Acupuncture is a natural health care option to help people with back pain. It can be combined with other tools of East Asian Medicine including massage, moxibustion, gua sha or cupping. All of these approaches can offer a natural, drug-free alternative for back pain relief as well as address the underlying causes of back pain.
This article will explore the common effects and causes of back pain, with tips to prevent onset. The evidence for back pain treatment options with Chinese Medicine will be explored.
What is the effect of back pain on a person?
The presence of back pain limits the ability to perform normal life activities. The results of this may include:
- Time off work
- Inability to engage in their favourite sports
- Unable to perform their hobbies
- Difficulty being active with younger family members
1 in 5 experienced persistent back pain, with an additional group — almost 1 in 3 — who developed back pain over time. . These two groups were associated with greater pain limiting activity, disability, and depression, as well as increased healthcare and medication use.Mayilee Canizares, Ph.D – Medical News Today
The presence of back pain also affects mental health. The increased isolation can become a major contributing factor.
Both back pain and chronic back pain are associated with an increased likelihood of depression, psychosis, anxiety, stress, and sleep disturbances.Dr. Stubbs –Medical News Today
What is the prevalence of back pain in Australia?
According to the Australian Pain Management Association, back pain is common. It estimated to be the third most common presentation in a GP clinic.
As much as 15% of the population currently experiences issues with back pain. That percentage is higher in those aged 65-74. Arthritis Australia observes that 80% of Australians experience back pain at some point.
Back pain is also a recurrent symptom, returning in around 34% of cases.
What are the risk factors for back pain?
Risk factors include:
- Age – back pain is more common as we age
- Fitness level – back pain is more common in people who are physically unfit
- Pregnancy – shifting weight dynamics often lead to back pain
- Weight gain – excess weight can place strain on the spine and back muscles
- Occupation – jobs with repetitive, high load activities increase the chance of back pain
- Stress – higher stress can lead to increased muscle tension, which in turn creates back pain
What are the common causes of back pain?
Acute trauma, repetitive use, and poor posture are common back pain causes. Muscle or ligament strain is most commonly involved, though disc issues and skeletal irregularities can also contribute.
Underlying conditions can also lead to the presence of back pain. These may include osteoporosis or arthritis.
Weak or disengaged abdominal muscles is also a factor. This is because the back muscles must compensate to keep the body upright.
Acute back pain
Acute back pain is back pain that has been present for less than 6 weeks. This can arise from:
- a direct external force on the back
- over flexion or overextension of the spine (esp. when cold)
- improper lifting
- violent twisting or jarring of the lower back (esp. when cold)
Some common presentations of acute back pain include
Rib fractures arise from a history of trauma. This trauma is generally easily identifiable eg sporting injury, car accident.
This is also known as a ‘costovertebral sprain’ or ‘popped rib’. This generally affects the 11th or 12th rib and presents with pain lateral to the spine
Chronic back pain
Chronic back pain is back pain that has been present for over 3 months. Chronic back pain can be a symptom of a more serious pathology such as
- disc degeneration
- nerve impingement
These are not common but should be watched out for. See a GP for further exploratory investigation and imaging if there is:
- Signs of neurological change (eg numbness, tingling, shooting pain)
- Unexplained weight loss or muscle weakness
Chronic back pain can result from underlying syndromes such as:
Ankolysing spondylosis is a chronic inflammatory joint disease. It involves stiffening and fusion (ankylosis) of the spine and sacroiliac joints. There is a suggested genetic component to Ankolysing spondylosis. The HLA-B27 genetic marker present in 70- 80% of sufferers.
Scoliosis is a sideways curvature of the spine. This places strain on the supporting muscles.
As people age, bone strength and muscle elasticity and tone tend to decrease. The vertebral discs begin to lose their fluidity and flexibility. This decreases their ability to cushion the vertebrae.
The walls containing the disc can weaken, which in turn can lead to a disc protrusion. The protruding disc places pressure on the nerve roots causing pain.
The most common presentation from this is sciatic pain
There are many other reasons why back pain may occur, consulting a practitioner can help to unravel these causes for you.
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Tips for the prevention of back pain
Some tips to prevent back pain include:
- engage in regular, moderate exercise
- try to avoid being stationary, sitting or standing, for too long
- avoid sudden movements
- reduce excessive heavy lifting, being mindful of good lifting techniques
- having a supportive mattress to sleep on
- wear flat shoes with supportive cushioning
- attending to ergonomics of work station
- consider the ergonomics of exercise equipment eg if you regularly commute by bike then check out these tips at bikesreviewed.com
What are the back pain treatment options
There are few direct options for the treatment of back pain through a GP.
Pain medication such as paracetamol, NSAIDs or opioids is the most common approach. Unfortunately, this only masks the symptoms and does not address the underlying issue.
This can be very useful to reduce the pain to allow for healing to occur. If the body is under stress from intense pain, it will struggle to recover. This may also prevent one from engaging in other treatment approaches.
The advice is for minimal bed rest to ensure regular light movement and activity. This keeps the affected area flexible and mobile.
Strengthening or stretching therapies such as physiotherapy, pilates or yoga can help. Suggestions of direct treatment may include osteopathy, massage or acupuncture.
