Back pain is ranked second only to headaches as the most frequent location of pain. It can occur for no apparent reason and at any point on your spine. Due to the bearing of weight of the body, the most common site for pain is your lower back. Back injuries are one of the most common causes of disability. The total cost to society of 20 to 50 billion dollars a year in the United States were estimated. There are a dozen of causes to the lower back. Surprisingly, many times with rather simple approach the back pain can be treated (such as acupuncture) or can be prevent (the way to sit or stand and exercise).

 

Causes of back pain

The causes of back pain more than 80% are unknown. A number of things may contribute to back pain, including poor muscle tone, improper or heavy lifting, excess weight, and poor posture in sitting or standing. Researchers believe that back pain often begins with an injury. 

l        Muscle strains or spasms. These are common responses to injury.

l        Herniated disc (slipped disc). The discs, which have a rigid outside rim and a soft gel-like center, act as shock absorbers and protect the spinal cord. Normal wear, tear, stress, or a mechanical problem in the spine can cause a spinal disc to bulge or rupture. The damaged disc may pinch or irritate a nerve root, causing pain on the back or leg.

l        Osteoarthritis. As the body ages, past age 60, the discs in the spine dry out, the bones and ligaments become less flexible and thicken. The spurs (formed followed degeneration of bone) and the narrowing of the intervetebral space (formed followed disc thinning) caused nerve roots or spinal cord to be pinched or compressed.

l        Sciatica. The sciatic nerve, composed of several lumbar nerve roots, is one of the nerves most likely to become irritated. Sciatic nerve, travels through the pelvis and deep in the buttocks, then down the hip and along the back of the thigh to the foot, usually compressed by a disc causing pain the lower extremities.

l        Osteoporosis. Osteoporosis is a condition of chronic losing of bony textures that cause a gradual weakness of bones. One in three women older than 50 is affected by painful vertebral compression fractures due to osteoporosis. 

l        Fibromyalgia. A multiple aching, tenderness and stiffness in muscles and body areas. The cause of fibromyalgia is still not well known.

 

Treatment options

l        Medications. Nosteroidal anti-inflammatory drugs (NSAID) and muscle relaxants are frequent prescribed.

l        Physical therapy. This may include hot compression, massage, or traction.

l        Electrical stimulation. Transcutaneous electrical nerve stimulation (TENS) may help to stop pain by blocking nerve signals from reaching to the brain.

l        Chiropractic. Using manipulation and massage of the spine and muscles to relive pain.

l        Acupuncture. (see below)

l        Surgery. If leg or back pain limits normal activity, resulting in an unacceptable quality of life; weakness or numbness in the legs; difficulty walking or standing; or medication and physical therapy are ineffective, surgery may be the choice to treat the back pain.

 

Acupuncture provides long term relief of back pain

 

Back pain has been estimated that up to 80% of the world’s population will suffer from back pain at some point in their lives. The lower back region is the most common location of pain. Although most lower back pain problems aren’t life threatening, and most of them last less than 2 weeks, but it usually provided an uncomfortable influence to the daily life. Research has shown that recurrence rates for low back pain can reach as high as 50% in the first few months following an initial episode.  Many times low back pain can be managed by using hot compression, massage or exercise. But still there is a lot of people experienced intolerable or inexpedient to the pain particularly to the labor population. While there is no definitive way to resolve lower back pain, the use of acupuncture to treat this condition has increased dramatically in the past few decades. In 1998, the National Institutes of Health concluded that acupuncture may help conditions that involve chronic pain, including low back pain. Many hospital clinics provide acupuncture treatment as one of the main methods of pain control. For example, the Mayo Pain clinic has used acupuncture since 1974 in some cases in which people don’t experience pain relief from medications or nerve blocks. 

 

The principle of acupuncture treatment is based on the theory of Traditional Chinese Medicine (TCM). According to TCM, pain occurs when there is “obstruction”. The meaning of obstruction can be translated into modern concept which will be blockage of circulation, spasm of muscles, compression of nerve and stasis of lymphatic vessels. The acupoints used mostly are analgesic points, muscle relaxing points, mental claming points and energy enhancing points. Needling areas are not only locally on the back, but also on the lower leg, arm and even on top of the head. When the flow of different energies are return to floating ahead, no more obstruction, pain will eventually disappeared. Since many low back pain conditions are exited for long time, thus treatment also need to apply for a rather longer period to heal. A persisted obvious result of treatment cannot be gained just by several treatments. A patient will be disappointed if he or she expects to have a good result by only a very briefly acupuncture treatment.         

 

Literature review 

 

Ernst E, White AR, Wider B.  Acupuncture for back pain: meta-analysis of randomised controlled trials and an update with data from the most recent studies.

