therapy tend to be with muscular impingement; while spinal stenosis and herniation can require more gradual and focused treatment in order to begin to see favorable results. Very frequently, however, we can help our patients avoid more aggressive  therapies such as surgery.

With an acute back spasm we can usually have the person feeling much better within 1-2  treatments, while with chronic back problem I usually tell patients that they will feel a measurable improvement with 3-4 treatments which will indicate that we are on the right track. From that point forward, we will continue to treat until the problem is gone and the clients returned to full functioning.

Research and Articles about Back Pain and Acupuncture

Pain expert Dr. Scott Fishman answers questions about back pain . Partially excerpted from DiscoveryHealth.com

Q: My doctor has recently suggested acupuncture. Is acupuncture safe and will it really help?

A: Acupuncture is one of the most time-tested treatments known to mankind. If the value of a treatment were based solely on how long it has been around, and how long people have thought that it was helpful, then acupuncture would probably be the most effective treatment known to humankind.

Typically, acupuncture is performed with a very thin needle that causes gentle sensations. It is usually not painful. Classically, acupuncture involves using a needle — although sometimes electricity is passed through the needle, and sometimes the burning of traditional Chinese herbs is employed as well. Burning these herbs is called "moxabustion."

The points that are used for the needle insertions often are at a distance from the actual area of symptoms. So, if someone has pain in their back, they may be getting needles in their feet, their ears or somewhere else distant from the actual site of the pain.

Taken all together, acupuncture is an ancient, time-tested form of therapy that seems to have exceptionally few side effects and appears to be safe for pain management. . . In my experience, many patients have found relief from pain through acupuncture. For those of my patients who have not found relief with standard medical therapies, I am always open-minded to any kind of treatment that will help, particularly those that have the fewest side effects. Thus, I embrace acupuncture. I look forward to revelations through science that better explain how it works and how it may be best applied to fight the war on pain.

 Excerpted from the University of Maryland Medical Center:

STUDY ANALYSIS SHOWS ACUPUNCTURE EFFECTIVE FOR TREATING CHRONIC LOW BACK PAIN

With the acupuncture needles in place, the back pain patient rests for several minutes. The wires are part of the electrical stimulation used in the treatment. Most patients say the needles are painless and they find the treatment very relaxing.

Millions of people suffer with low back pain, and it is one of the top reasons people seek medical treatment. Back problems are also, by far, the primary reason for appointments with acupuncturists. But does acupuncture really help these patients? Researchers from the University of Maryland School of Medicine and the Peninsula Medical School, Plymouth, U.K., analyzed dozens of studies from around the world on acupuncture for low back pain.

“For people with chronic low back pain, this analysis shows that acupuncture is clearly effective in providing considerable pain relief,” says Eric Manheimer, study author and director of database and evaluation for the University of Maryland Center for Integrative Medicine. “The research also showed that acupuncture provided true pain relief. The benefit was not just due to the placebo effect.”

The reviewers scoured the medical literature for all studies involving acupuncture for treating low back pain. To minimize bias, the American and British teams developed explicit criteria for evaluating the studies and did the evaluations independently. Their analysis included only randomized controlled trials, the gold standard study design for evaluating medical procedures.

Thirty-three studies covering more than 2,100 patients met the criteria for review. In the end, the researchers used 22 of these studies for their analysis. All 22 evaluated Chinese-style acupuncture for chronic low back pain, defined as pain that has been on-going for more than three months. The other 11 studies were excluded because they either only reported data that could not be combined statistically, they only included patients with acute back pain or pregnancy-related back pain or they involved forms of acupuncture other than traditional Chinese acupuncture.

Manheimer says, “We wanted the studies for the analysis to meet the highest scientific standards. As a way to account for a possible placebo effect, we looked at many studies that used ‘sham acupuncture’ as a control group, where acupuncture needles were inserted only superficially or in the wrong place.”

The sham acupuncture studies were double-blinded, meaning neither the researchers nor the participants knew who was receiving the real or the sham treatment. When looking at those studies, the reviewers found the differences in pain ratings showed a significant difference between the real acupuncture and the sham acupuncture groups, indicating that the benefit was not just due to the placebo effect.

“From our analysis, the message for people with chronic low back pain is that acupuncture is a truly effective therapy that provides significant pain relief,” says Manheimer. “Patients with low back pain have many options for treatment including medication, chiropractic care, physical therapy and back exercises. However, these treatments do not always help, and scientific evidence indicates that they have only modest effectiveness.”

The researchers evaluated the effects of acupuncture both in the short-term (defined as three weeks after the last acupuncture treatment) as well as in the longer term. They found acupuncture provided definite pain relief in the short-term, and this relief appeared to be sustained over the longer term. However, they say it’s too early to be certain of longer term effects, and more studies are underway.

