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and the effects on
Back pain is one the one of the most common reasons people visit a health care provider. According to the National Institute of Health, up to 80% of the population of the United States will suffer from back pain in their lifetime, with lower back pain as the most common location of this pain (www.ninds.nih.gov/disorders/backpain/detail_backpain.htm). Acupuncture is an increasingly used treatment for this back pain.
The history of acupuncture begins about 4,000 years ago with the beginning of traditional Chinese medicine. Traditional Chinese medicine is one of the oldest continuous systems of medicine in history. Instances of its use date back as far as 2,000 B.C.E. Chinese medicine is complex and difficult for outsiders to understand. It is based on the Daoist belief that everything in the universe is interconnected. The mind and body are part of an energetic system within this universe. Organs and organ systems are interconnected and work together to keep the body functioning. In other words, what happens to one part of the body affects every other part of the body.
The main concept of Chinese medicine is the Qi (pronounced “chi”), which is considered a vital force or energy responsible for controlling the workings of the mind and body. Qi flows in the body through pathways called meridians. There are in total 20 meridians in the body. Of these, 12 are primary meridians which match specific organs, organ systems, or organ functions. The other 8 are secondary meridians. Imbalances in the flow of Qi are what cause illness, and correction of this flow restores the body to balance and, therefore, health. Acupuncture is the most often practiced component of traditional Chinese medicine used to restore the body’s balance.
(all “About acupuncture” above from: http://www.acupuncturetoday.com/abc/)
How acupuncture is done
Acupuncture is performed with very thin needles. The needles are inserted into pressure points that are often far from the actual site of symptoms ( Acupuncturists can use up to 9 types of needles. Only 6 are generally used today. These needles can vary in length, width, and shape. There are a few different methods for needle insertion. Needles can be inserted anywhere in the range of 15 degrees to 90 degrees relative to the skin surface. In most cases a patient should feel a sensation accompanying the needles. This sensation, which should not be pain, is called deqi (pronounced dah-chee). After the insertion of the needles, the acupuncturist may perform a variety of techniques. These include: raising and thrusting, twirling or rotation, a combination of raising/thrusting and rotation, plucking, scraping (vibrations sent through the needle), and trembling (another vibration technique). Techniques are carefully chosen based on the disorders. Another acupuncture technique is called Electro-Acupuncture. This is done by sending very small electrical impulses through the needles. This is a technique commonly used for pain relief ().
Are there any side effects?
Generally not. However, in extreme cases, if not done properly, damage can be done to nerves, organs, etc. A publication by the International Spinal Cord Society stated that in Korea, a 64-year-old man was admitted into the hospital because of epidural abscesses and spondylitis. These happened during an acupuncture session. Despite antibiotics, he did not experience neurological recovery and was left paraplegic (Bang and Lim 2005). This case is, of course, very extreme.
What the people say
Looking at patient testimonials, all have claimed that acupuncture helped relieve their pain more than any other treatment and kept it away longer.
Here is an example of one of these testimonials: “Hello, My name is Janet Shepard and I live in Alaska. I want to say that my first three acupuncture treatments have significantly healed constant neck and back pain that I have had for years. Although movement therapy and chiropractics helped me previously, nothing has reduced the pain more than acupuncture. I have recommended it to several friends that have constant neck and back pain. One of my friends that went to my acupuncturist has been very pleased with the reduction of her neck/back pain” (http://www.acupuncture.com/testimonials/neckback.htm).
What the studies say
According to a 2002 study by DC Cherkin, RA Deyo, and KJ Sherman, the most frequent reason that Americans visit a licensed acupuncturist is for low back pain treatment (Cherkin DC, Deyo RA, Sherman KJ, 2002).
A 2005 study reviewed previously conducted studies on the treatment of low back pain between February 2003 and August 2004. They also contacted experts from various countries for randomized, controlled trials that compared needle acupuncture to other forms or no treatment. They included 22 trials of this sort. They analyzed the data from these trials based on the results on short-term effectiveness on pain, long-term effectiveness on pain, and short and long-term effects on functional status and overall improvement. They found through these various studies that on short-term effectiveness acupuncture was 58% more effective in relieving pain than mock acupuncture, thereby removing the chance of a placebo effect. It was more effective in 3 out of 4 studies than using transcutaneous electrical nerve stimulation. Acupuncture was more effective in 2 out of 3 studies than pain medications. Long-term effectiveness was found to be 61% more effective than mock acupuncture. The study found that in both instances, the effect on functional status and overall improvement was significantly more effective than the mock treatments (Manheimer E, White A, Berman B, et al, 2005).
A 2001 study observed 33 women and 17 men around the age of 49 that had been suffering from chronic low back pain for at least 6 months and had tried other methods of treatments that had failed. The subjects were assigned randomly to three groups: manual acupuncture, electro-acupuncture, and placebo. The patients were given a total of 10 treatments spanning an 8 week period. Assessments were performed by a blind, independent observer. The study revealed that there was a significant difference in the amount of pain experienced after treatment in the placebo group and the acupuncture group with the acupuncture group having less pain. The data also revealed that acupuncture was more effective in women (Carlsson C, Sj˜lund B, 2001).
Another 2005 study tested particularly the long-term effects of acupuncture for acute or chronic lower back pain. The subjects were given 10 sessions of acupuncture over a 10 weeks span. Follow up interviews were conducted by phone 3 and 6 months after the treatment. The results found that pain tolerability was significantly improved (3.4 to 6.8) and remained so up to 6 months after the initial treatment. Therefore, acupuncture has a long term effect on cognitive and emotional pain coping (Kukuk P, Lungenhausen M, Molsberger A, Endres HG, 2005).
According to a 2005 study that not only tested the results on pain but also the cost effectiveness of the treatment, acupuncture is a safe and acceptable treatment for patients with non-specific low back pain. They had general practitioners recommend patients aged 18-65 years who had been suffering low back pain for 4 to 52 weeks to acupuncturists. They did a baseline assessment and followed up after 3, 12, and 24 months. Acupuncture was significantly more effective in reducing bodily pain than was the general practitioner’s method of treatment as shown in the 12 and 24 month follow up. They also said that the referral to an acupuncturist was a cost-effective intervention for reducing low back pain over this 24 month period (Thomas KJ, Macpherson H, et al.2005).
Despite data being mildly sparse, particularly on the long-term effects, there is now reasonable evidence that acupuncture is an effective treatment for chronic back pain. It has both short-term and long-term effectiveness and may be considered a viable option for those who suffer from acute to chronic back pain.
1. Bang MS, Lim SH. Paraplegia caused by spinal infection after acupuncture. Spinal Cord advance online publication 2005.
2. Carlsson C, Sj˜lund B. Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Clinical Journal of Pain 2001;17(4):296-305.
3. Cherkin DC, Deyo RA, Sherman KJ, et al. Characteristics of visits to licensed acupuncturists, chiropractors, massage therapists, and naturopathic physicians. Journal of the American Board of Family Practice 2002;15:463-72.
4. Kukuk P, Lungenhausen M, Molsberger A, Endres HG. Long-term improvement in pain coping for cLBP and gonarthrosis patients following body needle acupuncture: a prospective cohort study. European Journal of Medical Research 2005; 10(6):263-272.
5. Manheimer E, White A, Berman B, et al. Meta-analysis: acupuncture for low back pain. Annals of Internal Medicine 2005;142:651-663.
6. Thomas KJ, Macpherson H, et al. Longer term clinical and economic benefits of offering acupuncture care to patients with chronic low back pain. Health Technological Assessment. 2005;9(32):1-126.
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