Ask an expert - muscles and bones - back / spine

63 questions

Q: My partner has two slipped discs in her back. She been refused surgery due to her age and has now been refused injections.
Will acupuncture help her?

A: We have been asked surprisingly few times about slipped discs, and our answers to the questions have been relatively circumspect, as you can see from this example:

Slipped discs can take a long time to recover, even when using therapies which are known to help. Where the standard treatment in conventional medicine used to involve a great deal of bed rest, continual movement is now the order of the day to help the accumulated tissue to disperse. Our fact sheet on sciatica

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

mentions a number of studies which show some encouraging results for the kinds of secondary problems which can arise from a slipped disc.

Sight unseen it is very difficult to offer a detailed opinion, but speaking in very general terms, there is often an accident or underlying pattern of weakness which predisposes someone to have a slipped disc, and there are often ways of understanding the disease process from a Chinese medicine point of view which offer treatment possibilities. This can often be the case when someone has reached a plateau in the conventional treatment they are having.

However, it is not uncommon for people to seem to plateau and then for the condition to resolve after 3-6 months, and you may well find that you suddenly begin to make progress again. Acupuncture treatment certainly won't do you any harm, and given that the area where you have been affected will have been quite immobile and 'stagnant' for a few months it is possible that from a Chinese medicine perspective there are significant blockages whose clearance may help to speed up your recovery.

At least a part of the reason for this circumspection is the fact that herniation usually resolves after about three to six months, and it can be difficult to assess in the circumstances whether the acupuncture treatment has added to the speed of recovery. The range of problems covered by the generic term 'slipped disc' is also quite extensive, and assembling a control and test group with identical problems may present problems in the current climate of minimal funding for acupuncture research in the West. We are confident that trials will have been conducted in China but most are never translated. Where there have been good results, though, they do tend to surface quickly, and the absence of research which meets western standards probably speaks volumes.

The fact that surgery has been considered probably points to some quite serious herniation, and we would probably surmise that the best we could achieve would be to lessen some of the pain and reduce some of the symptoms. The extent to which this worked, and how sustainable the change would be, is something only treatment itself would establish.

We always believe that the best option for cases like these is to visit a local BAcC member for an informal assessment of what may be possible. Most offer a small amount of time without charge to prospective patients to get a better idea of what benefit there may be in cases where it is not clear from the 'headlines', and if someone does commit to treatment there is usually a very clear agreement to assess progress after three or four sessions to see whether the progress warrants further time and expense.

Q: Can acupuncture help with polymyalgia? I have this fairly under control with steroids but have a very painful lower back pain.

A: Not surprisingly we have been asked many times about polymyalgia, and a typical response has been:

There are surprisingly few studies into the effects of acupuncture treatment on polymyalgia, and this does limit what we can say from a conventional medical perspective about the treatment of the condition. However, we suspect that this is a great deal to do with the diffuse ways in which the condition presents. In our experience the definition is imprecise, and we have seen patients with identical presentations diagnosed very differently.

From a Chinese medicine perspective, though, this doesn't really matter. For us the description of the patient's symptoms is seen against an entirely different theoretical framework. This involves an understanding of the body as a flow of energy whose rhythms, flow and balance can affect someone's health. When pain arises it is usually a sign of blockage in the system, or excesses and deficiencies which we can correct with the use of needles.

The real skill and art of the practitioner lies in identifying the true source of the problem. Such is the complex web of inter-relationships within the body a symptom will often not be the same as the cause of the problem. Finding out where the root cause is and addressing it is what differentiates a traditional practitioner from someone using simple all-purpose formula points. If the root is not addressed then the problem will come back. This also explains why a dozen people with the same symptom can be treated in a dozen different ways, with treating being individualised to each case.

The best advice that we can give is that you visit a BAcC member local to you so they can give you a brief face to face assessment of what could be possible. A skilled practitioner should be able to give you a rough idea quite quickly of how much change they think they might achieve and over what period of time. Most of our colleagues are happy to give up a few minutes without charge to enable the patient to make an informed choice, and will also be likely to offer good alternatives if they think these will address your problems better.

If asked by a patient what the evidence for the success of acupuncture for PMR is, though, we would have to be honest and say that not only does it not meet the gold standard of western research, the RCT, but often fails to meet any reasonable standard. We believe that this is partly to do with the difficulties of assembling a meaningful cohort for a trial, the diagnosis not always being precise, but partly to do with the fact that treating it as a purely physical condition may not be dealing with the underlying causes, some of which are often mental and emotional.