Previous attempts to synthesize information on acupuncture and chronic low back pain provided mixed results. But since 1999, the publication of five high quality, large-scale studies has added new evidence for the analysis. The current analysis includes these newer studies as well as earlier research not included in previous reviews.

In all, this analysis contains more than twice as many studies as earlier reviews and includes reports in English, Chinese, Japanese, Korean as well as Germanic and Romance languages. For this study, the reviewers received funding from the National Center for Complementary and Alternative Medicine, a part of the National Institutes of Health.

Mesothelioma and Acupuncture

I was contacted yesterday by the Mesolthelioma Center who asked if I wouldn't mind creating a link to their noteworthy foundation. I am all too glad to do so given the often horrific after effects of asbestos exposure in the form of mesothelioma.

Mesothelioma is a cancer of the mesothelium - the lining covering many parts of the inside of the body, in particular the outer covering of the lungs, chest wall and abdomen.  It is almost always caused by exposure to asbestos although other risk factors, such as smoking, can increase risk for disease and worsen the prognosis. Symptoms may not appear until decades after the exposure, which can often obscure the origin of the symptoms that the individual is experiencing and make the eventual diagnosis more difficult to achieve.

Symptoms of mesothelioma depend upon the area of the body affected. I have lifted the following directly from wikipedia.com since the symptoms possible are so lengthy. However, see the Mesothelioma Center's page here for a more in-depth breakdown of the parts of the body affected and the ways in which the disease can manifest.

Symptoms of peritoneal mesothelioma include weight loss and cachexia, abdominal swelling and pain due to ascites (a buildup of fluid in the abdominal cavity). Other symptoms of peritoneal mesothelioma may include bowel obstruction, blood clotting abnormalities, anemia, and fever. If the cancer has spread beyond the mesothelium to other parts of the body, symptoms may include pain, trouble swallowing, or swelling of the neck or face.

These symptoms may be caused by mesothelioma or by other, less serious conditions.

Mesothelioma that affects the pleura can cause these signs and symptoms:

• Chest wall pain
• Pleural effusion, or fluid surrounding the lung
• Shortness of breath
• Fatigue or anemia
• Wheezing, hoarseness, or cough
• Blood in the sputum (fluid) coughed up (hemoptysis)

In severe cases, the person may have many tumor masses. The individual may develop a pneumothorax, or collapse of the lung. The disease may metastasize, or spread, to other parts of the body.

Tumors that affect the abdominal cavity often do not cause symptoms until they are at a late stage. Symptoms include:

• Abdominal pain
• Ascites, or an abnormal buildup of fluid in the abdomen
• A mass in the abdomen
• Problems with bowel function
• Weight loss

In severe cases of the disease, the following signs and symptoms may be present:

• Blood clots in the veins, which may cause thrombophlebitis
• Disseminated intravascular coagulation, a disorder causing severe bleeding in many body organs
• Jaundice, or yellowing of the eyes and skin
• Low blood sugar level
• Pleural effusion

• Pulmonary emboli, or blood clots in the arteries of the lungs
  Severe ascites

 As I have described in other parts of this website, I often work with people with cancer - for the management of the side effects and symptoms of the chemotherapy, surgeries, and radiation therapies, as well as for immune system regulation. As such, I have seen many people going through the treatments associated with mesothelioma at the Northside Holistic Center. What the Mesothelioma Center asked me to do was to print the following code block below, which I am happy to do. Please contact them for additional information on this disease and it's associated symptoms. I would be happy to serve as an information and treatment source on the acupuncture and Chinese medical side of the equation.

Acupuncture has been linked to alleviating the nausea associated with chemotherapy and the pain incurred from the constant surgeries that cancer patients undergo. The Mesothelioma Center offers the most comprehensive and current information on asbestos exposure and a complete list of mesothelioma causes.

Another great resource is the website Mesothelioma Symptoms which gives a good sense of symptoms, treatments and resources for those working through mesothelioma.

Effective Treatment of Trigeminal Neuralgia with Acupuncture

Trigeminal neuralgia is a very painful condition of the nerves in the face which often torments those who suffer from it for long periods of time. Western medicine struggles, often quite unsuccessfully, in addressing the discomfort and patients are rarely satisfied with their treatment. Happily, acupuncture is an extremely useful means of addressing this problem and we see many cases of it in our clinic with the vast majority of clients extremely pleased with what we are able to do for them. 

