Acupuncture significantly improved acute low back pain

Acupuncture helped pain relief significantly in patient with acute low back pain and analgesic effect of acupuncture lasted up to 3 days after a treatment. A clinical study of efficacy of acupuncture on low back pain in the emergency department was reported in journal of Evidence-Based Complementary and Alternative Medicine.

Low back pain is one of the most common complaints from patients in the emergency department. Although there are many pain relief medications available and some are quite temporarily effective many associated side effects make them not suitable for many patients. Acupuncture has been used to treat both acute and chronic pain in China since the beginning use of acupuncture.

Recently a group of scientists and physicians led by Dr. LC Lo in Taiwan, China carried out a clinical study to assess the efficacy and safety of acupuncture treatment to acute low back pain in emergency department. Recruited patients with acute low back pain were divided into verum acupuncture group (n=45) and sham acupuncture group (n=14). Due to most patients were unable to maintain a face-down posture during treatment acupoints were selected at the limbs according to traditional Chinese meridian system. Within verum group patients were given acupuncture at LI4, LI10, ST36, GB34 and LR3 acupoints for 15 min. The control group were received sham acupuncture by pasting seed-patches next to the acupoints used in verum group. Outcome evaluations include the visual analogue scale and heart rate variability and adverse events. The visual analogue scale was graded from 0 points (no pain) to 10 points (the worst possible pain) and was measured 3 times, before, after treatment and 3-day follow-up.

Data from study showed that verum acupuncture significantly reduced low back pain soon after treatment and the therapeutic effect of acupuncture maintained 3 days after acupuncture compared with sham acupuncture. There were no obvious alternations in heart rate variability and no adverse effect was reported.

The authors suggested that acupuncture produced an immediate pain relief in patients with low back pain in emergency department. Acupuncture could be a very viable alternative for pain management for those patients.

Reference

LC Lo et al., Efficacy and Safety of Acupuncture for Acute Low Back Pain in Emergency Department: A Pilot Cohort Study. Evidence-Based Complementary and Alternative Medicine. Volume 2015, Article ID 179731,8 pages.    http://www.hindawi.com/journals/ecam/2015/179731/

Acupuncture relieves acute low back pain caused by psoas muscle strain

Low back pain caused by psoas muscle injury is common but difficult to be treated due to its deep location. However, acupuncture stimulation at the BL52 acupoint specifically directed to the psoas muscle showed a fast pain relief in a patient with acute low back pain.

Psoas muscle is believed to be one of the most important muscles in the body. It is a deep hip muscle that originates on the vertebral bodies and transverse processes of lumbar vertebrae (L1-L5) and discs of thoracic 12/lumbar 1 to L4/5. The psoas functions as hip and thigh flexor, which makes it the major walking muscle. When the psoas becomes contracted due to the stress, injuries, poor postures and prolonged sitting it can cause many problems including low back pain, sacroiliac pain, sciatic, disc problems, knee pain and menstruation pain etc. Common approaches to psoas muscle pain, such as strengthening and stretching exercise, message and muscle relaxation, are not always satisfactory.

Dr. Kwan Leung Chia, in Australia, reported a case of acupuncture treatment of acute low back pain caused by psoas strain. A 65-year-old woman had a sudden onset of pain over the right low back and lasted for more than a week. The pain was rated 7/10. Because examination found active flexion of the hip exacerbated the pain more than other movements, psoas muscle strain was suspected as the cause of back pain. The patients did not feel much improvement about the pain after the first session of acupuncture. Then, Dr. Chia looked how best acupuncture needle can be inserted to psoas muscle by studying anatomical position of psoas major in relation to the low back on cadavers. It was found that needling BL52 at an angle of about 70^o would reach posterior portion of psoas muscle without damaging neighbouring tissues.  At the next session, the same acupoints were applied and large needle, 0.30mmx70mm were inserted into BL52 at an angle of about 70^o to the surface, and toward ipsilateral side of lumbar vertebrae to avoid damage visceral organs. The patient reported de qi sensation soon after needle being inserted into psoas muscle and felt less pain immediately after acupuncture. After another 5 sessions of acupuncture patient felt free of back pain.

The case study demonstrated that acupuncture needling to the specific muscle causing pain immediately relieve condition. It has been reported that acupuncture needle stimulation induces the local release of analgesic chemicals such as adenosine that exerts pain relief quickly.

