Ask an expert - muscles and bones - back / spine

65 questions

We are delighted to say that there is some very good evidence  for the treatment of lower back pain with acupuncture. Indeed, until a recent reversal of policy based on what we believe was very unsound interpretation of research, NICE, the clinical guidelines body, was recommending ten sessions of acupuncture treatment as one of the basic offers for people with chronic back pain of over six months duration. You can see some of the evidence on which this decision was based on our factsheet which can be found here:

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

Of course, from a Chinese medicine perspective treating back pain per se is not really how we work. It isn't just empty rhetoric that we treat the person, not the symptom, and although the symptom might be identical in twenty people they may well be treated in twenty different ways. Each symptom arises against a backdrop of imbalance, and it is by treating the imbalance as well as, and sometimes instead of, the symptoms real change can both be made and sustained. There are obviously specific points which can affect the lower back, but if these are treated alone and a deeper underlying problem is not addressed the pain will return.

The fact that pain can arise in many different ways means that sometimes the obvious diagnosis doesn't really work either. Most people over the age of 50 have some deterioration of the lower spine, but although it is often declared the cause, it may not be. We have certainly treated many people with serious deterioration of the lower spine whose pains have gone.

Acupuncture can also be used for straightforward pain relief, and here the main questions which we have are not whether it works but how much and how sustainable the results may be. There has been a great deal of high quality research into the use of acupuncture to release the body's own painkillers (easily measured and easy to assemble test groups), and it is largely on this basis that most Pain Clinics offer acupuncture.

The best advice that we can ever give, since each patient is unique and different, is to visit a local BAcC member for an informal assessment. Most are only too happy to give up a little time without charge to see whether acupuncture is the best option for your specific presentation. We are confident that you will get an honest appraisal and assessment.

A great deal depends on whether the damage to the nerve had become permanent before the operation successfully dealt with the disc herniation. It is unlikely that the continuing numbness is a consequence of the operation itself unless it was already impinged and then further damaged by the surgery. If this is the case then the evidence for nerve regeneration through acupuncture is not at all convincing and related mainly to experiments on animals. From a conventional medicine point of view unless there is an obvious site of inflammation, or the operation itself has left scar tissue which is impinging the nerve it is probable that this may be permanent.

However, from a Chinese medicine perspective it may just be possible that what you are experiencing as numbness may derive from changes in the flow of energy caused by first the herniation and then the operation itself. We are not in the business of giving people unrealistic expectations but we have come across situations, especially post-operatively, where changes in the flow of energy, called 'qi' in Chinese medicine, can manifest as a loss of sensation. Reinstating this flow can sometimes start to restore some of the sensitivity of the tissues.

This would be a bit of a long shot, but may nonetheless be worth trying. The best advice we can give, and which applies particularly in your case, is to visit a local BAcC member for an informal assessment of what may be possible based on physical sight of the problem. Most members offer some time without charge to prospective patients to check whether acupuncture is the best option, and if they find that there is a strong correlation between your areas of numbness and acupuncture channels it may convince them that treatment would be worth trying. 

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.

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