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

20 questions

A:  In theory acupuncture treatment for your lower back should have no harmful side effects or secondary effects on your other health conditions. The underlying aim of all acupuncture treatment is to restore the natural flow, rhythms and balances of the energy of the body, called 'qi' in Chinese medicine, and as such it is more likely that treatment for your back may have a beneficial effect on any other conditions which you have, especially since from a Chinese medicine perspective the practitioner is treating the person, not simply the symptom.
 
In fact, this is the one caution we do tend to issue, given that we are not sure whether you are talking about Type 1 or Type 2 diabetes. In the case of the latter there is very often a residual pancreatic function generating some, but not adequate, insulin, and a combination of oral medication and diet ensure that someone is able to maintain their blood sugar at safe levels. There have been one or two cases where the use of acupuncture has stimulated this residual function, and as a consequence has reduced the blood sugar. This has never yet resulted in a serious hypoglycaemic episode, but it remains a theoretical possibility immediately after a treatment, so we tend to caution patients about carrying some glucose or a carton or orange juice in case they feel their levels dropping a little. In the main, however, acupuncture is always seen as encouraging homeostasis, a correction to normal function, rather than an 'overshoot', so this is more a theoretical than real risk.

Q:  I have lower backpain which is supposedly caused by the muscles in my back. I am in pain from I get up in the morning until I go to bed at night. My biggest concern is that my balance is being affected to such an extent I am even going backwards. This is very concerning. I had an MRI scan which thankfully came back clear. Would acupunture help my problem, particularly my balance.

 

A:  As you can see from our fact sheet

Please click here

 the use of acupuncture treatment for chronic low back pain is well-established, and NICE guidelines now recommend a course of ten sessions for people suffering chronic low back pain. The question which an acupuncture practitioner would want to resolve is whether your balance problem relates directly to the back problem or whether it is a separate manifestation of a deeper underlying imbalance. Traditional acupuncture, when it is used properly, treats the person, not simply the condition. While this does not make a great deal of difference in many cases, there are times when a symptom which two people have may be treated entitely differently because in one the symptom is the problem and their health is otherwise good, but in the other the symptom is one of several signs that the system as a whole is not functioning well. This has all sorts of implications for prognosis and for the kind of treatment and secondary advice one might give.
 
As far as the back pain is concerned, therefore,. we would be fairly confident that a course of acupuncture treatment would be beneficial. If the balance problem is a direct consequence of the back problem itself this should resolve as the back pain improves. If it is a separate issue then we think that a good practitioner should be able to make sense of it within the framework of Chinese medicine, and may well be able to help with reducing its effects. There are a number of conditions such as vertigo and Meniere's disease where the evidence for the benefits of acupuncture treatment, while not yet conclusive, are very encouraging.
 
Our advice in these situations is always to contact a BAcC member local you and seek a face to face assessment of what they think acupuncture may be able to do for you. 

Not just advisable, we would say, but probably likely to be beneficial
 
Although acupuncture has now been accepted by NICE as a legitimate treatment on the NHS for chronic low back pain, the fact is that a great many of the strategies which one can use in Chinese medicine for treating chronic low back pain are just as applicable to the treatment of acute back pain. Although it may not be popularly recognised a great many people come to acupuncturists as their first choice for acute back problems, and it is far from everyone who goes straight to an osteopath.
 
Without delving too much into Chinese medical theory, a great deal of chronic low back pain arises as a consequence of the causes of an acute pain transforming over time into what the Chinese would cause stagnation in the channels on the lower back. Treatment is often aimed at moving or unblocking this stagnation and reestablishing a good flow of energy in the area, because it is often the blockage which is said to cause the pain. Clearly if someone can treat the area before the acute trauma has consolidated into something more fixed, there is more chance of moving the short term problem and reducing the longer term problem. Getting research to validate this would prove difficult - getting dozens of patients in the same area with exactly the same acute problems would prove difficult in the West - but it is standard practice in many outpatient departments in Chinese hospitals to have a course of ten acupuncture treatments daily after an acute episode to ensure that the area is moblised again as quickly as possible.
 
