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Ask an expert - muscles and bones - back / spine - lower back pain
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.
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
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
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
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.
Q: I had an epidural when Ihad my son over 2yrs ago. Since I have sufferd really bad lower back pain. Due to the pain I hardly go out and I have put on a lot of weight. Do you think acupuncture could help me?
A: This is quite a difficult question to answer. The official NHS sites quote statistics from studies which demonstrate that there are no long term side effects, perhaps only mild and short-term problems, but a quick internet search reveals hundreds of posts from women who have suffered long term debilitating problems.
It is very important to establish as much as possible what the problem is. In the first instance this means going back to your doctor and trying to get an MRI scan of the area to eliminate the possibility that there has been some damage during the epidural or some form of haematoma or tissue change which is causing the problem. This will determine how good the prognosis is.
It is also important to consider the possibility that the back pain may not be a result of the epidural. Pregnancy involves carrying a large weight at a disadvantageous angle, and if there were any minor irregularities or misalignments of the lower spine, these might have been pushed one stage further by the pregnancy and vigorous exertion of birth.
Acupuncture treatment may offer some hope. As our factsheet shows
there is some evidence that acupuncture can help with non-specific back pain, and the NICE guidelines (which determine what treatment doctors can offer) have included ten sessions of acupuncture as one of the cost-effective options to consider.
Back pains arise for all sorts of reasons, however, and even in Chinese medicine there are dozens of ways of categorising what may be happening. Sometimes this will offer a good prognosis, at other times not. The skill of the practitioner lies in seeing what else is going on in the system as a whole and using this knowledge to understand what patterns of imbalance of energy have developed over the years. It is rare for someone to have only one symptom, and there are often changes to the normal systems which people just accept without mentioning, like digestive problems or sleep disorders which just become the 'normal' order of things.
The best advice we can give, apart from following things up with your doctor, is to visit a BAcC member local to you and ask for their opinion in a brief face to face assessment. This can give you a much better idea of what can be done than we can give here.