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ACUPUNCTURE FOR BACK PAIN
& SCIATICA BACK PAIN

September 24 issue of Archives of Internal Medicine,

ACUPUNCTURE TWICE AS EFFECTIVE AS CONVENTION TERAPY FOR LOW BACK PAIN.

"Low back pain is a common, impairing and disabling condition, often long-term, with an estimated lifetime prevalence of 70 percent to 85 percent," the authors write as background information in the article. "It is the second most common pain for which physician treatment is sought and a major reason for absenteeism and disability." Acupuncture is increasingly used as an alternative therapy.

Michael Haake, Ph.D., M.D., of the University of Regensburg, Bad Abbach, Germany, and colleagues conducted a randomized clinical trial involving 1,162 patients (average age 50) who had experienced chronic low back pain for an average of eight years. Patients underwent ten 30-minute sessions (approximately two sessions per week) of Vero acupuncture (387 patients), Shallow Needling Acupuncture (387 patients) or conventional therapy (388 patients). Vero acupuncture consisted of needling fixed points and additional points to a depth of 5 millimeters to 40 millimeters based on Traditional Chinese Medicine, while Shallow Needling Acupuncture consisted of inserting needles superficially (1 millimeter to 3 millimeters) into the lower back avoiding all known verum points or meridians.

Conventional therapy consisted of a combination of medication, physical therapy and exercise.

"A total of 13,475 treatment sessions were conducted (verum acupuncture, 4,821; Shallow Needling Acupuncture, 4,590; conventional therapy, 4,064)," the authors write:

Response rate was 47.6 percent in the verum acupuncture group, 44.2 percent in the Shallow Needling Acupuncture group, and 27.4 percent in the conventional therapy group,"

The superiority of both forms of acupuncture suggests a common underlying mechanism that may act on pain generation, transmission of pain signals or processing of pain signals by the central nervous system and that is stronger than the action mechanism of conventional therapy,"

the authors conclude. "Acupuncture gives physicians a promising and effective treatment option for chronic low back pain, with few adverse effects or contraindications. The improvements in all primary and secondary outcome measures were significant and lasted long after completion of treatment."

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Daniel J. Mazanec, M.D., F.A.C.P., F.A.C.R., F.A.A.D.E.P. More than 1 million Americans are treated with acupuncture annually for musculoskeletal disorders including back pain and Fibromyalgia. Recent surveys reports 57% of rheumatologists and 69% of pain specialists have made referrals to practitioners of acupuncture. The author notes the recent NIH conference which concluded that acupuncture may be a "reasonable" treatment option for patients with low back pain.

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The results of a recent study published in the Clinical Journal of Pain³ provide further proof that acupuncture is a safe and effective procedure for low-back pain, and that it can maintain positive outcomes for periods of six months or longer without producing the negative side-effects that often accompany more traditional pain remedies.

Drs. Christer Carlsson and Bengt Sj˜lund of the Lund University Hospital in Sweden recruited 50 patients (33 women, 17 main) from a tertiary level pain clinic for their study. The median age of the participants was 49.8; each patient had been suffering chronic low back pain for a minimum of six months and had tried a variety of other therapies (such as corsets, nerve blocks, drugs and physiotherapy) to treat their condition, but to no avail.

Subjects were randomly assigned to a manual acupuncture group, an electroacupuncture group or a placebo group. Treatment sessions lasted a total of 20 minutes each and were delivered once per week for eight weeks, with the same amount of time and care given to all patients in each group. A followup treatment was given after two months, and a tenth and final treatment was given after an additional two months.

Figure I: Flowchart of the study design.

In the manual group, local points on the lower back and distal points on the lower limbs, forearms and hands were used. The number of needles used per patient increased from an average of eight during the first session to as many as 18 during the third or fourth session. Needles were stimulated three times during each session to attain de qi.

A slightly different protocol was used on patients receiving electroacupuncture. Patients in this group received manual stimulation only during the first few sessions, followed by electrical stimulation of four needles in the low back in subsequent sessions. A similar number of needles as used in the manual acupuncture group were inserted and activated by hand.

The placebo group was given mock stimulation using what the researchers termed an "impressive" -- but disconnected - stimulator attached to two large electrodes. The electrodes were placed on the skin over the most painful areas in the lower back. During mock stimulation, flashing lamps from the machine were displayed and made visible to the patient to give the illusion that treatment was being delivered.