Shmerz 2002 Apr;16(2):129-39

Department of Complementary Medicine, School of postgraduate medicine and health sciences, University of Exeter

OBJESTIVES: Acupuncture is commonly used to treat back pain. To compare our meta-analysis of trials of acupuncture for the treatment of back pain with a qualitative review and the most recent studies on the subject.

METHODS: A systematic literature search was conducted to retrieve all randomised controlled trials of any form of acupuncture for any type of back pain in humans. The main outcome measure for the met-analysis was consulting 6 experienced acupuncturists. The main outcome measure for the meta-analysis was numbers of subjects who where improved at the end of treatment.

RESULTS: 12 studies were included of which 9 presented data suitable for meta-analysis. The odds ratio of improvement with acupuncture compared with control intervention was 2.30. For sham-controlled, evaluator-blinded studies, the odds ration was 1.37. The results from the majority of the most recent studies also support the effectiveness of acupuncture in the treatment of back pain.

CONCLUSIONS: Collectively, these data imply that acupuncture is superior to various control interventions. 

 

Carlsson CP, Sjolund BH

Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Clin. J. Pain 2001 Dec.;17(4):296-305

Department of Rehabilitation, Lund University Hospital, Sweden.

 

OBJECTIVE: Dr. Carlsson and associates use a blinded placebo-controlled study with an independent observer to determine whether a series of acupuncture treatments produced long-term relief of chronic low back pain.

PATIENTS: Fifty consecutive patients  (33 women, 17 men with a mean age of 49.8) with chronic low back pain (mean pain duration 9.5 years) and without rhizopathy or history of acupuncture treatment were included in the study.

INTERVENTIONS: The patients were randomized to receive manual acupuncture, electroacupuncture, or active placebo (mock transcutaneous electrical nerve stimulation). Treatments were given once per week for 8 weeks. Two further treatments were given during the follow-up assessment period of 6 months or longer.

MEASUREMENTS: Patients were examined and monitored by an investigator who was blinded to the treatment given. The observer made a global assessment of the patients 1, 3 and 6 months after treatment.  The patients kept pain diaries to score pain intensity twice daily, analgesic intake and quality of sleep daily, and activity level weekly.

RESULTS: At the one-month assessment, 16 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo groups showed improvement  (p<0.05). At the 6-month follow-up assessment, 14 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement (p<0.05), A significant decrease in pain intensities occurred at 1 & 3 months in the acupuncture groups compared with the placebo group. There was a significant improvement in return to work, quality of sleep, and analgesic intake in subjects treated with acupuncture.

CONCLUSIONS: The result of this study demonstrated a long-term pain-relieving effect of needle acupuncture compared with true placebo in a great percentage of patients with chronic nociceptive low back pain.  

 

Leibing E, Leonhardt U,Koster G,Gierkutz A,Rosenfeldt JA, Hilgers R,Ramadori G.

Acupuncture treatment of chronic low-back pain – a randomized, blinded, placebo-controlled trial with 9-month follow up.  Pain 2002 Mar;96(1-2):189-96

Department of Psychosomatics and Psychotherapy, Georg-August-University Goettingen, Germany

 

OBJECTIVES: Since there is some evidence for the efficacy of acupuncture in chronic low back pain (LBP), but it remains unclear whether acupuncture is superior to placebo. This study is designed to evaluate the effect of traditional acupuncture in chronic low back pain. 

PATIENTS: A total 131 consecutive out-patients of the Department of Orthopedics, University Goettingen  (mean age of 48.1, 58.5% female, duration of pain 9.6 years) with non-radiating LBP for at least 6 months and a normal neurological examination were randomized to one of three groups over 12 weeks.

INTERVENTIONS: Each group received active physiotherapy over 12 weeks. The control group (n=46) received no further treatment, the acupuncture group (n=40) received 20 sessions of traditional acupuncture and the sham-acupuncture group (n=45) 20 sessions of minimal acupuncture.

MEASUREMENTS: Changes from baseline to the end of treatment and to 9-month follow-up were assessed in pain intensity and in pain disability, and secondary in psychological distress and in spine flexion, compared by intervention groups.

RESULTS: At the end of treatment acupuncture was superior to the control condition regarding pain intensity (p=0.000), pain disability (p=0.00), and psychological distress (p=0.020). Compared to sham-acupuncture, acupuncture reduced psychological distress (p=0.040) only. At 9-month follow up, the superiority of acupuncture compared to the control condition became less and acupuncture was not different to sham-acupuncture.

CONCLUSIONS:  A significant improvement by traditional acupuncture in chronic LBP compared to routine care with physiotherapy but not compared to sham-acupuncture.