Acupuncturists will not only ask the client for a description of where on the face the pain is, but also for a detailed overview of their whole system. The process of doing Chinese medicine properly involves evaluating any one problem, in this case trigeminal neuralgia, against the backdrop of the patient's whole constitution. It often surprises our clients that we seem to be as interested in their digestion, skin, or menstrual cycles as we are in the reason they came in to see us. The reason for this is no one symptom exists in a vacuum and to take care of the problem most effectively, we need to treat the person's whole body. This ensures that not only will the problem be treated, but that it is less likely to return and that the patient is healthier overall.

For reference, I am excerpting and publishing links to a small smattering of the enormous number of articles and studies on acupuncture and Chinese herbal treatment of trigeminal neuralgia below:

A small study showing the utility of acupuncture in the treatment of trigeminal neuralgia:

Research/Articles

From the journal Headache comes a research study evaluating acupuncture for trigeminal neuralgia entitled, Acupuncture Treatment of Chronic Facial Pain -- a Controlled Cross-over Trial. A summary of it can be read here. The patients received 10 treatments over the course of two weeks. The study's summary concludes that,

Traditional Chinese acupuncture was found to be significantly more pain-relieving than placebo acupuncture according to the pain registration of the patients themselves and to their subjective preferences.

In a controlled trial the effect of traditional Chinese acupuncture versus placebo acupuncture was evaluated in 16 patients with chronic facial pain (13 atypical facial pain, 2 atypical and I typical trigeminal neuralgia). All patients suffered from daily pain, the intensity of which was recorded by the patients over a period of 16 weeks. Each patient was treated by traditional Chinese acupuncture as well as placebo acupuncture in a cross-over design following randomization. Each period of treatment comprised 10 treatments during two weeks of hospitalization.

Traditional Chinese acupuncture was found to be significantly more pain-relieving than placebo acupuncture according to the pain registration of the patients themselves and to their subjective preferences.

Effect of Acupuncture in Trigeminal Neuralgia

Tapan K. Chaudhuri, Abhisek Ray. Medical Acupuncture. December 2008, 20(4): 231-237. doi:10.1089/acu.2008.0640.

(excerpted from the complete study, which can be viewed at: liebertonline.com/

Results: Of the 17 patients, 2 did not have classic TN. Three patients did not return after the second treatment. These patients were excluded from this series. Of the remaining 12 patients with classic TN, 4 of 5 men and all 7 women responded with markedly decreased visual analog scale scores (VAS; from mean [SD], 8.75 [1.02] to 1.95 [2.84]; P < .001). Five patients (1 man and 4 women) stayed in complete remission, which has lasted 11–15 months following their last acupuncture treatment. These 5 patients stopped taking all medications for TN. The remainder of the patients have continued to receive acupuncture on an as-necessary basis (mean [SD], 31.65 [18.26] days) for the maintenance of pain relief and no resistance to therapy has developed, with the longest follow-up being 18 months. The patients who had a history of multiple operations and procedures also had a good response. No adverse effects were observed.

Conclusions: Acupuncture produced beneficial effects in the majority of patients in this series. Acupuncture should be considered as a safe therapeutic option in patients with TN, especially before invasive intervention is done.

Definition of trigeminal neuralgia from Acupuncture.com: (see complete article at: acupuncture.com

Trigeminal Neuralgia (TN), also called tic douloureux, is a condition that affects the trigeminal nerve (the 5th cranial nerve), one of the largest nerves in the head. TN is primarily known for the intense level of pain it causes. The trigeminal nerve is responsible for sending impulses of touch, pain, pressure and temperature to the brain from the face, jaw, gums, forehead and around the eyes. The disorder is more common in women than in men and rarely affects anyone younger than 50. 

What are the symptoms of trigeminal neuralgia?

TN is characterized by a sudden, severe, electric shock-like or stabbing pain typically felt on one side of the jaw or cheek. The attacks of pain, which generally last several seconds and may be repeated one after the other, may be triggered by talking, brushing teeth, touching the face, chewing or swallowing. The attacks may come and go throughout the day and last for days, weeks or months at a time.

A small research study: (see complete article at: acupuncture.com

Practical Application of Meridian Acupuncture Treatment for Trigeminal Neuralgia

By Beppu S; Sato Y; Amemiya Y; Tode I.

Practical application of meridian acupuncture treatment for trigeminal neuralgia.

Anesthesia and Pain Control in Dentistry, 1992 Spring, 1(2):103-8.
(UI: 93005964)

Abstract: This report evaluates the effect of meridian acupuncture treatment on trigeminal neuralgia. Ten patients aged 26 to 67 years (mean 55.4 years) who visited the outpatient Dental Anesthesiology Clinic at Tsurumi University Dental Hospital from 1985 to 1990 were studied. Five of the patients suffered from idiopathic and five from symptomatic trigeminal neuralgia. The patients underwent meridian treatment by acupuncture alone or acupuncture combined with moxibustion. The acupuncture method used was primarily basic treatment employing only needles without electrical stimulation. Meridian acupuncture treatments were repeated from two to four times a month.