Figure III: Mean weekly pain intensity scores for acupuncture and placebo groups. Measurements were taken at baseline and at one-, three- and six-month follow-up assessments.. Throughout the study, patients recorded pain levels and other measurements in small booklets called pain diaries. Among the variables measured were pain intensity (recorded twice daily on a visual analog scale from 0 to 100, 100 being severe as possible); intake of analgesics (recorded daily); sleep quality (scored on a scale of "good," "slightly disturbed by pain" or "badly disturbed by pain"); and activity level. These diaries were compiled and their results analyzed by a nurse practitioner at the end of the study.

In addition, assessments were performed by an independent observer who did not know which type of acupuncture each patient received. These assessments were taken at four intervals: baseline, one month, three months and six months after the treatment period. These assessments consisted of a clinical interview and physical examination, after which the observer classified the patient's pain as improved, unchanged, or worse.

"Significant" Changes Observed in Acupuncture Patients

Analysis of the pain diaries revealed "significant" differences between acupuncture and placebo patients at the one-, three- and six-month intervals following treatment, all of which favored acupuncture as a more effective form of pain relief. For example, in the acupuncture group, both morning and evening pain scores were lower than baseline measurements and continued to decrease for the duration of treatment. In the placebo group, however, pain scores were several points higher after one month than they were at baseline, and continued to remain higher than the baseline scores throughout the study.

Activity levels were also markedly improved in the acupuncture group. Fourteen acupuncture patients and seven placebo patients had been on sick leave (either part-time or full-time) prior to the start of the study. By the time the tenth acupuncture treatment was delivered, six of the acupuncture patients on sick leave had returned to part-time or full-time work; another six were retired but still reported improved activity levels. In comparison, only one patient in the placebo group showed an improvement in activity; another patient actually regressed to being put on full sick leave.

Figure II: Acupuncture points used in the study. Points are labeled according to World Health Organization standards. Furthermore, acupuncture patients experienced less episodes of sleep disturbance than their placebo-treated counterparts. Before the study, 30 acupuncture patients and 12 placebo patients reported sleep disturbances due to pain. The researchers reported that the sleep pattern was "significantly less disturbed after the treatment period" in the acupuncture group, but that there was "no significant difference in sleep disturbance" in the placebo patients.

Finally, total intake of analgesics dropped dramatically in the acupuncture group, but not the placebo group. At the start of the study, patients in the acupuncture group consumed an average of 31 pills per week; those in the placebo group consumed an average of 23 pills. At the six-month follow-up, the number of pills taken by placebo patients remained almost identical (21.5 per person per week), but had dropped more than 28% to 21.4 pills per week in acupuncture patients.

Independent examination by the blinded observer appeared to corroborate the patients' pain estimates. One month after the initial treatment period, 16 acupuncture patients (but only two placebo patients) were judged to be improved. After six months, 14 acupuncture patients (and only two placebo patients) were still improved. Both types of acupuncture worked effectively; of the 14 patients who showed improvement after six months, eight received manual acupuncture and six received electrical stimulation.

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Pain expert Dr. Scott Fishman answers questions about back pain:

Q: My doctor has recently suggested acupuncture. Is acupuncture safe and will it really help?

A: Acupuncture is one of the most time-tested treatments known to mankind.

If the value of a treatment were based solely on how long it has been around, and how long people have thought that it was helpful, then acupuncture would probably be the most effective treatment known to humankind. Nonetheless, we still do not know why acupuncture works, how it works best, and for whom it is best used.

Many patients advocate acupuncture as a very effective treatment. Symptoms include pain from a variety of causes, as well as many other conditions including nausea, smoking cessation, problems with addiction, inflammatory conditions, even anxiety and depression, to name just a few.

There are many different forms of acupuncture. One form of acupuncture completed by one acupuncturist may be quite different than another, and any given practitioner may perform the acupuncture differently than another.

Taken all together, acupuncture is an ancient, time-tested form of therapy that seems to have exceptionally few side effects and appears to be safe for pain management.

In my experience, many patients have found relief from pain through acupuncture. For those of my patients who have not found relief with standard medical therapies, I am always open-minded to any treatment that will help, particularly those that have the fewest side effects. Thus, I embrace acupuncture. I look forward to revelations through science that better explain how it works and how it may be best applied to fight the war on pain.

