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

21 questions

Q. I have pain in both hips now although until recently i have suffered with Bursitis in left hip. I have been told by a physiotherapist in local hospital that as i suffer from odoema in leg that i cannot have acupuncture in hip as it will cause the leg to loosr feeling. Is this true. I have had acupuncture in the past for back pain and it has worked.

A. We have to say straight away that we are unaware of any evidence that acupuncture into an oedematous leg can cause loss of feeling, or that needling the hip itself when there is oedema can cause loss of feeling. There are certainly no adverse event reports of which we are aware. The main caution observed for treating a patient with oedema is the possibility of causing cellulitis, and a BAcC member will spend considerable time discussing with any patient suffering from oedema what may be responsible for this. 
 
One of the great strengths of Chinese medicine is that it treats the person, not just the symptom, and this does mean that a practitioner can treat problems in one part of the body with needles somewhere else. In the case of oedema, as we have mentioned above, there is a great deal which can be done without necessarily needling the affected limb. In your particular case, if the bursitis is seen to have arisen from a wider and more systemic problem involving the fluids of the body, there is much that can be done without going near the affected part. Generally, however, it is best to treat the specific area affected alongside the body as a whole.
 
If acupuncture has been successful for you before it may well prove to be very helpful now. While we would not wish to create discord between patients and other health professionals, we would recommend that you ask the physio what the evidence is for the potential loss of sensation. We are not infallible and there may be studies or reports of which we are not aware where this risk has been highlighted. In the absence of published reports or guidelines suggesting the contrary, we think that you would be perfectly safe to have acupuncture treatment and hope that it brings you some relief from your discomfort.
 

As our factsheet here shows low back pain is one of a small number of conditions for which the evidence is good enough such that acupuncture is now a NICE recommendation for people with chronic non-specific back pain of over six months duration. This does not mean it doesn't work on many other things, only that the specific type of evidence accepted in the West is very narrow, and the vast quantity of Chinese research available is often methodologically less than perfect.

 

 

However, if your case the pain appears to have a very clear specific cause which may make it not be so amenable to treatment. If the scarring and adhesions are significant and permanent, it is possible that acupuncture may have little or no effect. That said, it is surprising how often a physical manifestation such as degeneration of the lower vertebrae or scar is adjudged without further ado to be the explicit cause of a pain. Most people over the age of 50, for example, are likely to be showing some signs of degeneration of the vertebrae in the lower spine, and that does not necessarily mean that this is the root of every reported back pain.

 

It would be worthwhile discussing the specifics of your case face to face with a practitioner to get a better idea of whether they feel that treatment may be able to help based on a proper inspection of the nature of the problem. The fact that you have scarring and adhesions suggest a wider pathology than simply back pain, and a practitioner would perhaps be able to make better sense of any patterns by actually looking directly at what's going on.

There is evidence, accepted by NICE, that acupuncture can be used for the treatment of low back pain. Our BAcC factsheet details the studies which have supported this conclusion for non-specific pain.

 

However, in your case there is a very clear cause, and no accepted evidence of which we are aware of that prolapsed discs can be treated with acupuncture as an alternative to surgery. There are dozens of anecdotal accounts from BAcC practitioners of using acupuncture to encourage the reduction of inflammation and to keep it at bay while the protruding section of disc is dealt with by the body, but this is not sufficient basis for us to make an unqualified recommendation.

 

A great deal depends on the advice of your neurosurgeon. If the bulge is bad enough to require surgery then it would be unwise to ignore this advice. If, however, he or she believes that there is a possibility that with rest and careful exercise the problem can be managed without surgery, then acupuncture along with some form of gentle manipulation like odteopathy may well be able to accelerate the recovery process. We would also recommend that you discuss alternative options with the neurosurgeon; many are very supportive of complementary therapies which encourage restoration of normal function.

Plumber Stephen Morris shares his thoughts on how acupuncture treatment helped his lower back pain

 

Q. I was wondering if you could help me and give me some advice. I have had some back pains for the last 3 months which radiate to other areas and which my Dr says are caused by muscle knots/trigger points in my back. He says the best way to treat it would be with Trigger Point Acupuncture. But many people I know say that the best is to have acupuncture using the traditional Chinese method. My question is: is it actually safe to do both, for example 2 sessions of traditional acupuncture and 2 sessions of Trigger Point Acupuncture in a week?

 

A. As you will see from our website and factsheets the use of acupuncture for chronic back pain is recognised by NICE as an effective intervention. The NICE guidelines make no comment on the style of acupuncture which ise used, however, because the trials on which the good results were achieved left the choice of points and rationale to the individual practitioner.
 
Trigger point acupuncture is a system mainly used by western trained doctors and physios, whereas Traditional Chinese Medicine is the province of professional acupuncturists. In clinical practice there is often a great deal of overlap - after all, it's all the same body and points are likely to be in the same place, whatever system is used to classify and choose them. It is quite likely that both forms of intervention will use much the same kind of strategy with the same aims, so in theory there should not be a problem in doing both.
 
That said, most practitioners, western and eastern, like to be able to assess how effective treatment is, and if someone else is doing something similar but not identical, it might be an issue for both practitioners to determine how well sessions worked and what fine tuning may be necessary. From a traditional practitioner's perspective a problem also occurs against a backdrop of someone's overall health, and the treatment may not necessarily focus on the back itself. This might have an impact on how they approach treatment.
 
The final point is whether after three months of difficulty you need four sessions a week. In Chinese hospitals where acute back pain is treated with acupuncture it is not uncommon to have ten sessions, once a day for ten days, but chronic problems are sometimes treated over longer periods of time to give the body a chance to re-adjust. Over-treating can sometimes be as much a problem as under-treating.

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