Ask an expert - muscles and bones - back / spine

66 questions

Q:  I had solilcsis curvature of the spine and was corrected with surgery 21years ago.  I get spouts of bad back pain which become unbearable and it's hard to continue with work and life even with medication ....would acupuncture help.  I've  had all other physio which is not of great help.

A:  A huge amount depends on the kind of surgery you had when you were younger. This often involves some kind of spinal fusion, although if the surgery is performed in pre-teenage years it may not be quite so drastic.

Without a much greater amount of detail about the surgery and the potential this has created to interfere with other physical structures like spinal nerves it would be difficult to say precisely how much benefit you might expect. This expert, for example, has a patient with a serious ankle deformity which has meant operations leaving the right leg longer than the left leg. The effect of this on the lower back is going to be permanent as her body strives to maintain the head over the centre of gravity while the pelvic and sacro-iliac joint are rotated. However, treatment does seem to contain the occasionally more severe bouts of pain, although in one bout the pain simply did not respond at all.

This was a surprise because acupuncture for pain relief is a fairly well established option. After the US President Nixon's visit to China in the 1970s where we saw operations where acupuncture was used instead of anaesthetic there was a huge amount of research into acupuncture for pain relief, and the main question is not so much whether it works but how much it works and how sustainable the results are. If a treatment can buy a week or two's reduction in pain it might be a viable long term option, even if the cause remains and will continue to cause bouts of pain. It may come down to a matter of how deep someone's pockets are, but there is certainly provision within NHS Pain Clinics if you are lucky enough to get a referral to one.

Other than that the best that we can recommend is that you visit a BAcC member local to you for an informal chat about what acupuncture treatment may be able to offer. Most members are happy to give up a small amount of time without charge if they or the prospective patient are not entirely sure whether acupuncture would be a good option. This also gives you a chance to meet them and see where they work, factors which can make a difference in people's choices.

Q:  Can acupuncture help to repair nerve damage after a spinal injury? I'm asking specifically in relation to a lower (sacral) spinal injury and associated incontinence. 

A:  There are precious few studies of this problem. One of the few, which is too small from which to draw too many conclusions,

http://www.ncbi.nlm.nih.gov/pubmed/9739588

dates from 1998, and a second study from over a decade ago

http://www.ncbi.nlm.nih.gov/pubmed/12510181

uses some quite all-purpose formula treatments and seems to generate some interesting but unspecified results.

Generally speaking a great deal depends on the nature of the cause of the problem. If the spinal nerves were damaged by an accident there is usually a great deal less that can be done than when the problem is caused by a problem like collapsed discs or crushed vertebrae.

Nerve regeneration is a hot topic at the moment, with considerable optimism being placed in the concept of neuroplasticity. While we have seen some interesting case histories involving re-wiring taking place in the brain damage to the spinal cord does not seem to have been tested yet. There are some lab tests on animals using acupuncture to stimulate nerve regeneration, what out colleagues disparagingly describe as 'ratpuncture', but even if this were to show positive results it would not be conclusive that similar treatment would work with a human.

The best advice we can give, especially in cases like yours, is to visit a local BAcC member to get a brief face to face assessment of what might be possible given your own unique and specific circumstances. This will be far more accurate than any view we can advance from here without seeing exactly what is happening. The system which we use is based on a theory of the flow of energy, and if a practitioner sees blockages in major pathways of flow there may be something which acupuncture can achieve. There are occasions, for example, where physical damage can affect a nearby pathway of energy in such a way as to cause a functional disturbance which looks to all intents and purposes as though it were directly caused by the original injury.

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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:  Three years ago my partner had 2 discs removed from his spine and has been in severe pain in his back and legs ever since. Would acupuncture help him ?

A:  A great deal depends on the extent of the physical changes which have occurred in the operation and whether the vertebrae have been fused. If the physical structure is now such that the spinous processes constantly  impinge nerves then the chances are that the best one could hope for is to turn down the volume a little.

This is certainly an aspect of acupuncture practice which has been thoroughly researched since Nixon's visit to China in the 1970s. The sight of people having operations without anaesthetic meant that there was an upsurge of research into acupuncture for pain relief, and quite an impressive amount of research into the effects of acupuncture on the release of endorphins and enkephalins, the body's natural painkillers. Of course, the issue with this kind of treatment is that like all painkillers they wear off, and the rather unfortunate equation is between cost and effectiveness. If treatment can reduce pain for a significant time then the cost of doing this on a regular basis becomes the main issue.

This kind of use of acupuncture is not really traditional acupuncture, though, and we would have perhaps one or two ways of considering what is happening based on our view that the body is a system of energy in movement and that pain arises where the energy (called 'qi' in Chinese medicine) does not flow as it should. This can mean in some cases that post-operative pain can have as much to do with the blockage in the flow of qi caused by the surgery as  the problem which the surgery was intended to correct.  Even scar tissue can act as  a block.

However, we would not want this to be read in a way that gives unrealistic expectations. Some people do respond well to post-operative treatment, but again, a great deal depends on the state of the whole system. If a chronic problem sits atop a history of other chronic health problems then the potential for recovery may be less. The strength of Chinese medicine, though, is that it looks at the person as a whole, and tries to make sense of why this person has these particular problems.

This is why we most frequently advise people to visit a BAcC member local to them for advice on what may be possible given their own unique balance. There may be aspects of the presentation which will inform a practitioner about the likelihood of successful treatment, and most members are happy to give up a little time without charge to make this assessment. Our postcode search facility on the home page will show you the practitioners working closest to where you live or work. 

 

A: The simple answer is that it works!

As our factsheet shows

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

there is an increasing amount of evidence that acupuncture treatment is very effective at reducing back pain. One of the most impressive results comes from what are known as the GERAC studies, a truly huge study conducted in Germany about ten years ago. The scale meant that many thousands of treatments were examined, and the results, as you can see from the paper cited here

http://www.ncbi.nlm.nih.gov/pubmed/17893311

were very impressive. Of course, the so-called sham treatment also scored far better than the conventional treatment, but as a medical colleague of ours remarked, a 'placebo' treatment that can outperform conventional treatment by such a huge margin would be worth the investment even when the exact mechanism is not known.

In fact we have always taken issue with the idea of sham acupuncture. There are no places on the body, in our view, which are inert energetically, and what we see in most sham vs verum trials is a comparison between good and indifferent acupuncture. Some of the sham techniques are now becoming more sophisticated, but a great many of the aspects of traditional acupuncture which may well contribute to the therapeutic effect may well be a part of the sham mix.

NICE, the National Institute for Clinical Excellence, made ten sessions of acupuncture its recommendation alongside other treatments in the basis of cost effectiveness as much as efficacy, and for many years this has been the case. The sector paper is under review again and we are working our hardest to ensure that this situation does not change.

Back pain is, of course, as old as mankind, so it is not at all surprising that the ancient Chinese had a handle on what might be causing it from a Chinese medicine perspective, and plenty of potential treatments to help to relieve the symptoms.  It remains one of the conditions which brings clients to acupuncture practitioners, and our sense is that it is only because of the good reputation that traditional acupuncture has that the treatment works that word of mouth referral is still so strong.  The Chinese understanding of the flows of energy and the functional relationship of the Organs provide a detailed and elaborate picture of how the healthy back functions, and with that plenty of space for interpretation of how each individual presentation has occurred.


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