Monday, March 26, 2012

Consider Acupuncture When Walking With Back Pain is too Painful

Chronic low back pain (CLBP) can be a debilitating disorder which can lead to loss of ambulation, often resulting in loss of quality of life.  When it comes to treating the loss of ambulation due to CLBP, there is no one-size-fits-all cure; in fact, managing CLBP alone can be a frustrating ordeal taking many months of trial and error therapies to find the best-fit therapy.  In the medical field, many treatments focus on relieving the pain by addressing only the anatomical problems, leaving limited options such as prescription medication or surgery but fails to address the ambulatory issues associated with the causal symptoms.  However, other means of treating CLBP can provide temporary relief from pain and aid in the restoration of ambulation over time.  One such therapy to consider is acupuncture.

Acupuncture has been around for 3000 years, originating in China.  Acupuncture uses the concept of Qi, or energy, to heal the body.  In America, this ancient art is brought to life by licensed acupuncturists adept in Traditional Chinese Medicine.  For many practitioners, incorporating this ancient healing tradition into modern day practice has many advantages, including enabling their patients to have the capacity of customizing a treatment best suited for them.    

When looking at studies which refer to acupuncture for sufferers of CLBP, it was important to segregate those studies which incorporated exercise or walking as part of the study, either as the control or in both.  Secondly, it was important to look for similarities in those studies and look for correlations.  What I found was absolutely shocking.  
Relieve Pain
Correlation with Ambulation
Witt, C; et al, (2011)
Randomized Control Trial
Class A
Size: 9,990
Age: Adult
Location: Germany
Inclusions: Patients with osteoarthritis of knee or hip, low back pain, neck pain, or headache.
Exclusions: All patients fulfilled predefined diagnosis-specific criteria.
Patients randomized into groups which received routine care, or 10 acupuncture treatments plus routine care for 3 months.
Positive outcome in acupuncture group.
Manipulation techniques and exercise for chronic pain positively correlates with outcome independent of the intervention.

Haake, M; et. al, (2007)
Randoized Control Trial
Class A
Size: 1162
Age: 18 - 86
Location: Germany
Inclusions: History of chronic low back pain for 6 months.
Exclusions: Previous spinal surgery, spinal fractures, infectious or tumorous spondylopathy or disease-influenced chronic pain.
Patients randomized into 3 groups, acupuncture, sham, and conventional therapy. Conventional therapy included 10 sessions with personal
contact with a physician or physiotherapist who administered physiotherapy and exercise.
Acupuncture was not superior to sham. Both treatments were positive over conventional treatment alone.
Half the patients in both groups experienced clinically relevant improvement in pain intensity or back-specific disability.
Weidenhammer, W. et al. (2007)
Cohort Observational Study
Class A
Size: 2564
Age: adult
Inclusions: Diagnosis of either lumbago with sciatica or back pain with complaints lasting 6 months.
Exclusions: No indication of other disease conflicting and no acupuncture treatments in previous 6 months.
Patients filled out questionnaires which included intensity and frequency of pain, functionality, depression, and QOL before and after 6 months of acupuncture treatments.
45.5% of patients showed significant improvement in functionality. Mean number of days with pain decreased by half. Employed patients reported 30% decrease from baseline of work days lost.
Number of days off work for employed patients decreased over 6-month observational period and their functionality improved slightly.
MacPherson, H; et al, (2004)
Randomized Control Trial
Class A
Size: 148
Age: Adults
Location: UK
Inclusions: Low back pain lasting more than 4 weeks and less than a year.
Exclusions: Patients with back pain resolved prior to treatments.
241 patients randomized in a ratio 2:1 leaving 160 to receive up to ten individualized treatments including acupuncture, cupping, herbs, exercise and lifestyle advice (12 patients were excluded).
Diagnoses among patients were individually based, however, a theme emerged with Qi and Blood Stagnation being the most prevalent.
A combination of adjunct therapies were also prescribed, including yoga and specific exercises.
Yip, Y; et al (2004)
Randomized Controlled Trial
Class A
Size: 51
Age: adult
Location: China
Inclusions: Patients who had non-specific sub-acute LBP for most days in the past 4 weeks, had not received acupuncture, physiotherapy, or manipulative therapy in the past week, and would comprehend and comply with the study guidelines.
Exclusions: Patients who had LBP caused by disorders, infections, or diseases, undergone surgery, pregnant, had allergies to lavender, or had wounds at acupoint sites.
Patients randomized into control group or treatment group for a 3 week trial. Control group received normal therapy while treatment group received 8 sessions of relaxation acupoint stimulation and acupressure with lavender oil.
8 sessions of acupoint and acupressure with lavender oil was not effective in relieving short-term LBP.
By combining traditional therapies with alternative therapies, short-term reduction in LBP is possible.

What was found is that although acupuncture did not appear to work on CLBP alone, however conjunctive therapies which incorporated acupuncture worked on the majority of the patients.  Part of the therapies which helped decrease pain was exercise, changing to a better diet, and physician-monitored care.  More importantly, when looking at a study focusing on acupoint therapy, the subjects were able to walk for longer and  farther after the sessions than before the study started.

Conclusion:  Considering acupuncture for CLBP may be a good idea, but it is an even better when it is used as a part of a therapeutic routine which includes exercise, healthy diet, and the normal medical treatments prescribed by physician.  It perhaps is circular logic, but in order to walk farther without CLBP, one needs to walk more.  As far as enhancing quality of life, incorporating a healthy routine with preventative maintenance and sticking with the new regimen will help to decrease the pain enough to lead a relatively normal life.       

Haake, M; Muller, H; Schade-Brittinger. C; Basler, H; Schafer, H; Maier, C;
Endres, H; Trampisch, H; Molsberger, A, (2007) German Acupuncture Trials (GERAC)
for Chronic Low Back Pain Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups Arch Intern Med. 2007;167(17)   

 MacPhersona, H; Thorpe, L;  Thomasb, K; Campbellc, M. (2003) Acupuncture for low back pain: traditional diagnosis and treatment of 148 patients in a clinical trial. Complimentary Therapies in Medicine V 12: 38-44

Weidenhammer, Q; Linde, K; Streng, A;  Hoppe, A; Melchart, D. (2007) Acupuncture for Chronic Low Back Pain in Routine Care A Multicenter Observational Study Clinical Journal of Pain Volume 23: 2
Witt, C.;  Schutzler, L; Ludtke, R; Wegscheider, R;  Willich, S.  (2011)
Patient Characteristics and Variation in Treatment Outcomes:
Which Patients Benefit Most From Acupuncture for Chronic Pain? Clinical Journal of Pain V 27:550–555

Yip, Y; Tse, S. (2004) The effectiveness of relaxation acupoint stimulation and acupressure with aromatic lavender essential oil for non-specific low back pain in Hong Kong: a randomised controlled trial. Complimentary Therapies in Medicine V 12: 28-37


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