This low back pain research study concludes that acupuncture is a highly effective, affordable treatment that primary care physicians should promote. Low back pain (LBP) is one of society’s most common musculoskeletal disorders. LBP is categorized according to duration as acute (less than six weeks), sub-acute (between 6 and 12 weeks), or chronic (more than 12 weeks).
Burdens of Low Back Pain
LBP interferes with activities of daily living and work performance and is a significant reason for people seeking medical consultation. This disorder contributes to a substantial burden on individuals, employers, the healthcare system, and society at large. According to a report by the World Health Organization (WHO) in 2013, back pain and neck pain were the second highest cause among the 20 leading non-fatal health conditions from 2000 to 2011.
The survey, published in the Lancet in 2017, highlights the extent of health loss due to diseases, injuries, risk factors, prevalence, and mortality rate by age, sex, and geography at specific points in time. LBP was the number one cause for the most years lived with disability (YLDs) worldwide. The investigators in this low back pain research study reviewed the randomized controlled trials (RCTs) addressing LBP and the mechanisms targeted by acupuncture.
Causes and Risk Factors of Low Back Pain
While common, LBP is a complex multifactorial disorder with many possible etiologies. These originate from injuries, trauma, or fractures to the body, lumbar spine degeneration, and disc herniation or nerve entrapment. Other causes include infections, autoimmune diseases, orthopedic diseases, or tumors.
In addition, LBP can result from the following:
- Occupational ergonomic factors related to heavy physical work
- Repetitive motion due to job requirements
- Sports-related injuries
- Sedentary lifestyle
- Prolonged sitting or inactivity
- Lack of exercises
- Post-operation or surgery-induced
- Secondary from other medical conditions
- Lifestyle factors
- Poor trunk control
- Postural impairment
- Psychosocial and behavior-related factors from smoking, alcohol abuse, obesity, depression, or stress
- Socio-economic factors
- Natural aging process
Despite this long list of triggers, identifying the origin of LBP is often difficult. Surprisingly, 85–95% of the total cases of back problems are not associated with a specific pathoanatomical source or attributed to any recognizable pathology patterns.
Standard Western Treatment for Low Back Pain
The goal of LBP treatment is to control or reduce pain, improve structural impairment of the spine, and return to normal life activities as soon as possible. Most current international guidelines recommend pharmacological management for pain relief of LBP, including:
- Paracetamol
- Non-steroidal anti-inflammatory drugs (NSAIDs)
- Muscle relaxants
- Opioid analgesics
- Epidural steroids
- Anticonvulsants
- Antidepressants
- Corticosteroids
Unfortunately, most of these pharmacological treatments produce limited pain relief. In addition, severe side effects, such as drowsiness, dizziness, addiction, allergic responses, reversible reduction of liver function, and negative impacts on gastrointestinal functions accompany them. Approximately 25 to 30% of patients treated with opioids experience at least one of these side effects.
The major problem with this approach is that while pain may be temporarily relieved, it does not address the source of LBP, and alternative treatments are required. These include acupuncture, physical therapy, spinal manipulation, exercise therapy, massage therapy, cognitive-behavior therapy, yoga, and tai-chi.
Acupuncture Treatment for Low Back Pain
Acupuncture is a branch of Traditional Chinese Medicine (TCM). It involves inserting thin needles into the muscle on specific acupuncture points placed along meridians to treat various conditions. Many countries throughout the world use acupuncture for pain relief.
The World Health Organization (WHO) estimates that one-third of the world’s population has no regular access to modern medicines, especially in many parts of Africa, Asia, and Latin America. Fortunately, complementary and alternative medicine (CAM), such as herbal and traditional medicine and acupuncture, are available and accessible.
Acupuncture Points for Lower Back Pain
Six out of fifteen RCTs stated precisely the acupuncture points used for treating LBP. According to this low back pain research, the most common acupuncture points included GV 3, BL 23, BL 25, and BL 40. GV 3, BL 23, and BL 25 are all local points, while BL 40, located behind the knee, is a distal point for treating LBP. Other distal points are BL 60 and K 3, situated behind the lateral and medial malleolus of the ankle.
Lee et al. did an investigation based on 53 clinical studies and summarized the most frequently used acupuncture points for treating LBP. It clearly shows that both the bladder and gallbladder meridians are the chosen choice for treating LBP with acupuncture, mainly BL 23 (51%), followed by BL 25 (43%), BL 24, BL 40, BL 60, and GB 30 (32% each), BL 26 and BL 32 (28% each), and GB 34 (21%).
Clinical Relevance of Acupuncture Points
The following is a breakdown of the functions of acupuncture points for treating LBP:
- Acupuncture points BL 23, BL 24, and BL 26 improve circulation to the local tissue, resolve myofascial dysfunction, and promote tissue recovery.
- BL 25 relaxes the fascia and frees entrapped and irritated nerves.
- Acupoint BL 40 may improve circulation and nerve health by reducing myofascial tension caused by neurovascular compression.
- BL 60 and K 3 are located on each side of the ankle and represent the distant points for LBP. They contain an extensive sympathetic nerve supply that provides homeostatic effects.
- GB 30 sits on top of the sciatic nerve and is an excellent choice to treat sciatica caused by piriformis entrapment syndromes.
- GB 34, located on the neck of the fibula, is a choice point to treat common peroneal (fibular) nerve syndrome.
- GV 3 influences the segmental spinal nerve and has neuromodulatory properties for treating LBP, paraparesis, sciatic pain, genitourinary conditions, and lower gastrointestinal disorders.
Discussion
Low back pain is one of the most common musculoskeletal disorders today. With every passing year, more patients seek complementary therapies, such as acupuncture, as a way to supplement conventional treatments.
This low back pain research study demonstrates that combining acupuncture with other regular therapies produces better results than conventional therapies alone. Therefore, medical facilities should integrate acupuncture with conventional treatment to benefit patients.
Conclusions
In 2002, the WHO confirmed the effectiveness of acupuncture based on controlled clinical trials for 28 diseases, symptoms, and conditions. LBP was one of the conditions mentioned in this report. Furthermore, a meta-analysis of 33 RCTs of acupuncture for LBP showed better results than sham acupuncture and no treatment. Therefore, the investigators in this low back pain research study conclude that practitioners should recommend acupuncture for patients with chronic LBP due to its cost-effectiveness and low adverse effects.
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Reference
Lim T-K, Ma Y, Berger F, Litscher G. Acupuncture and Neural Mechanism in the Management of Low Back Pain—An Update. Medicines. 2018; 5(3):63. https://doi.org/10.3390/medicines5030063
Focus Keyphrase: low back pain research
Photo by Yan Krukau: https://www.pexels.com/photo/physiotherapist-touching-womans-back-5793653/
What our Clients are Saying
I came to Raleigh Acupuncture. After 1 treatment, my back felt better than it has in a year. I’ve had acupuncture before elsewhere and it has never been this effective.
I went in for a bulging disc in my back and a couple of days after the first treatment I had no pain in my back. Before treatment I had a constant dull pain in the middle of my back when at rest. The treatments were about a week apart and I completed 3 of them. It has been about 3 weeks since I have been and have a slight pain in my back but is nowhere near what it was before I started treatment. Before getting acupuncture I tried chiropractic and felt worse when I was done. For those that are skeptical like me, let me tell you that it works. I would definitely recommend Dr Mark in his ability to help with your pain.
I suffered from low back pain for years and tried many different remedies. When I came to Raleigh Acupuncture, they really listened to understand my issues. I can honestly say that they cured my chronic back pain. I didn’t think it was possible, after all these years. I highly recommend this practice. The doctors take the time and do good work.