We believe that, downbeat as it may be, this is still a good answer. PMR is a condition which can on occasion be intractable, and it would be remiss of us to start making claims for treating all cases with great success. For many people the diagnosis is much broader than PMR itself, and there are often complex emotional problems which arise from having been incapacitated for a long time.

However, we are always careful when we see patients not to assume automatically that any pain which they experience is always a result of their 'headline' problem. There are often back pains which have an entirely different root cause, and if this is the case we usually feel pretty upbeat about our chances of achieving something with the patient. Until recently NICE recommended a course of ten treatments of acupuncture for chronic low back pain, and it is one of the commonest presentations in our clinics. The evidence for acupuncture treatment is good, as ourfact sheet shows:

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

There's actually a short video on our home page of one patient's experience of treatment for back pain.

The advice we gave in the earlier reply still holds good. Find a local BAcC member and ask for a brief interview to discuss with them whether they think they can help. The fact that they can see what is going on and talk to your directly will give you a much more precise answer than we can offer here.

Q: I have been diagnosed with Spinal Stenosis which gives me intermittent severe phantom pains in my toes and feet. I have had a steroid injection in my back but this had little effect. I do not want to take the pain relieving medication suggested as it severely affects my life style. Would acupuncture be able to relieve these pains I get which are not actually where they seem to be?

A:

We have been asked about spinal stenosis on a number of occasions, and the most recent answer, albeit three years old, still remains a good one. We said:

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. We try to keep on top of any changes or developments; occasionally research appears which is of a sufficiently high standard for us  to use it in our marketing materials as a claim for efficacy. The only study we found which was more recent and directly applicable was this one, https://www.ncbi.nlm.nih.gov/pubmed/26953235 which was far less enthusiastic than the earlier ones we cited. Aside from that we did unearth a rather strange study about a technique called acupotomy, but given that this is a minor surgical technique we suspect there are few practitioners in the UK who could legally perform it.

The broader question of pain relief is one we didn't address in the earlier answer, and does need to be mentioned. Clearly the visit of Nixon to China in the 1970s and the amazing footage of people having surgery using acupuncture as an anaesthetic kicked off a huge amount of research in the West about the use of acupuncture for pain relief. The general conclusion was that for neurophysiological reasons acupuncture is believed to trigger a pain-relieving chemical, and the main question is not whether it works but how well it works and for how long. If someone can have a treatment which provides a few days of considerable relief, then as long as they can afford to continue regular treatment or target those occasions when it would be beneficial to be pain free, then this may be a viable option.

The only real answer, though, will come from direct inspection of the problem by a practitioner. This will enable them to see what is happening in the context of your overall system, and that in turn offers a much better chance of getting a clearer view of what may be possible, certainly better than  we can generate at this remove.

Q: Can acupuncture help or make it worse for pain related with severe disc degeneration and acute inflammation Modic type 1 to the endplates? I've had my condition for three years, with no pain free moment ,which is common with Modic type 1 inflammation. I tried all types of treatment for the condition and the pain, but nothing helped. I was told this is the case with people with my condition, as it is nothing like any other back condition since the most pain is caused by the bacteria in my spine. Recently I was referred for acupuncture treatment and I had two sessions. After each one I felt much worse including pain in the affected area, aches all over the body and massive headache lasting for a week or so. After the second session I experienced a huge relapse with my back problem, with severe pain not going away for days, even with increased dosage of prescribed painkillers, Tramadol. While it's been scientifically confirmed that there is no proof that acupuncture can help with the type of condition I have I still wanted to try. My concern is that I have been much worse after treatment and it takes a week to go back to my 'normal' days when I can somehow manage the pain, which is not possible after acupuncture. Would you recommend continuing with the treatment in my situation?

A: When someone has a problem such as yours it can be quite difficult even in conventional medicine to predict what might happen with treatment. We have conducted a database search for treatment with acupuncture specifically aimed a Modic Type 1 and there is no evidence of any trials which focus on this specific diagnosis. However, until recently NICE used to recommend acupuncture as a valid treatment for chronic back pain of over six months duration on the back of some very strong evidence, and we strongly suspect that many of the thousands of the patients in these studies had Modic Type 1 problems alongside the chronic degeneration of the lumbar spine and discs which may have been assumed to be the cause. The estimates of between 20% and 40% of patients with chronic low back pain being troubled as you are would seem to make this a reasonable conclusion to draw.

