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Pain can be acute or chronic

Acute pain warns you that you have been hurt. It starts suddenly, and when the injury heals, the pain stops. In acute injury, the pain is due to pressure from inflammation in the tissues and nerves at the site of the injury. This inflammation leads to the swelling that is observable and is part of the body’s healing response.

Chronic pain continues after the injury has healed, lasting for weeks, months, even years. In chronic injury, nerve signals that were active during acute injury continue to send messages that the body is in pain. Although chronic pain is not completely understood, it is potentially due to nerves that have become damaged. New research also suggests that chronic pain can come from a malfunction in the way the brain ‘maps’ sensory information.(1)

Pain affects quality of life

Nearly two-thirds of people with chronic pain report problems sleeping. Lack of restorative sleep often makes the pain worse, thus resulting in a frustrating cycle of pain and sleeplessness. Unrelieved pain can result in longer hospital stays, increased re-hospitalizations, increased outpatient visits, and decreased ability to function, leading to lost income and insurance coverage. In addition to the financial burden that comes with chronic pain, the emotional costs to patients and family can be high as well.

Chronic pain constitutes a tremendous expense to employers in healthcare and rehabilitation costs, and lost worker productivity. Migraine is the 3rd most prevalent disease on the planet (2) and a 2015 study showed that headache pain was the most commonly attributed cause of lost productive time at work in the U.S.

ACupuncture for pain

Acupuncture is widely known for its effectiveness in the treatment of pain. Its unique role in reducing suffering in patients experiencing pain is one of the main reasons it has become so popular around the world. The research is plentiful on the effects of acupuncture on specific painful conditions. For acute pain, a systematic review of 13 trials found that acupuncture was more effective than both sham needling and injection with painkillers.(3)

For chronic pain, in the largest study of its kind to date, 454,920 patients were treated with acupuncture for headache, low back pain, and/or osteoarthritis in an open pragmatic trial. Effectiveness was rated as marked or moderate in 76% of cases by the 8,727 treating physicians.(4) In a 2-year retroactive survey of over 89,000 patients published in 2016, 93% of patients said that their acupuncturist had been successful in treating their musculoskeletal pain.(5)

A meta-analysis of 17,922 patients from randomized trials concluded, “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo.”(6) A follow up study with this data looking at long-term pain relief, found that the benefits of acupuncture persisted 12 months after treatment ended.(7)

Another study in the journal, Current Opinion in Anesthesiology, in the paper titled ‘Acupuncture for Chronic Pain: an Update and Critical Overview’ concluded that “mounting evidence supports the effectiveness of acupuncture to treat chronic low back, neck, shoulder, and knee pain, as well as headaches. Additional data are emerging that support the use of acupuncture as an adjunct or alternative to opioids, and in perioperative settings.”(8)

Low back pain

Low back pain is generally considered to be the leading cause of disability worldwide. In the USA, it is the fifth most common reason that people go to their doctor and the most common cause of chronic or permanent disability in people under 65 years old.(9)

Different types of low back pain

Low back pain can be separated into different groupings, according to which treatments are most likely to be effective.

  • Acute low back pain – Acute low back pain normally lasts a few days to a few weeks. If your doctor decides that there is no other health issue affecting a new case of low back pain, then during the episode they may recommend interventions such as short-term medications, application of heat, normal routine activities, goal-setting and certain physical therapies. Acute low back pain is considered to be a self-limiting condition, meaning that most cases will resolve on their own. Remaining active and involved with your recovery is thought to help prevent the acute pain episode from becoming a chronic problem. (10,11)

  • Sciatica – A condition called lumbar radiculopathy is commonly called “sciatica” because it can involve the sciatic nerve in the lower back. It is also commonly called “pinched nerve”. There are usually specific symptoms and your doctor will normally refer you to imaging studies to check the disc, bones or ligaments in the area surrounding the affected nerve. They will then recommend the best treatment for your situation.

  • Other specific causes of low back pain – depending on the cause of your pain and the symptoms you have, your doctor will decide on the diagnosis and discuss various ways to recover function or manage symptoms.

  • Chronic low back pain – if there is no known specific cause of low back pain, and it has been present for three months or more, then this is called chronic low back pain.

What are the recommended treatments for chronic low back pain?

