The fact that acupuncture is effective for all kinds of back pain is a testament to the traditional ways of thinking in Chinese Medicine. An osteopath or a chiropractor may have no interest in whether your back pain is worse after movement or rest, whether it feels worse when it’s cold or damp outside, or if it responds better to heat or massage, but for an acupuncturist this kind of information is crucial for determining the best course of treatment. The essential differentiations depend on whether the pain is acute or chronic, and whether the pain at its source is coming from excess or deficiency. A couple of typical examples should help to make this clear.
An acute muscle strain in a young body, caused while doing some martial arts for example, will have a very different treatment from the chronic back that has been put out again in an older patient doing some light gardening. In the first case, the injury is both acute and will exhibit local stagnation of qi and blood. In this case, acupuncture treatment would be aimed at looking to release the so called ah-shi points that become connected to the injury. An ah-shi spot is characterised by unusual tenderness or pain when pressed, and is at a location that one might not expect given the injury itself. These tight spots develop due to the injury preventing good flow of qi and blood further away in the body. Once an acupuncture needle is placed into one of these ah-shi points, a typical sensation can be one of deep throbbing dullness, which indicates that blood has started flowing again through this area. Once the blood has started moving, the stagnant energy can be taken away from the area and expelled from the body, leading to relief of the symptoms of pain and swelling at the original area. Stronger treatment, and the possible use of cupping can also help in this case.
In our second example, a chronic lower back can also exhibit ah-shi points, but in an older patient the chances are that the lower back pain is coming from a background of deficiency so strong treatment would not be advised. It would be common for such a patient to notice that it feels worse if it’s cold or damp outside. If the yang energy is deficient, this can lead to a reduced tolerance to cold, so colder conditions will exacerbate the condition. Acupuncture points would be chosen that have a good ability to access the inner yang energy, and warmth would be applied either through moxibustion, or a heat lamp, or simply needling to create a sense of inner warmth. A more gentle approach overall would be used.
There has been research to show that traditional acupuncture can be very effective for back pain. In August 2005, an NHS Health Technology Assessment (HTA) monograph was published as a result of a study commisioned for the HTA Programme (Thomas et. al. HTA vol.9: no.32 (2005)). The aim of the study was to test whether patients with persistent non-specific back pain gained more long-term pain relief as a result of traditional acupuncture treatment when compared with conventional primary care.
A pragmatic, 2 parallel group, randomised controlled trial was designed. Patients were assigned to either usual care from their general practitioner (GP) or treatment by a traditional acupuncturist. This assignment was random. 39 GPs in a total of 16 practices in York referred 240 patients (ages 18-65) for the study. All were diagnosed with non-specific low back pain, and assessed as suitable for primary care management by their GP.
Patients in the acupuncture group received 8 personalised acupuncture treatments on average, depending on the severity of their symptoms. Their personal perception of back pain was assessed with a standard research questionnaire, which they were asked to fill in at the start of the trial, and after 3 months, 12 months and 24months. This helped to give a longer term view of the treatment.
Overall the results were positive. Acupuncture treatment was found to be significantly more effective in reducing bodily pain than usual care from their GP over the long term. At the 24 month time, the acupuncture care group was significantly more likely to report 12 months being pain free. In addition, they were significantly less likely to report the use of medication for pain relief.
Friday, October 24th, 2014
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