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Ask an expert - muscles and bones - back / spine - lower back pain

21 questions

Q:  I have had recurring back pain problems for about 10 years.  I have had various physiotherpists give me exercise but I am still have back pain.  Would acupuncture help?

A: For back problems we can make a positive recommendation of acupuncture treatment. The evidence which has accumulated over the years has been sufficient to convince NICE, the body which defines suitable treatments within the NHS, that a course of up to ten treatments should be available within the NHS for chronic back pain. Unfortunately acupuncture is just one of a number of options for treatment, and we have seen very little evidence of anyone contracting with our members to provide treatment which is free at point of delivery, but in time we hope this begin to happen.

Our fact sheet on back pain

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html

provides references to some of the research, but such is the prevalence of the problem there have been many more studies of varying degrees of rigour which all seem to point to positive outcomes.

The two factors which will be of interest to a practitioner will be the way that the problem developed and how it relates to the overall functioning of the body, and how entrenched some of the coping patterns have become. As far as the former is concerned, unless the pain has arisen as a consequence of an injury it is usually a part of the much larger picture of what is happening in the body, and this is the great strength of Chinese medicine, understanding this back pain in this person rather than simply applying formula treatments for everyone. The latter issue can sometimes be important. People learn a number of coping mechanisms to deal with the pain, such as holding their bodies in different ways, and it can sometimes take a while to encourage the muscles to revert to natural positions when they have been trained over time to hold the body in a position which avoids pain. Many of our members often work closely with osteopaths in a  two-pronged strategy to encourage the body back into its correct shape.

The best advice always, though, is to visit a BAcC member local to you for advice on whether acupuncture can help your specific problem. Although the evidence is good, most of us can tell quickly what the best options for a patient are, and are always happy to refer on to other healthcare professionals if we think that they are the best line of attack.

 

Q: I have been diagnosed with lumbar spinal stenosis.  I find it difficult to stand for any  length of time or walk any distance. I have to sit because of a severe ache in my  lower back.
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A:  We were asked this question a couple of years ago and our answer then

Q. Following an MRI scan I have been diagnosed as having "central canal stenosis with degenerative changes at L4-L5 level and moderate disc herniation". I have difficulty walking more than 200 metres. Is it at all likely that acupuncture would have a significant positive effect?

A. We are sorry to hear of your difficulties. We were asked this question many years ago, and our advice has not changed that substantially. Back then we wrote:

Lumbar canal stenosis can manifest in many symptoms dependent on the extent of the stenosis. Our colleagues in America are very upbeat about the potential for success in treating lumbar canal stenosis; if you google 'lumbar stenosis acupuncture' you will see an article on the www.acupuncture.com site which speaks positively of success rates, as well as an 'acupuncture today' listing which also gives good cause for hope.

Personally we tend to take a slightly more guarded view of the chances of success, and base our own prognoses on gathering as much information as we can about the condition - how long the person has suffered from it, is it degenerative, does it have peaks and troughs, has it been exacerbated by accident or trauma, and so on - before committing to treatment. Even though we are working with entirely different diagnostic systems, if a condition has some very severe manifestations based on irreversible physical change, the expectations of a 'good' result have to be lowered accordingly, even what might count as a 'good' result.

The best advice that we can give is that you discuss this with a practitioner whom you might consider seeing and ask their advice. Many of our colleagues are happy to discuss someone's concerns with them rather than book them straight in, and a significant number are happy to set aside a few minutes to meet someone and offer a more informed view of whether they can help based on a rapid assessment of the actual presentation.

Since we gave this advice there have been a number of studies such as this one

http://www.ncbi.nlm.nih.gov/pubmed/22534725 :

which give some cause for optimism, although finding a UK practitioner able to deliver this particular form of treatment may take some doing. The most recent systematic review

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373659/

is much more guarded in its views.

However, it is often possible that the symptoms from which people suffer are not directly related to a physical change in the same area. We find that many people are told that arthritic changes in the lower spine are responsible for their chronic low back pain, but we often see the pain reduce or vanish without any accompanying physical change. Acupuncture has, in fact, been accepted within NICE guidelines as an effective treatment for the treatment of chronic low back pain, and the evidence base is certainly more compelling than for many other western named conditions. Our fact sheet on back pain
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html
gives more background.

The best advice we can give remains the same - visit a BAcC member local to you for a brief face to face assessment of whether they think you might benefit from acupuncture treatment.

still represents the clearest expression of what we think may be possible. Stenosis tends not to be reversible, and it would be unwise to encourage too much optimism about the possibility for change and improvement. However, we have to remind ourselves sometimes when we take on case with very fixed western names and well determined causes that we are working in a paradigm of medicine which starts with the patient's experience of their pains and discomfort and then works towards an understanding of that through the lens of Chinese medicine. As we said in the earlier response, not every experience of disease is necessarily reducible to the physical findings which are discovered through investigation. Although most are, there remain some where treatment with acupuncture may have a significant impact.