There are a number of guidelines in different states and countries, but generally-accepted treatment for chronic low back pain often includes:

  • Pain relieving medications

  • Exercises

  • Manual therapies

  • Acupuncture

  • Combined therapies (eg physical plus psychological treatment) (4)

 

A recent guideline (10) suggested that the first treatments offered for chronic low back pain should be non-drug treatments, because these therapies are associated with lower risk of harm. They should be provided by qualified practitioners. These treatments include:

  • Exercise

  • Multidisciplinary rehabilitation (combining two or more approaches eg physical treatment with psychology, acupuncture with exercises)

  • Acupuncture

  • Mindfulness-based stress reduction

  • Yoga

Other therapies which may include tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (10,12)

What makes Chinese medicine treatment for chronic low back pain different from some other approaches?

A group of researchers in Germany looked at different subgroups of chronic low back pain patients, and determined that trying to describe a one-size-fits-all treatment is unlikely to be effective. (13)

In contrast taking a holistic Chinese medicine approach, which looks at the whole person and their individual circumstances. Chinese medicine is a body-mind approach, seeing a person’s physical reality as inseparable from their mental, emotional, social and spiritual life.

We can help you by explaining how Chinese medicine sees all of your symptoms as an integrated whole, not just looking at isolated symptoms such as pain. The Chinese medicine framework is about understanding how factors in your life are interconnected, so that you can set goals for your recovery and work towards regaining wellbeing in an integrated way.

Alongside acupuncture treatment, we generally recommend tailored lifestyle modifications such as stress reduction, meditation, adjustments to exercise routines, dietary therapy or self-care at home such as heat therapy.

 

How can acupuncture work with other therapies for low back pain?

Chronic low back pain is often associated with changes to work, activities or quality of life. Studies have looked at the impact of a “biopsychosocial” model, involving a team of health professionals from different disciplines (such as physical therapies plus psychology). They have found positive effects of this approach on pain and function scores as well as increasing the likelihood of returning to work. (14)

Chinese medicine is a body-mind approach that considers the way a person is interconnected in their natural and social environment. In this way, Chinese medicine is inherently a “biopsychosocial” model.

Some studies have looked at combinations of treatment, and there are positive findings for combinations such as acupuncture combined with conventional medical care or with exercise therapy. Integrated therapy may be more effective than single therapies alone (9).

This has been our observation and we often recommend people to combine approaches such as osteopathy or remedial massage with traditional Chinese acupuncture. We are very comfortable working within a team approach to your health if you are also seeing other health practitioners.

 

How effective is acupuncture treatment for chronic low back pain?

For all non-invasive therapies, patients in research studies tend to experience a greater benefit in pain reduction than improvement in function. (15)

In research studies, acupuncture treatment has been compared to no treatment, to usual care and to “sham” acupuncture (“fake” acupuncture which aims to act as a placebo). At the end of a course of treatment and at three month follow up, acupuncture tends to lead to improvements in pain intensity and in some situations also improvements in function. (12,16,17).

When compared with medications, acupuncture tends to lead to greater pain relief and better function, measured at the end of a course of treatment. (12)

It is important to note that all non-invasive treatments for low back pain tend to show relatively small benefits when applied in research settings, and what happens in a real acupuncture clinic might be different from the limited and controlled treatments that are used in research studies. (16)

 

How many sessions of acupuncture are needed for chronic low back pain treatment?

Studies have varied in the number and frequency of acupuncture sessions, from around four to over 20. Some studies have even looked at results from a single session, but this is not a reasonable expectation.

You can expect to have around 10 sessions to achieve a noticeable improvement. (18) Be aware that each person is different and, with chronic conditions, there may be other factors that need to be addressed to bring about positive changes.

 

Is dry needling the same as acupuncture?

Dry needling is a technique that is usually taught over a short duration, sometimes just one weekend, for physiotherapists or other health practitioners to use an acupuncture needle in a muscle trigger point. Trigger points are “knots” in muscles that are thought to create referred pain.

This is similar to just one small part of acupuncture theory. In acupuncture, we sometimes use “Ah Shi” treatment – “Ah Shi” means “Ah yes”. When the acupuncturist presses on a knot, the patient says “yes, that’s it”. Releasing an Ah Shi point is a very basic application of acupuncture.

Acupuncture has developed over thousands of years, with systematic observations of trial and error handed down through many generations. It is taught in modern times as a university degree over four years, with hundreds of hours of clinical practice. This allows acupuncturists to not only practice according to safety guidelines, but also to consider the whole body-mind system when addressing any single symptom.

Chinese medicine theory is integrated and holistic, meaning that the body systems, conscious experience and a person’s surroundings are considered as an interconnected web of cause and effect. Chinese medicine diagnosis is about seeing these relationships and working with your strengths to encourage the body to regain its self-sustaining balance.

 

Further information or seeking treatment

For further information on Chinese Medicine for pain conditions contact Dr Nicole Trudgeon (Chinese Medicine Practitioner). Nicole is a practitioner of acupuncture and chinese herbal medicine (AHPRA registered) at her Booragoon clinic and is a Chinese Medicine Lecturer at the Endeavour College of Natural Health Perth campus.

