Welcome to my blog, discover acupuncture with Dr Maggie Ju

Qualified as a medical doctor in Western medicine in China with a Medical degree from Beijing, China and a PhD degree from the UK. Many year research and clinical experiences. This blog is for information only.

Wednesday, 3 August 2022

Having low back pain? Know anything about acupuncture for low back pain?

Acupuncture is a popular treatment for low back pain, do you still not know this, still not tried acupuncture for your low back pain?

Effectiveness and acceptance of acupuncture for low back pain

There was a study involved 18000 patients with chronic pain including low back pain. This study showed that the effect of acupuncture was more than placebo. There was a further evidence provided by research from Germany showing that acupuncture is effective for chronic low back pain and acupuncture was highly accepted and had positive effects in patients with chronic low back pain. This was a randomized controlled trial. There were 143 participants with chronic low back pain. 74 patients were offered acupuncture twice a week, while other 69 patients were not given acupuncture as a control. Acceptance of acupuncture, health-related quality of life and pain/symptoms were assessed. The result of the study showed that acceptance of acupuncture was excellent. 89% of the patients would like to have TCM integrated treatment and 83% would have paid for TCM if necessary. Physical functioning, general health, vitality and emotional role were all better in patients with acupuncture treatment compared with control group. Pain relief in acupuncture group was superior to the control group. For instance, pain with sitting/standing, pain upon carrying loads of 10 kg or more and pricking in hands and feet were significantly reduced. Author’s conclusion was that acupuncture was highly accepted and had positive effects in patients with chronic low back pain. Acupuncture can be an effective, well tolerated therapy with no major side events.

Why acupuncture is effective for low back pain?

There are several mechanisms that explained the effectiveness of acupuncture on pain relief. Acupuncture stimulates nerve endings located in muscles and other tissues leading to production of endorphins and other neurohormonal factors. Acupuncture reduces inflammation by releasing vascular and immunomodulatory factors. Acupuncture increases local blood circulation and improves muscle stiffness, joint mobility and swelling. Also how brain and spinal cord processing pain has been altered. In neuroscience, the default mode network (DMN) is a functional network of brain regions that show increased activation during wakeful rest. In patients with low back pain, this DMNconectivity has changed. Acupuncture has been widely accepted for effective low back pain treatment. How acupuncture affect DMN is not clear. Tang et al studied this subject. They used RsfMRI technique to analyse the connectivity of DMN and recruited 20 patients with low back pain and 10 health subjects for controls. They found that there was less connectivity within the DMN in patients with low back pain than healthy subjects, mainly in the dorsolateral, prefrontal cortex, medial prefrontal cortex, anterior cingulated gyrus and precuneus. After 4 weeks acupuncture treatment, patients brain connectivitys were restored almost to the levels seen in healthy controls. Reductions in clinical pain were correlated with increases in DMN connectivity. It can be seen from this data, modulation of the DMN by acupuncture is related to its therapeutic effects.

Which acupuncture points are frequently used in lower back pain?

There are over 400 acupuncture points in human body according to Chinese medicine theory. The selection of appropriate acupuncture points is the first step to obtain therapeutic effects. How acupuncturists select acupuncture points? There are three basic principles to select acupuncture points: the first is local acupoints near the area where symptoms occur; the second is distant acupoints along the meridian and the third is distant acupoints based on symptom differentiation. Lee SH et al analysed acupuncture points from 53 studies using modern techniques to extract most commonly used acupuncture points. There were 33 most frequently used acupoints for lower back pain (LBP). The most frequently used acupoints in the treatment of low-back pain were BL23 (51%), BL25 (43%), BL24 (32%), BL40 (32%), BL60 (32%), GB30 (32%), BL26 (28%), BL32 (28%), and GB34 (21%). All local acupoints for LBP are on the Bladder and the Governing vessel especially at the low back position of these meridians. Most of the distant acupoints are on the Bladder and Gallbladder meridians. The acupoints include seven acupoints (BL23, BL24, BL25, BL26, and BL32 as local points and BL40 and BL60 as distal points) on the bladder meridian and two acupoints (GB30 as a local point and GB34 as a distal point) on the gallbladder meridian.

Acupuncture helps patients with low back pain reducing lumber surgery rate

Low back pain (LBP) is a very common condition globally. Invasive surgical procedures are increasingly being used to treat LBP despite a lack of solid evidence supporting their long-term benefits. There is a research investigated the association between acupuncture treatment and lumbar surgery rate in patients with LBP. The participants in this study were all newly diagnosed LBP in Korea between 2004 and 2010 and they were allocated into two groups: acupuncture group and control group. The lumbar surgery rate in the two years following the first visit (control group) or the first acupuncture session (acupuncture group) was calculated. 130,089 patients were included in each study group which is not a small sample study.

The lumbar surgery rate was significantly lower in the acupuncture group than in the control group. This was regardless of age. Decrease in surgery procedure rate was consistently observed in the acupuncture group for all age strata, except for patients in their 20s. Lumbar surgery tended to be further reduced in the older age groups upon acupuncture treatment. There were no apparent sex-related differences. Neither this was no link with income. All income groups observed had reduced surgery rate in the acupuncture group; the higher income group tended to decrease more. The more intensive acupuncture treatment was associated with further reduction in lumbar surgery rates. They concluded that acupuncture treatment is associated with lower lumbar surgery rates for LBP patients in Korea.

This was good news that acupuncture can help people with LBP without having to have surgical procedure.

References

Pach D et al (2013) Evid Based Complement Alternat Med 2013:125937

Hogeboom CJ et al (2001) Complement Ther Med 9:154-66

Tang WJ et al Acupunct Med 2013 Nove 26. Doi:10.1136/acupmed-2013-010423

Cheshire A et al BMC Complement Altern Med (2013)13:300

Lee SH et al Evid Based Complement Alternat Med (2013) 2013:402180

Weiss J et al J Altern Complement Med (2013) 19:935-41

Hsu C et al BMC Complement Altern Med (2014) 14:276

Koppenhaver SL et al Man Ther (2015) Mar 13. pii: S1356-689X(15)00051-X. doi: 10.1016/j.math.2015.03.003. [Epub ahead of print]

Koh W et al PLoS One (2018) Jun 12;13(6):e0199042. doi: 10.1371/journal.pone.0199042. eCollection

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