We often warn people with back and neck problems to be aware that the next 48 hours after treatment may be a little rocky. We are not alone in doing this; many osteopaths and chiropractors similarly warn their patients, and many of our patients report feeling worse after manipulation. There are various reasons which we have heard advanced for this phenomenon, and the most compelling is that trying to encourage structural or postural changes associated with good function is bound to bring muscles into play which have been relatively untested for years. From a Chinese medicine point of view there is an equally compelling picture of stagnant energy and its renewed movement. This can often be quite unpleasant, rather akin to having cold hands or feet and warming them in front of a fire to restore circulation. This can often be slightly unpleasant to begin with.

The key thing about these reactions to treatment is that they tend to occur for the first one or two sessions only, after which the body had made its initial changes of direction and is now moving forward in a more predictable fashion. Hence sessions three and four and onwards will often have none of the more challenging outcomes as the first ones. If it carries on being painful, then it is just possible that the patient is too sensitive for the treatment. If so, there are only two options. One is to reduce the impact of the needles by using less needles, inserting them less deeply and manipulating them less. Practitioners can do quite a great deal to 'turn down the volume' so to speak, and some forms of acupuncture treatment, especially Japanese style needling, are barely perceptible.

There is, however, a small minority of patients whose sensitivity to needles is such that treatment is a bit of an ordeal and will continue to be so. This can manifest as you describe it, and unless the overall trend is upwards after the first two or three sessions then it would be wise to sit down with the practitioner and discuss how best to carry on. If it has no impact on the pain, then there would seem little point in carrying on. In our experience, though, most people do begin to enjoy lower levels of discomfort, and the usual question is how much pain relief and how sustainable it is.

Of course, the factor which we haven't mentioned is that the acupuncture treatment and the relapse are entirely coincidental. In practice we have to be careful when we broach this because it sounds like the beginnings of an 'it wasn't me' denial. In reality, though, with over 4 million treatments a year in the UK we are going to see a number of occasions where an increase in symptoms has nothing to to with the treatment, and our main aim then is to find out what is happening rather than getting involved in arguments about whether acupuncture treatment was the cause. We find that getting to the bottom of what is happening usually establishes that very quickly so there is nothing to be gained by delaying further investigation.

We do hope, however, that this is a typical pattern of things getting slightly worse before they get better, and that the next few sessions bring you the relief from pain which you would like to experience.

 

 

Q:  Can acupuncture for lower back pain cause imbalance and dizziness . The next day I spent in bed because when I moved I felt I might fall over and and everything was moving especially when I bent down or moved quickly.

A: We are sorry to hear of your problems.

 The first thing we have to be clear about is that acupuncture, whether performed as traditional acupuncture or one of the versions of medical/symptomatic acupuncture, treats the person as much as the condition. To that extent even a symptom elsewhere in the body may have been triggered by treatment aimed at something entirely different. The same applies even if the person thinks they are 'only treating a bad back', and we have registered our concerns over the years about people using formula treatment having unexpected effects on the patient.

 That said, the reaction which you have had is a great deal more severe than we would normally see. We warn patients that they may feel a little odd for 24 to 48 hours, but the 'normal' reactions of this type are relatively minor - a slight headache, additional tiredness for a while, and occasionally a slight return of an earlier symptom as the body reverses the process of disease. To have to spend a day in bed feeling dizzy after a treatment would be highly unusual; we gather statistics on what we call adverse events, and this is not one we come across before. That does not mean that it hasn't happened, only that it hasn't been reported to us. However, we find that patients are usually very keen to tell us when something has happened.

 We think the most likely reason is that you have had the misfortune to have a viral infection which has by chance coincided with your treatment. With over 4 million treatments a year in the UK there are going to be a few cases where something happens after a treatment which has nothing to do with it, and this may well be one. It does sound rather unpleasant, however, and if it has persisted into a second or third day we think you might do well to consult your GP. There are other possibilities, none of which you should worry about but which treatment may be able to help. There are a number of problems associated with the inner ear, for example, which can generate these symptoms, and your GP may well be able to help you deal with this.

 We shall definitely keep a record of what you have reported, though. The fact that we have had very few reports like this in the past does not mean that there isn't a theoretical risk that it could happen, and if we find over time a cluster of cases we would always update our information to the public to make them aware of the potential risk.

 In any event, we do hope that the problem has already resolved, and that it hasn't put you off having further treatment for your back. As you may be aware from our literature back pain is a problem which really does seem to respond well to acupuncture treatment to the extent that it forms one of the recommended treatments in the NICE guidelines for NHS patients.

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