Back pain is shared by all people regardless of race, and acupuncture has been around for a while now to help in easing the pain. All around the world, people have sought medical care at one time or another for back pain. There are a number of causes of back pain but mostly it’s due to overstretching of the ligaments, or commonly called as “sprain”. Sometimes it is caused by a tear or strain in the muscle. These situations can be brought about by injury, poor posture or a disease that has developed.

Nowadays people tend to turn to alternative medicine due to the prohibitive cost of health care, or sometimes due to the concern over the side effects of drugs. Of the various traditional options in the market today for the relief of back pain, acupuncture has emerged as one of the most effective and least expensive choice. Acupuncture is a traditional Chinese therapeutic method that has been around for centuries. It uses fine needles inserted at specific places in the body, which the Chinese call “meridians”. They believe that these “meridians” correspond to the major body systems, and that the punctures are meant to release our body’s vital energy called the “qi”. It is believed that if the “qi” is unblocked and is allowed to flow freely in the body, it can correct whatever disorder a person is suffering from.

Acupuncture can be either distal or local. In distal therapy, the needles are inserted away from the area of pain. This is often used for instant relief of acute pain. Sometimes the needles will be complemented with cupping or electric stimulation. Acupuncturists would know where to find the points that will have impact on the pain and concentrate the punctures there. The frequency of the acupuncture sessions depend on the level of pain: as the pain dissipates, the sessions decrease as well.

There have been studies to support the effectiveness of acupuncture in removing back pain. A Swedish hospital released a study conducted on patients with chronic back pain where they concluded that long term relief is obtained through acupuncture, and that better sleep and an improved sense of well-being likewise resulted from acupuncture. In the United States, acupuncture is now widely accepted as complementary therapy for the treatment of musculoskeletal pains, including back pain. However, there are very few definitive studies on the subject due to the very low number of research on acupuncture.

Nevertheless, acupuncture has remained quite popular across the country, and many swear by its effectiveness in relieving all kinds of pains. It appears to be quite effective and has unbelievably very few side effects. Because it is only mildly invasive, it can be carried out alongside conventional pain treatment regimens. If you are one those people who have been using spending a considerable amount of money on conventional treatment of back pain, all to no avail, it may be high time for you to consider acupuncture. It is always better to keep an open mind while staying reasonably cautious about alternative therapies such as acupuncture.

Back pain is mankind’s bane. It is one of the most common reasons for visiting the doctor, and around 90 percent of adults have at one time or another experienced it. The pain we feel can originate from any one of our numerous bones, joints, muscles, tissues and ligaments in the back. In terms of pain, our back can be divided into four sections. There is the tailbone pain, the lower back pain, the pain in the upper back and the pain in the neck. Pain can come and go, it can be mild or excruciating, and it can also be chronic. It can start in one place then radiate to other parts of the back. There are back pains that radiate to the arms, legs and feet, and sometimes radiating even to the head. Sometimes the pain is accompanied by a tingling sensation, even numbness and weakness.

What keeps us upright is our spine, which is a complex interconnection of bones, nerves, joints, ligaments and muscles that are all susceptible to injury or damage which in turn can cause pain. What ensues is a brief look at some of the causes of back pain.

The number one cause of back pain is lumbar muscle strain, which can be due to a variety of causes, and a patient may not be able to pinpoint what happened to trigger the muscle strain. The upside of this type of back pain is that it subsides over time and may be completely resolved in weeks.

As we age, our spinal canal can be constricted and cause back pain. This is known as spinal stenosis, and is common among the elder population. The constriction of the spinal canal can be caused by a number of reasons the most common of which is arthritis.

A herniated spinal disc is another cause of back pain. The spinal disc is a cushion located in the gaps between each vertebra. It is elastic but wears out with age, and an injury or an accident can rupture it, causing a portion to slip outside its normal boundary, causing back pain.

While arthritis usually occurs in the joints of the extremities, such as the fingers and knees, sometimes it can affect our joints in the spine as arthritis can affect all the joints in the body. This is a condition known as lumbar spine arthritis. Arthritic pain comes and goes, and happens in varying degrees.

Discogenic back pain occurs at the lower region of the back, caused by injury to the intervertebral disc where the disc is not herniated. A discogram is used to diagnose this type of back pain.

Back pain can also come from osteoporosis, or “brittle bone disease”. This condition causes the weakening of the bones, and its increased susceptibility to breakage. Osteoporosis can cause a broken hip or a spine fracture. This is usually prevented by taking calcium to strengthen the bone. Never mind the back pains, osteoporosis could be quite debilitating and life-threatening if it remains unchecked.