The vital thing with acute back pain, however, is to ensure that there is no physical damage to the vertebrae or the discs, and no misalignment which if left untreated by conventional medicine could make the situation worse. It would also be vital to rule out any underlying physiological problem; gall bladder problems and kidney problems, for example, can manifest in such a way that the pain feels as though it is in the tissue of the back. It is always best to start with your GP, as we are sure you have, and then perhaps seek the advice of an osteopath if your pains started after a particular movement or injury. We are sure that a BAcC member will guide you carefully through this process if you seek their advice, and most are more than happy to spend a little time without charging giving you a better assessment based on a face to face chat of your options. 
 

Q:  I have an exposed nerve in my lower back due to wear in my lower spine. I have been told I need a spinal steroid injection which I dont want. Could acupuncture give me any relief?

 

A:  Spinal steroid injections can be helpful for some groups of patients while offering limited benefit to others. As this study shows
 
http://www.ncbi.nlm.nih.gov/pubmed/15363419
 
there is no doubt that it can help, but a great deal depends on the extent of the deterioration and where its exact location is.
 
Acupuncture treatment can have some very positive benefits for lower back pain and for sciatica, as our factsheets show please click here

and please click here

and as we are sure you are aware it is now amongst the recommended treatments in the NICE guidelines for lower back pain. However, there are limits to what any form of treatment can achieve in the face of extreme deterioration of a spinal joint, and you would almost certainly need to be assessed face to face by a practitioner for them to be able to give you an informed professional view on whether they could help you.
 
It is important to be aware, however, that Chinese medicine as a system operates on an entirely different basis from conventional medicine, using concepts such as 'qi', a description of the energy of the body, and of flow of energy around the body. The practitioner will want to know not simply where things hurt now, but how the whole system is working and why the back has deteriorated in the way it has, along with what other symptoms you nay have. All of this information will help them to build up a comprehensive picture of your system and give you the best possible advice on the advisability of acupuncture treatment.   
 

Q:  Hi I have had back pain for nearly 5 years, after I had flu injection, that night I could not walk. I was sent to A E by my doctor. There I was given a pill and left to sleep. I was  sent home  in a wheel chair. My doctor requested  a MRI. I had a small trapped nerve for which I now take more and more pills. I have had pain treatment which gave me 3-4 week free. this was nice, I was given  a tens machine. On using this I had a pain down my spine to my feet.  I  collapsed  it was like cramp. The doctor sent me to A E for a DVT and after 1 week of treatment it was not. It  was a nerve problem. The last 8 weeks have been hard and the pain is worse. I am on a morphine based tablet with another bunch.  The  last MRI showed no damage to lower spine l-5 l-4 l-3.   Is there any chance that acupuncture, could help me this time

 

A:  Generally speaking the advice which we give to people suffering from back pain is straightforward. As our factsheet shows please click here
 

there is a considerable volume of research suggesting that acupuncture can help with chronic low back pain, such that NICE now make it one of the recommended options for treatment.
 
However, it seems as though something else has happened in your case, and the question which a practitioner would have to resolve would be how much the flu injection was causally connected to the sudden escalation of your problem, and if not, what else might have been going on which could have caused the pain and restriction of movement to have increased so much. Back pain is used as a generic term in both eastern and western medicine to cover an enormous variety of specific causes and types of pain. Just as the conventional doctors have tried to elicit by elimination what is causing your continuing problems a practitioner of Chinese medicine would want to try to establish how to classify your symptoms within the diagnostic patterns of Chinese medicine, and then make sense of how some of the interventions appear to have made things worse.
 
Your case has such specific factors that it is difficult to give unequivocal advice, but based on the recognised role of acupuncture in the treatment of low back pain we can say with confidence that it would be worth your while visiting a BAcC member local to you for them to be able to give you face to face assessment of whether they think that acupuncture will benefit you. Of concern, though, will be your reaction to TENS. Although these machines are much more vigorous than acupuncture treatment they often use similar areas of the body for treatment, and the practitioner will want to check whether your system has become hyper-sensitive to some forms of treatment, which can happen when pain becomes constant and debilitating.
     
 
 

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