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

25 questions

Q: . I have been in quite severe pain in my back and also my stomach area due to scoliosis. The pain killers the doctors given me for the last 4 odd years make me drowsy and constipated. Would acupuncture ease my pain and what kind of price am I to expect for treatment. I'm a student single mother so this worrys me. 

A: The use of acupuncture for pain relief has a long and interesting history. After President Nixon visited China in the 1970s and the  world saw acupuncture being used for operations it started a huge amount of research into acupuncture for pain relief. Fortunately the markers for pain relief, the release of the body's own endorphins and enkephalins, are very easily measured, and it was soon established that treatment could stimulate the release of these. Many Pain Clinics now use acupuncture as a standard treatment, and the main question is usually not whether it works but the extent to which it works and how sustainable the results might be.

As you have probably already worked out, the answer can eventually become a financial one - if treatment works for a week, is it possible to keep paying weekly for treatment? For someone with deep pockets and a need to be at work this might be a worthwhile deal, but for someone on a tight budget this could price it out of reach. Many of our members feel quite strongly  that acupuncture treatment should not be a middle class preserve, and following a model set up in the States have opened multibed clinics where treatment is offered in a groups setting with three or four couches in a large room for a very much lower fee. The normal safeguards apply for dignity and privacy, but obviously this is not quite the same as being in a private space. For many people, though, this is a good deal, and a list of these clinics can be found here on the website of a special interest group set up to develop this concept.

There is also every chance that most BAcC members will be prepared to offer a fee reduction in circumstances of need. Obviously we don't openly advertise this because it always leads to people who can well afford treatment starting to bargain us down, but I am not aware of many colleagues who have not treated someone as cheaply as they can because they recognise a case of genuine need. This is far easier for those with their own treatment space - if you are renting on a sessional basis you have to cover the overhead - but asking costs nothing.

The only caveat is that problems like scoliosis are generally not fully fixable, however good the treatment is, and it pays to be realistic about the outcomes. Most people we have seen are mainly concerned with managing the pain rather than looking for dramatic change, but it is always really important to be clear about outcomes when dealing with a chronic and potentially irreversible condition. However, we are confident that if you could reduce your reliance on painkillers you would probably be well pleased; being permanently tired and constipated is not much fun.

That said, sometimes the best and unexpected happens, as here

Q:  I had acupuncture  on my neck, shoulder and back.  I am suffering bad pain on the right side of back going into my buttocks. 

A:  A great deal depends on whether the pain is at a needle site or not, and to some extent what you were being treated for.

If the pain is at a needle site, then there is a small chance that you have a minor bruise which may not yet have shown itself at the surface but may be quietly impinging nerves in the area. If this is the case the pain will have come on soon after the treatment and been pretty consistent. It also means that as the bruise heals the pain will diminish, and eventually go.

However, if you were being treated for a back or neck problem it is not unusual for there to be a reaction after treatment which can make someone's symptoms worse before they start to get better. Very often the body becomes used to operating slightly out of kilter so when a practitioner tries to restore normal function and the body re-arranges itself it can feel very uncomfortable. Osteopaths and chiropractors tend to give the same warning to patients, but generally the adverse effects have worn off after two or three days.

There is always a chance that the pain has nothing to do with the treatment itself. We are not being defensive in saying this but we do come across cases where a pain kicks off after treatment that is not related to what has been done. In these circumstances our job is to ensure that someone gets the appropriate treatment rather than argue about whose fault it was. The diagnosis and treatment usually establishes quite quickly what the cause was.

The best advice we can give is that you speak first to the practitioner to get an idea of whether the pain is related to either the needle site or the problem you are addressing. If it is, then we expect that they will do their best to sort it out when they next see you. If they are mystified about the cause, or if you feel uneasy going back to confront them, and the pain carries on at the same pitch it would be worth booking an appointment with your GP to make sure everything is OK. This is just a precaution, but always worth taking rather than wait too long (given that same day appointments are something of a rarity).

We have a cycle for replies which means that by the time you get this we are hoping that the pain has already started to subside. If it continues, then you need to call the practitioner or your GP soon.

Q:  I had decompression surgery July 2015 to relieve l5 nerve. I reherniated within 3 months and again have lower back pain and nerve pain. Could acupuncture help deal with pain/inflammation?

A:  There is certainly a considerable amount of evidence for the use of acupuncture in the treatment of low back pain, as our factsheet shows

The evidence is sufficiently robust that NICE make acupuncture one of its recommendations for treatment of chronic back pain lasting more than six months.

However, when there is a specific cause like a herniated disc, we tend to be just a little cautious about what may be possible, especially when we are not entirely sure of the nature of the surgery (fusion, laminectomy, discectomy, and so on). Where there are specific physical changes in the body that can limit what we are able to achieve. This may mean, for example, that treatment might be aimed at pain relief and reduction of inflammation but only with the expectation that this will eventually return. The equation then is between how much relief and how sustainable, and the cost of maintaining an 'acceptable' level of discomfort.

It is best not to be too negative, however.Our clinical experience is that when there is disc protrusion which will probably resolve of its own accord within six to twelve months treatment may be able to speed up that process, and may well be able to reduce some of the inflammation which it causes. There is a spiral of discontent where a problem causes inflammation which exacerbates the initial problem, and conventional medicine is often aimed at the same thing, to break the cycle and let things stabilise.

In summary, we suspect that treatment may well be able to help with the pain and inflammation, but we think that the best option is for you to visit a BAcC member local to you for a slightly better assessment than we can offer here. Most are willing to give up a some time for prospective patients without charge and this sort of face to face assessment would in our view be essential to give you the best possible information. We treat people, not conditions, and the great Canadian physician William Osler summed this up well; 'tell me not about the disease the patient has, tell me about the patient who has the disease.' The wider context within which the symptom sits can have a huge impact on what can be done, and with problems like yours really does need to be taken into account. 

A:  Acupuncture has traditionally been used for chronic pain, often because the first major publicity event for acupuncture in the West, Nixon's visit to China in the 1970s, saw operations carried out without anaesthetic under acupuncture, and a great deal of research was stimulated into the pain relieving and anaesthetising effect of treatment. Many pain management clinics now feature acupuncture as a part of their offer. The main question is not whether the treatment will relieve the pain as much as how much relief it will give and hows sustainable its effects are. Used in this way it can sometimes, if affordable, be enough to keep someone going.

However. from a Chinese medicine perspective pain only arises where the flow of energy, called 'qi', has been affected, either from a blockage, or from a deficiency or excess in the channels through which it is said to flow. Knowing where pain appears is less important than understanding how this sits against the backdrop of the whole system. On many occasions the pain is local and to do with specific local issues, but even here the question is how the system has lost its ability to repair. More often than not, however, the pain appears as evidence of a deeper functional disturbance, and the skill of the practitioner lies in making sense of the local manifestation of discontent in the context of someone's overall balance.

The way in which energy flows in the body, and the various functions which are grouped together under the heading of an Organ (capitalised because the meaning is far broader in Chinese medicine) often show greater connections than are apparent from a conventional medical point of view. If the symptoms, for example, tended all to lie on the same channel, and this channel happened to be associated with an Organ generating other symptoms of functional disorder, this would immediately inform the practitioner and point to various treatment possibilities.

The best advice for concerns like yours is to visit a BAcC member local to you and seek a brief face to face assessment to see what they think may be possible. We would be very surprised if they did not immediately make some connections which informed their view, and if so, we think they will probably advise you that four or five sessions may be a worthwhile investment to see how well your system reacts.


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

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.


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