ACUPUNCTURE FOR SCIATICA

Warm needle acupuncture, cupping & sciatica.(Acupuncture and Moxibustion)

From: Townsend Letter for Doctors and Patients | Date: 1/1/2005 | Author: Wolfe, Honora Lee

In issue #5, 2004 on page number 27 of Gan Su Zhong Yi (Gansu Chinese Medicine), Song Yu-fang published an article titled, "Observations on the Therapeutic Efficacy of Treating 318 Patients with Sciatic Pain with Warm Needle & Cupping." Because sciatica is a common problem in clinical practice for any practitioner doing physical medicine (acupuncture, chiropractic, physical therapy, massage therapy, osteopathy), a summary of the main points of this article is presented below.

Cohort description

Altogether, there were 502 patients enrolled in this two-wing comparison study. Of these, 302 were male and 200 were female aged 26-70 years. The course of disease ranged from one half month to 20 years, Two hundred four patients had foot shao yang gallbladder sciatica, 256 had foot tai yang bladder channel sciatica, and 42 had pain on both these channels. These 502 patients were then randomly divided into two groups, a so-called treatment group of 318 patients and a comparison group of 184.

Treatment group: Main points chosen: Shen Shu (BI 23), Da Chang Shu (BI 25), Huan Tiao (BI 30), Yang Ling Quan (GB 34). Additional points depending on symptoms: If there was foot tai yang bladder channel pain, then Kun Lun (BI 60), Wei Zhong (BI 40), and Zhi Bian (BI 54) were added. If there was foot shao yang gallbladder channel pain, Feng Shi (GB 31), Jue Gu (GB 39), and Zu Lin Qi (GB 41) were added. If there was pain on both these channels, then both sets of above points were added. Patients were asked to lie on their side with the affected limb uppermost. After disinfection with alcohol, 28 gauge fine needles were inserted deeply into the respective points. After obtaining the qi, even supplementing-even draining and technique was used. Then, while the needles were retained in situ, 2-2.5cm long sections of moxa roll were affixed to the handles of the needles and burnt. After the moxa burned down, the needles were removed, and fire cupping was used over Shen Shu, Da Chang Shu, and Huan Tiao. Shen Shu and Da Chang Shu were needled 1-1.5 inches deep with the tips of the needles angled towards the spine. Huan Tiao was needled 2-3 inches deep and a sensation of soreness and distention was propagated down the leg. Yang Ling Quan was needled 1-1.5 inches deep with a sensations of soreness and distention propagated to the foot. The cups were retained for 5-15 minutes and produced either redness or a purplish color in the area on which they were affixed. The patients in this group received one treatment per day, and 10 treatments equaled one course. Between each successive course, they were allowed a 3-5 day rest.

Comparison group: Main points chosen: Da Chang Shu (BI 25), Huan Tiao (GB 30), Yang Ling Quan (GB 34). Additional points: If there was foot tai yang bladder channel pain, Zhi Bian (BI 54), Wei Zhong (BI 40), and Kun Lun (BI 60) were added. If there was foot shao yang gallbladder channel pain, Feng Shi (GB 31), Jue Gu (GB 39), and Zu Lin Qi (GB 41) were added. After disinfection, 28 gauge fine needles 1.5-3 inches long were inserted 0.5-2 inches deep and then manipulated with specific supplementation or draining hand technique. After obtaining the qi, the needles were retained for 30 minutes and were restimulated at 10-minute intervals. One such treatment was given per day, and 10 treatments equaled one course.

Study outcomes

Cure was defined as complete disappearance of all the clinical symptoms with an ability to return to normal work and no recurrence on follow-up within half a year. Marked effect was defined as basic disappearance of clinical symptoms. However, there was still some discomfort depending on the weather or after the patient over-worked and became fatigued. These patients were also able to resume their ordinary work. Improvement meant that the clinical symptoms showed improvement. No effect meant that there was no change from before to after treatment. Based on these criteria, in the treatment group, 144 patients were cured, 115 got a marked effect, 48 improved, and 11 got no effect, for a total effectiveness rate of 96.5%. In the comparison group, 66 patients were cured, 48 got a marked effect, 44 improved, and 26 got no effect, for a total effectiveness rate of 85.5%. Therefore, it was concluded that the protocol using warm needle and cupping was more effective than the acupuncture alone.

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