We can only repeat what we said in the earlier reply: ask a BAcC member local to you for advice. Most are more than happy to give up time without charge to discuss with prospective patients whether treatment may be of benefit to them.

Q: Are 12 needles for 40 mins for my second visit too much? I was lying on my stomach for the full 40mins for lower back pain.

A:  The short answer is not at all. It is not uncommon when treating lower back pain to use a significant number of needles locally, and this can often easily run to a total of 10 or 12 needles. It is also quite common to have the patient relaxed in a face down position.
 
If you felt that it was too much, however, or that the position was uncomfortable for 40 minutes, then it is a simple matter to raise this with your practitioner who will be delighted, we are sure, to adjust the treatment for you.
 
A very small number of patients are very sensitive to acupuncture treatment, and this can often limit the number of needles which a practitioner can use. In most cases, though, this is very clear because the patient feels a little spaced out or woozy after treatment, and not in a particularly pleasant way. Practitioners will always ask how the treatment affected someone and in cases like this would automatically scale the treatment down for the next session. 
 

 

Q:  I' ve got pain in my back L4 & L5.  Will I get rid of some of the pain after a first session of acupuncture? How quickly  does acupunture work?

A:  Without knowing exactly what kind of pain you have, how it has developed, what may have caused it and what else has happened to bring on the pain, it is very difficult to say!
 
This kind of question highlights the problems that we have using a different system of medicine from the one which is all around us and embedded in our common culture. People have 'bad backs', 'migraines', 'asthma', and so on, and a great deal of conventional medicine deals with this named condition in a very specific way. By contrast, the individual symptoms which piece together to define a named condition in conventional medicine are interpreted in Chinese medicine in an entirely different conceptual framework, so that there is no equivalent of a NICE guideline for a lower back problem because there are as many variations in the exact nature of the problem as there are people with it. A truism of our work is that twenty people with migraines may have twenty unique and different diganoses in Chinese medicine which would be treated in twenty different ways. We treat the person, not the disease.
 
However, clinical experience usually follows familiar patterns, and with back pains in this area there is often some change relatively quickly, and the question is how much and how sustainable it is. We usually warn our patients that for the first 48 hours after treatment it is possible that the pain and stiffness may increase a little, but after that there should be progress. The NICE guidelines for treating lower back pain recommend ten sessions, but most BAcC members would be reviewing a patient's progress at four or five sessions, at which point it is often possible to determine how well someone may respond. What you want to avoid is a pattern where there is some improvement for a short while which then reverts to the status quo. If this happens more than four or five times then the short term relief may not warrant the expense of treatment.
 
Each case is unique and different, though, and there may be other factors in play which would determine how much change and improvement you might experience. Have we had people for whom one treatment did the trick? Yes. Have we had patients who have not responded at all? Yes. The best advice is to visit a BAcC member local to you to get a brief face to face assessment of whether acupuncture treatment may be of benefit to your specific problem. 
 

 

 

Q:   I have had twp  sessions of acupucture to help me with lower back pain and sciatica. Before the first session my symptoms were not too bad. The following day my sciatica appeared to be more agitated. After the second session my back started to ache. It's been 3 days since my last session and both symptoms are causing me trouble. Is this normal?

A:  We would not go so far as to say that this is 'normal', but it can happen. Acupuncture can cause minor transient adverse events, and it is not unknown for people to have a day, or two at most, after a session where the system is in a state of flux and symptoms can become a little worse. In some cases this can be quite marked, but in all cases this should stop after about 48 hours.
 
If a problem continues after this, there are a number of possibilities. First, and this has to be expressed with great care in order not to offend a patient, the deterioration or increase in discomfort may have nothing to do with the acupuncture treatment. Many lower back problems have a 'tipping point' after which the symptoms become quite severe, and often what is happening at the time this takes place is unconnected to the change. A more positive therapeutic outcome, and very commonly experienced after osteopathic treatment of lower back problems, is that as the body reasserts its proper form some of the muscles which have been operating in a distorted structure are now forced to accommodate the better structure within which they should function. This is rather like the pain people sometimes experience after sitting in a restricted legroom seat at the theatre and then standing up.
 
In any event, the important thing is to discuss the problem with your practitioner and get their advice. They will know what treatments they have given and will be able to interpret what is happening to you better than we can at this remove. If they are concerned they may well invite you in for a flying visit just to take a look at the overall picture, and see if any short term adjustment is necessary.
 
Our expectation, however, is that by the time you read this the paim will have subsided considerably and you will be starting to feel the benefits of the treatment for your lower back.   

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