Most acute back pain will resolve within a few weeks. This assumes that the aggravating factors are no longer present. This does not help with pain in the short term, which treatment can help with.
The many tools of Chinese medicine can be very helpful for people with back pain.
Is acupuncture for back pain effective?
Acupuncture helps many people with back pain, so much so that we have seen an explosion of practitioners offering dry needling (a subset of acupuncture). There is good evidence to back up these results.
The Cochrane systematic review for the use of acupuncture and dry needling for back pain was last updated in 2005. Many more studies have been conducted since then.
They found that there existed a low quantity and quality of available evidence. This meant they could not make any firm conclusions at the time around the treatment of acute lower back pain.
Their research suggested acupuncture could be useful for chronic lower back pain in the short term. They found positive results when acupuncture was as an adjunct to other therapies.
A more recent systematic review by Lee et. al. in 2013 explored the use of acupuncture for acute pain. They noted the need for more research due to the limitations of their study and the available research.
Compared with nonsteroidal anti-inflammatory drugs, acupuncture may more effectively improve symptoms of acute LBP … For pain, there exists inconsistent evidence that acupuncture is more effective than medication…. Compared with sham acupuncture, acupuncture may more effectively relieve painLee et al Clinical Journal of Pain
A 2014 literature review explored noninvasive treatment for chronic lower back pain. The conclusion was that acupuncture had good evidence for efficacy and outcomes.
Acupuncture was found to be significantly more effective than either sham treatment or no treatment … acupuncture may be a useful adjunctive treatment to other therapies for chronic low back painWellington J Neuromodulation
A 2015 overview of systematic reviews concluded that
Acupuncture, either used in isolation or as an adjunct to conventional therapy, provides short-term improvements in pain and function for chronic LBPLiu et al Evidence-Based Complementary and Alternative Medicine
As is a common theme with these reviews they noted issues with the reliability of evidence.
More efforts are needed to improve both internal and external validity of systematic reviews and RCTs in this areaLIU ET AL EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE
Is cupping for back pain an option?
Moura et. al. in 2018 conducted a systematic review and meta-analysis into the use of cupping for chronic back pain. They concluded that cupping was a promising therapy for back pain. There is also a need for standardised application protocols to further improve the quality of research. In particular, they noted that
There was a significant reduction in the pain intensity score through the use of cupping therapyMoura et. Al. Revista Latino-Americano De Enfermagem
This followed the 2017 meta-analysis which showed significant improvement in VAS and ODI (but not MPPI) scales with cupping. Their findings were not reliable due to a high risk of heterogeneity and bias in the studies. They state that more robust studies are needed. They did observe that
Cupping therapy is a promisingly effective and safe therapy method for subacute or chronic low back painWang et al Journal of Back and Musculoskeletal Rehabilitation
Wang et al Yuan et al 2015 conducted a meta-analysis into the use of Chinese Medicine for neck and lower back pain. They found low-level evidence that cupping was more effective than medication for lower back pain. They also found moderate evidence that it was better than usual care for pain and disability.
Acupuncture, acupressure, and cupping could be efficacious in treating the pain and disability associated with CNP or CLBP in the immediate termYuan et al PLOS One
Is Gua Sha for back pain good?
There has not been a high level of studies into Gua Sha for back pain. Thus there are no current systematic reviews available to obtain a higher level of insight into the research.
There was a recent randomised control trial into the use of Gua Sha for chronic back pain. It calls for further, more rigorous studies to validate the findings that
Gua Sha appears to be an acceptable, safe, and effective treatment for patients with chronic low back painSaha et al Complementary Therapies in Clinical Practice
Lauche et al conducted a randomised controlled study in 2012 into the use of Gua Sha for neck pain and chronic lower back pain. They hope to see more research conducted to confirm their findings that
Gua Sha may be an effective treatment for patients with chronic neck and low back painLauche et. al. The American Journal of Chinese Medicine
Does Moxibustion for back pain help?
There is also limited research on the use of moxibustion alone for back pain.
A 2019 study in the Journal of Thai and Alternative Medicine compares acupuncture with moxibustion for back pain. For back pain from lumbar disc herniation nerve pain, both therapies showed similar improvements. This study is not blinded, so more quality research needs to be conducted to confirm this.
Heat wrap therapy for back pain, a form of moxibustion therapy, is recommended by the Australian Pain Management Institute. They recommended it above NSAIDS in the short term as it has less potential side effects.
Does massage therapy for back pain work?
A 2015 Cochrane Systematic review of 25 trials found evidence that massage helps to reduce pain, and improve function in chronic lower back pain cases. The evidence was considered of low quality, due to issues with creating effective blinded controls and measurements. This is because it is hard to provide an intervention that neither the giver nor receiver knows is a massage or not.
Does Chinese Medicine treat back pain?
As can be seen throughout the referenced studies, there is a positive indication for the use of Chinese Medicine for back pain.
A recurrent issue that is noted in these reviews is the quality of the research conducted. Issues commonly exist with bias and blinding, as manual intervention techniques are notoriously difficult to create double-blind sham treatments for. This article by John MacDonald is the essential beginning reading into the issue surrounding this type of scientific study into therapies like acupuncture.
Acupuncture for back pain in Melbourne
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