Reference:

Chia KL, Electroacupuncture treatment of acute low back pain: unlikely to be a placebo response. Acupunct Med. 2014 May 15. pii: acupmed-2014-010582.   http://aim.bmj.com/content/early/2014/05/15/acupmed-2014-010582.extract

Acupuncture alleviates sciatica

Sciatica is a set of symptoms, including pain in the lower back, buttock and leg, numbness, tingling, muscle weakness around the leg and foot. The sciatica is caused by the irritation, compression or damage of the sciatic nerve. The slipped disc is the common cause of sciatica and other causes include injury, a narrow spinal canal, infection and a growth within spine such as a tumour.  Sciatica is different to other back pain and it radiates out from lower back, down the buttock and into the leg including calf. Sciatica pain ranges from being mild to severe and is often made worse by laughing, sneezing and bending backward etc. The sciatic nerve is derived from spinal nerves lumbar 4 through 5, sacral 1, 2 and 3; and innervates nearly the whole of the skin of the leg, the muscle of the back of thigh, and those of the leg and foot. So the areas affected by sciatica depend on affected nerve roots. For example, symptoms occurring in the thigh may indicate affected nerve roots being lumbar 4 and 5. Some cases of sciatica may come and go without the need of treatment. Most cases of sciatica can just be alleviated by painkillers. Management of chronic sciatica requires exercise therapy, analgesics, corticosteroid spinal injection and consideration of surgery. However the effectiveness of these therapies is inconclusive.

Acupuncture exerts analgesia by releasing of antinociceptive substance such as adenosine locally and endorphin centrally, reducing inflammation and promoting regeneration of sciatic nerve if it was damaged. Studies of acupuncture on back pain and chronic sciatica showed that acupuncture treatment is significantly better than no treatment and is as good as standard therapy. It is best to approach sciatica using a combined treatments including acupuncture, Tui Na (Chinese medical message), cupping and stretching. Overall, the treatments should relax and stretch the tendons and fascia while strengthening muscles, allowing back to naturally heal. Also practising tai chi, the Chinese exercise and meditation, is very effective to strengthen the lower back and relax it.

Reference:

Takano T et al., J Pain. 2012 Dec;13(12):1215-23.  http://www.ncbi.nlm.nih.gov/pubmed/23182227

Acupuncture, adenosine and back pain

Back pain is one of the most frequent complaints. It is reported that one third of the people living in the UK are affected by low back pain. In the UK back pain is estimated to cost the economy over £12 billion per year and place a huge burden on society. Back pain usually originates from the muscles, nerves, bones and joints or other structures in the spine. Acute or short-term low back pain generally lasts from a few days to a few weeks. Most acute back pain is the result of trauma to the lower back or a disorder such as arthritis. Pain from trauma may be caused by a sports injury, work around the house or in the garden, or a sudden jolt such as a car accident or other stress on spinal bones and tissues. Symptoms may range from muscle ache to shooting or stabbing pain, limited flexibility and range of motion, or an inability to stand straight. Chronic back pain is pain that persists for more than 3 months. It is often progressive and the cause can be difficult to determine.

Although acupuncture is very effective in alleviating back pain in many patients its mechanisms of acupuncture-mediated analgesia has not been fully understood. It has been suggested that primary mechanism implicated in the anti-nociceptive effect of acupuncture involves release of opioid peptides in the central nervous system in response to long lasting activation of ascending tracts during intermittent stimulation. However, acupuncture is conventionally applied in close proximity to the locus of pain and analgesia is restricted to the ipsilateral side, indicating a peripheral and local action of acupuncture. Recent studies found that acupuncture stimulation at Zusanli on human subjects and pain models triggers increase in interstitial adenosine, a pain relieving substance, which reduce the severity of pain through activation adenosine A1 receptors. However acupuncture stimulation at the control point, 2 cm lateral to Zusanli acupoint did not elevate the interstitial levels of adenosine.

These studies together with other reports suggest that acupuncture stimulation at specific acupoints, on the one hand increase local adenosine level, on the other hand release opioid peptide in the brain, leading to the long lasting anti-nociceptive effect.

Reference:

T Takano et al., (2012) The Journal of Pain, Vol 13:1215-1223. http://www.ncbi.nlm.nih.gov/pubmed/23182227