Spondylolisthesis is another cause of back pain. It occurs when adjacent vertebra becomes unstable causing it to slip. Degenerative changes causes spondylolisthesis, this is when the stabilizing structures of our spine are lost. An unstable back is a painful one.

Understanding the causes of back pain would make it easier to control or eliminate altogether, but we are still the best judge of whether our back pain is something we can manage, or if we would need to seek medical attention.

The American Pain Society (APS) has issued a new clinical practice guideline for low back pain that emphasizes the use of noninvasive treatments over interventional procedures, as well as shared decision making between provider and patient. The findings are published in the current (May 1, 2009) issue of the journal Spine.

The new APS guideline, based on an extensive review of existing research, provides clinicians with eight recommendations to help determine the best way to treat patients with low-back pain. It also expands its current and previously published guideline for initial evaluation and management of this chronic condition.

“These recommendations are based on an even more complete body of evidence than was available just a few years ago. Consequently, we believe these recommendations will give physicians more confidence when treating patients with persistent back pain,” said Roger Chou, M.D., lead author, director of the APS Clinical Practice Guideline Program, and associate professor of medicine (general internal medicine), Oregon Evidence-based Practice Center, Oregon Health & Science University.

“Unfortunately, randomized trials for a number of commonly used interventional procedures are still too limited to generate evidence-based recommendations, and our review also highlights the need for more research,” Chou added.

Low-back pain is the fifth most common reason for doctor’s visits and accounts for more than $26 billion in direct health care costs nationwide each year. While a number of interventional diagnostic tests and therapies, and surgery are available, and their use is increasing, in some cases their usefulness remains uncertain.

“We have advocated strongly in many of our recommendations for physicians to use shared decision making because of the relatively close trade-offs between potential benefits relative to harms, as well as costs and burdens of these various treatment options,” Chou explained. Shared decision making involves a patient’s full participation in medical choices after receiving comprehensive information about the impact of all options on his or her particular life situation.

To develop the guideline, a multidisciplinary APS panel, augmented by experts on interventional therapies, reviewed 3,348 abstracts and analyzed 161 relevant clinical trials. The panel found that the evidence for the use of these interventions was mixed, sparse or not available. Based on the data the panel gathered, the APS now recommends:

1. Against the use of provocative discography (injection of fluid into the disc in order to determine if it is the source of back pain) for patients with chronic nonradicular low-back pain.

2. The consideration of intensive interdisciplinary rehabilitation with a cognitive/behavioral emphasis for patients with nonradicular low-back pain who do not respond to usual, non-interdisciplinary therapies.
3. Against facet joint corticosteroid injection, prolotherapy, and intradiscal corticosteroid injections for patients with persistent nonradicular low-back pain, and insufficient evidence to guide use of other interventional therapies.
4. A discussion of risks and benefits of surgery and the use of shared decision making with reference to rehabilitation as a similarly effective option for patients with nonradicular low-back pain, common degenerative spinal changes, and persistent and disabling symptoms.
5. Insufficient evidence to guide recommendations for vertebral disc replacement.
6. A discussion of the risks and benefits of epidural steroid injections and shared decision making, including specific review of evidence of lack of long-term benefit for patients with persistent radiculopathy due to herniated lumbar disc.
7. A discussion of the risks and benefits of surgery and use of shared decision making that references moderate benefits that decrease over time for patients with persistent and disabling radiculopathy due to herniated lumbar disc or persistent and disabling leg pain.
8. Discussion of risks and benefits of spinal cord stimulation and shared decision making, including reference to the high rate of complications following stimulator placement for patients with persistent and disabling radicular pain following surgery for herniated disc and no evidence of a persistently compressed nerve root.

Chou and his colleagues also reaffirm their previous recommendation that all low-back pain patients stay active and talk honestly with their physicians about self care and other interventions. “In general, noninvasive therapies supported by evidence showing benefits should be tried before considering interventional therapies or surgery,” said Chou.

Recommendations from the first APS Clinical Practice Guideline on Low-Back Pain are intended for primary care physicians and appeared in the Oct, 2, 2007, issue of the Annals of Internal Medicine. For diagnosis, the first APS low-back pain guideline advises clinicians to minimize routine use of X-rays or other diagnostic tests except for patients known or believed to have underlying neurological or spinal disorders.

Source:
Tamara Hargens-Bradley

Oregon Health & Science University