  1. Moseley, G. L., & Flor, H. (2012). Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabilitation and neural repair, 26(6), 646-652. DOI: 10.1177/1545968311433209

  2. Fried, N. T., Elliott, M. B., & Oshinsky, M. L. (2017). The Role of Adenosine Signaling in Headache: A Review. Brain Sciences, 7(3). https://doi.org/10.3390/brainsci7030030

  3. Xiang, A., Cheng, K., Xu, P., & Liu, S. (n.d.). The immediate analgesic effect of acupuncture for pain: a systematic review and meta-analysis.

  4. Weidenhammer W, Streng A, Linde K, Hoppe A, Melchart D. Acupuncture for chronic pain within the research program of 10 German Health Insurance Funds–basic results from an observational study. Complementary therapies in medicine. 2007;15(4):238-46.

  5. American Specialty Health Incorporated Health Services Department. (2016). Acupuncture: Does Acupuncture Provided Within a Managed Care Setting Meet Patient Expectations and Quality Outcomes?, 1–12.

  6. Vickers, A. J., Cronin, A. M., Maschino, A. C., Lewith, G., MacPherson, H., Foster, N. E., et al. (2012). Acupuncture for Chronic Pain. Archives of Internal Medicine, 172(19), 1444. https://doi.org/10.1001/archinternmed.2012.3654

  7. MacPherson, H., Vertosick, E. A., Foster, N. E., Lewith, G., Linde, K., Sherman, K. J., et al. (2016). The persistence of the effects of acupuncture after a course of treatment. Pain, 1–22. https://doi.org/10.1097/j.pain.0000000000000747

  8. Yin, C., Buchheit, T. E., & Park, J. J. (2017). Acupuncture for chronic pain: an update and critical overview. Current Opinion in Anaesthesiology, 1. https://doi.org/10.1097/ACO.0000000000000501

  9. Kizhakkeveettil A, Rose K, Kadar GE. Integrative Therapies for Low Back Pain that Include Complementary and Alternative Medicine Care: A Systematic Review. Global Advances in Health and Medicine. 2014;3(5):49-64. doi:10.7453/gahmj.2014.043

  10. Qaseem A, Wilt TJ, McLean RM, Forciea MA, for the Clinical Guidelines Committee of the American College of Physicians. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of Internal Medicine. 2017;166(7):514. doi:10.7326/M16-2367

  11. NSW Agency for Clinical Inovation (ACI). Management of people with acute low back pain model of care. Available from: https://www.aci.health.nsw.gov.au/__data/assets/pdf_file/0007/336688/acute-low-back-pain-moc.pdf. 2016

  12. Chou R, Deyo R, Friedly J, et al. Nonpharmacologic Therapies for Low Back Pain: A Systematic Review for an American College of Physicians Clinical Practice Guideline. Annals of Internal Medicine. 2017;166(7):493. doi:10.7326/M16-2459

  13. Hirsch O, Strauch K, Held H, et al. Low Back Pain Patient Subgroups in Primary Care: Pain Characteristics, Psychosocial Determinants, and Health Care Utilization. The Clinical Journal of Pain. 2014;30(12):1023-1032. doi:10.1097/AJP.0000000000000080

  14. Kamper SJ, Apeldoorn AT, Chiarotto A, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Back and Neck Group, ed. Cochrane Database of Systematic Reviews. September 2014. doi:10.1002/14651858.CD000963.pub3

  15. Chou R, Deyo R, Friedly J, et al. Noninvasive Treatments for Low Back Pain. Rockville (MD): Agency for Healthcare Research and Quality (US); 2016. http://www.ncbi.nlm.nih.gov/books/NBK350276/. Accessed April 2, 2019.

  16. Liu L, Skinner M, McDonough S, Mabire L, Baxter GD. Acupuncture for Low Back Pain: An Overview of Systematic Reviews. Evidence-Based Complementary and Alternative Medicine. 2015;2015:1-18. doi:10.1155/2015/328196

  17. Yeganeh M, Baradaran HR, Qorbani M, Moradi Y, Dastgiri S. The effectiveness of acupuncture, acupressure and chiropractic interventions on treatment of chronic nonspecific low back pain in Iran: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice. 2017;27:11-18. doi:10.1016/j.ctcp.2016.11.012

  18. Wong JJ, Côté P, Sutton DA, et al. Clinical practice guidelines for the noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. European Journal of Pain. 2017;21(2):201-216. doi:10.1002/ejp.931