Five patients were restored to a pain-free state. The other five patients noted a decrease in pain, but with some level of pain remaining (significant pain in one patient). It is concluded that meridian acupuncture treatment is useful and can be one therapeutic approach in the management of trigeminal neuralgia.

From China:

Therapeutic effect of acupuncture at local acupoints on trigeminal neuralgia

Zhang XY.

Sanya City TCM Hospital, Hainan, China. yangyang496@eyou.com

OBJECTIVE: To search for an effective method for increasing therapeutic effect on trigeminal neuralgia. METHODS: Ninety cases of primary trigeminal neuralgia were randomly divided into a deep needling group and a routine needling group, 45 cases in each group. The routine needling group were treated by shallow acupuncture at local acupoints and distal acupoints along the Hand and Foot-Yangming Channels, and the deep needling group were treated by acupuncture at the above acupoints and deeply needling at the local acupoints to nerve stem for 3 courses. RESULTS: In the deep needling group 12 cases were clinically cured, 24 cases were markedly effective, 7 cases improved and 2 cases were ineffective, with a total effective rate of 95.6%; and in the routine needling group, the corresponding figures were 7, 15, 12, 11, 75.6%. The therapeutic effect in the deep needling group was better than that in the routine needling group (P<0.05). CONCLUSION: Deeply needling local acupoints plus acupuncture at distal acupoints along the Hand and Foot-Yangming Channels can increase significantly the therapeutic effect on trigeminal neuralgia.

Flu {Swine, Avian and Other} and Chinese Medicine

 

With the last year's concern over the potential for a Swine Flu pandemic, clients and practitioners have been contacting the Northside Holistic Center with questions over the role of acupuncture and Chinese medicine in the treatment of influenza. This is a bit of a repeat of what happened when Avian Flu and SARS were in the news and most of my responses remain the same and bear repeating during this more recent viral season. At the Northside Holistic Center, we treat colds and flus throughout the year with tremendous success.

Historically in Asia, the flu has been treated effectively by acupuncture and herbal medicine and there is little reason to doubt that this would not be so in many cases of this particular genetic variation of Swine Flu. While I would recommend seeking Western biomedical assessment before a client came to see me for flu-like symptoms, as recommended by the CDC, I would not hesitate to use the tools of Chinese medicine to treat such a manifestation. All evidence to date suggests that we can dramatically shorten the course of most respiratory disorders and research supports the notion that acupuncture can be immune supportive and herbal formula, when correctly tailored to the patient, can be extremely useful in targeting the virus itself.

Studies, Articles and Links:

A new study, published in the Annals of Internal Medicine found that a Chinese herbal formula was comparable to Tamiflu in successfully treating the flu. You can read about it here.

Significant reductions in the time to fever resolution, compared with the control group were seen with oseltamivir (34%), maxingshigan-yinqiaosan (37%), and oseltamivir plus maxingshigan-yinqiaosan (47%). Time to fever resolution was reduced by 19% with oseltamivir plus maxingshigan-yinqiaosan compared with oseltamivir. 

I would add that in most clinicians' experience, adding acupuncture into the mix, in order to boost the immune system further and to address specific symptoms of the flu yields even better results.

A link to a study showing the effectivenss of Chinese medicine for treatment of the H1N1 virus. According to a spokesman for the study group, "From our clinical tests and observation, the traditional method of treatment left no after effects and it is safe, more over the recovery period was shorter and the cost relatively lower as compared to Tamiflu treatment," said Wang Yuguang, spokesman of Ditan Hospital at a special briefing for the media at Ditan Hospital Wednesday afternoon.

From a September 2009 New York Times article: good information for parents about Swine Flu.

The link below discusses treatment of flu from a TCM perspective. It was written by the Institute for Traditional Medicine (ITM) in response to Avian Flu concerns in 2006 but remains relevant in the face of this current health concern.

http://www.itmonline.org/arts/flu.htm

This link was written by ITM in 2003 when the world was in a panic over the potential SARS epidemic.

http://www.itmonline.org/arts/sars.htm

Here is a link to the Center for Disease Control (CDC) with up-to-the-minute updates on the movement of the Swine Flu, as well as prevention methods outlined, including the perennially-good idea: frequent hand washing.

http://cdc.gov/SwineFlu/

And finally, a link to an abstract from a research study into using acupuncture for upper respiratory infections and fever.

http://www.ncbi.nlm.nih.gov/pubmed/1291818?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum