Application of Acupuncture to Treat Low Back Pain
Working adults (ages 18 to 64) represent 63% of the population and account for 72% of all low back pain (LBP) health care visits.1 Low back pain has been identified categorically as acute, subacute, or chronic, depending on the onset, duration, and severity.1,2 Risk factors have included occupational posture, depressive moods, obesity, gender, and age, and risk is most likely affected by a combination of several of these variables.2 Low back pain is not a disease but rather a group of signs and symptoms that affects all age groups across the lifespan. It has been shown to be more common from age 35 to 55, with a higher prevalence in women.2,3
The World Health Organization anticipates that as the world population ages, the incidence of LBP will increase substantially and become 1 of the leading conditions for which the aging population will seek out medical intervention.2
Acupuncture may help improve quality of life as well as reduce lost workplace productivity through more effective and sustained pain relief.4,5 Stimulating nerves located in muscles and other tissues with the application of fine needles may lead to the release of endorphins and other neuro-humoral factors.6 The expected result is a change in pain processing between the brain and spinal cord.
Acupuncture has demonstrated efficacy in reducing inflammation by promoting the release of vascular and immunomodulatory factors and increasing local microcirculation.6-8 In turn, this may support better joint movement and relief of muscle stiffness as well as aid the healing of swelling and bruising.6,7
While the evidence for acupuncture remains inconclusive, there are a growing number of studies offering clinical support for the benefits of using acupuncture to address LBP.6-10 (See Four Pillars of Chinese Medicine)
Four Pillars of Chinese Medicine
- Looking at physical attributes such as the face, eyes, gait, and tongue is the first pillar. We examined the map of the tongue as it laid out the internal viscera and details of the tongue such as shape, color, texture, moisture, coating thickness and color, size of the papillae, and movement, as these features can be very revealing.
- Listening is a second pillar in the evaluation. The patient’s voice might offer evidence of a disturbance or irregular pattern.
- Palpation is the third pillar. For example, the pulse, like the tongue, presents a blueprint of a patient’s condition. The left and right side of the radial pulse is laid out into 3 sections (from proximal to distal): qi, guan, and cun. Each pair of organs can be recognized within each of these positions. Palpating the pulse is an extremely detailed task requiring complete focus to feel for the quality. The pulse has several attributes that serve as a window between the practitioner and the patient, including the depth, strength, consistency, and even the specific movement in which the blood travels through the vessel.
- Asking is the final pillar, which revolves around 10 essential questions that directly correlate to the patient’s overall being and constitution. These questions journey from the chief complaint and project to other life behaviors and inclinations that may encompass tendencies to be either hot or cold (or neither), sweating, gastrointestinal (ie, digestion, urination, bowel movements), sleep quality and quantity, emotional status, energy levels, and pain quality and consistency.
Source: Four Pillars of Chinese Medicine. Available at: http://www.china.org.cn/english/health/225768.htm
In this case review, the pain relief achieved by fascial manipulation was demonstrated through the release of superficial stagnation in the tendinomuscular channels that are responsible for pain; this process has been correlated to benefits in the deeper muscular layers and related meridians.11,12 We used Master Tung points in a special 3-needle arrangement called Dao Ma, in conjunction with a method called Dong Qi (movement Qi) in which the needle is manipulated as the patient exercises the affected area.13
We found that acupuncture’s overall therapeutic effects help in reducing the use of medication for back complaints, providing a more cost-effective treatment over a longer period of time (eg, at least 2 years).5,6,9
A 28-year-old patient came to the Farmingdale acupuncture clinic in December 2014 with low back pain radiating down his left leg due to disc herniation. It had started 4 months prior when he sneezed and suddenly felt intense pain in his mid-back in the T11-T12 area. After this episode, he had 18 to 20 sessions of combined physical therapy and chiropractic treatments, as well as 2 epidural injections. The patient reported not only that these treatments were not effective in eliminating his pain but also that physical activity and bending forward while sitting made it worse. At the time of the first treatment at our center, the pain was being controlled by over-the-counter medications, including ibuprofen and naproxen (Aleve); and prescription meloxicam and topiramate, which were taken as needed.
The patient reported pain at 7, using a numeric 1 to 10 pain rating scale. The patient complained of functional limitations, including bending forward, lifting, and sitting for periods longer than 15 to 20 minutes due to increased lower back, left buttocks, and left posterior thigh pain (Table 1).
Testing and Diagnosis
Magnetic resonance imaging (MRI) scans and myelograms of the lumbar spine and thoracic spine were ordered by an orthopedist. The first MRI of the lumbar spine, taken in October 2014, revealed a posterior disc herniation on the ventral surface of the cord, disc dehydration, and diminished disc space height. There was a Schmorl’s node (protrusion) located posterior to the inferior T11 endplate. In addition, at L4-L5 a posterior annular disc bulge pressed upon the ventral thecal sac with evidence of disc dehydration. At L5-S1, there was a posterior right-sided, subligamentous disc herniation impressing the right ventral epidural space and right S1 nerve root as it approached the lateral recess. Also, mid-facet hypertrophic changes were noted at both L4-L5 and L5-S1.
Transitional vertebrae were evidenced at the lumbosacral junction as a large ventral extradural defect was detected at T11-T12. In the same location, a large herniation with a subligamentous extrusion was evident on a post-myelogram computed tomography (CT) scan. There was compression of the distal cord and the proximal portion of the conus medullaris with the herniation at the midline without a lateralized fragment.
A small herniation also was noted at L4-L5 and L5-S1 with a mild sac effacement contained within the ventral epidural fat situated further to the right. The imaging findings as well as the patient’s initial description of his pain led to an orthopedic physician diagnosis of multilevel herniated discs at T11-12, L4-5, L5-S1.