Getting Back on Track
Low back pain is the most common disabling problem of working age adults.1 Every year 50 percent of working adults have symptoms related to their low back.2 There is a wide spectrum of anatomic conditions that cause lumbosacral pain including muscle sprains, disc herniations, facet joint arthritis, spinal arthritis, spinal malignancy, and fractures. Standard medical treatment includes rest, medication, physical therapy, anesthetic injections, and surgical treatment.3
Acupuncture is a complementary treatment strategy that can be employed alone or in conjunction with other treatments across the entire spectrum of back pain. Acupuncture has certain advantages when used in a comprehensive back pain treatment program.
Low Back Pain
Low back pain is one of the most common reasons for visits to a physician.1-3 It has been claimed that back pain causes the adult population of the United States to spend 77,534,000 days in bed each year.4
There are a multitude of reasons for low back pain because there are a multitude of spinal structures that can be abnormal, including ligaments, facet joints, vertebral bones, intervertebral discs, muscular fascia, and the spinal nerves. Simply, low back pain comes from disease or injury to the aforementioned spinal structures or from the effects of pathologic processes on nerve roots.
The most common causes of low back pain are muscle and soft tissue injury, arthritis of the intervertebral joints or facets, herniated disc, and degenerative disc disease.2 If these pathologic processes narrow either the spinal canal or the neural foramina (spinal stenosis) there can be radiation of pain and weakness to the lower extremities.
Likewise a multitude of accepted medical treatments for low back pain exist. These can be as simple as rest, chair cushioning, anti-inflammatory medications, physical therapy, massage, and/or chiropractic or osteopathic manipulation. Treatment for more severe varieties of back pain can include strong narcotic medications, injection of steroids and anesthetics into the facet joints or epidural space, and/or operative treatment.
For minor back pain that comprises a muscle strain without structural damage, therapeutic modalities like anti-inflammatory agents, spinal manipulation, and physical therapy are successful in the majority of instances.2 Unfortunately, back pain tends to recur multiple times even after a successful recovery.3 At the other end of the spectrum are patients who have severe function-limiting back pain that can require an operation to relieve pressure on the spinal cord or nerve roots. Even after operations for herniated disc, six to 40 percent of patients do not experience a satisfactory result.5
Acupuncture was developed in China and has been in almost continuous use for at least 2500 years.6 Despite differences in standards of clinical proof between Western medical scientists and Chinese medical publications, this system has been empirically successful for many conditions in China and many other countries where acupuncture is practiced.
Traditional Chinese medicine teaches that the normal functioning of the human body and mind depends upon the circulation of the body’s internal energy, Qi, throughout the body in the right amount at the right time. The acupuncture points are located on 14 invisible lines or meridians running the length of the body. Certain points on these meridians influence anatomic areas and physical conditions. Traditional acupuncture looks at disease as a deficiency, stagnation, or excess of the normal energy flow within the body. Tiny needles are placed into defined acupuncture points along the meridians to correct the flow of Qi energy and are thus achieve energetic balance and health.
In the United States, acupuncture is frequently used as a last resort.
Chinese medicine has always been a holistic system of medical care. All of the qualities that make up a person are taken into account. Chinese physicians recognized that there are intrinsic differences between individual human beings.
In the United States, acupuncture is frequently used as a last resort. This attitude is contrary to the tenets of Chinese medicine, which preaches early or preventive treatment. “When the evil wind attacks people, it comes like a storm… A superior doctor arrests disease at the skin level and dispels it before it penetrates deeper. An inferior doctor treats illness after it passes the skin… If it progresses and invades deep into the five zang organs, prognosis for recovery is only 50 percent.”7 We have frequently seen patients referred after they have not responded to all of the modalities offered by a university pain service. Even in this patient population, pre-selected for a poor therapeutic result, acupuncture can usually result in significant clinical improvements.
Acupuncture not only treats back pain but the person with the back pain. Each person is evaluated for the specific chief complaint like low back pain. The signs and symptoms are coordinated with each individual’s present energetic balance. A comprehensive acupuncture evaluation also includes a thorough evaluation of the patient’s basic constitution, which includes their propensity to different diseases and psycho-emotional imbalances. Each patient is treated with a custom-designed treatment plan that is continually modified based on the individual patient’s response to treatment.
Modern biomedical scientists have studied acupuncture effects. Acupuncture needling in the periphery stimulates skin and muscle sensory receptors. The signal is carried along the peripheral nerves to the dorsal horn of the spinal cord. Acupuncture possibly causes a central nervous system response at three potential levels — the spinal cord, the brain stem, and the hypothalamus.8 Endorphin synthesized by the hypothalamus is released into the blood stream and spinal fluid. In the spinal cord, acupuncture inhibits the release of substance P, which facilitates pain transmission in the spinal cord. This suppression of substance P results in beneficial effects regarding pain relief.8 Acupuncture effects on the brain stem causes the pituitary to release adrenocorticotrophin (ACTH) which stimulates the adrenal gland to produce increased levels of blood cortisol.9 The known anti-inflammatory effect of cortisol explains why acupuncture is useful in treating inflammatory conditions like asthma and rheumatoid arthritis. Acupuncture stimulates centers in the brain that send inhibitory messages to the pain pathways in the spinal cord. These messages suppress the response to noxious stimuli and modulate the experience of pain.10