Interesting notes from the Washington Acupuncture clinic where 88% of their clients had significant improvement with back pain.

DISC PROBLEMS AND SPINAL ABNORMALITIES

The intervertebral discs, especially between the fourth and fifth lumbar vertebrae, are subject to stress which leads to degenerative changes. Symptoms of back pain arise when surrounding vertebral ligaments are damaged or displaced, allowing disc material to protrude and cause nerve root irritation and pressure. In most cases, rupture or herniation of an intervertebral disc is caused by injury. Lifting with the trunk in a flexed position, or exertion with the back in an unusual alignment or posture, are recognized as precipitating factors. The resulting defect may become apparent immediately or be delayed for months or years.

Congenital abnormalities of the spine, or acquired abnormalities from polio, injuries, or surgery, predispose to disc problems. People with spina bifida, scoliosis, and kyphosis are likely to have episodes of pain from disc pathology causing nerve and muscle irritation. Acupuncture cannot correct these abnormalities, but it can relieve the pain and improve the general physiology of the structures involved to make the episodes of pain less frequent and discourage the development of arthritis.
The most common sites for intervertebral disc rupture are in the lumbosacral region. Herniation occasionally occurs in the cervical spine and very rarely in the thoracic region. The symptoms and signs associated with a degenerated or ruptured intervertebral disc depend on the location and size of the herniation.

It is important to rule out spinal tumors, which should be removed promptly, before acupuncture is attempted. If a spinal tumor is present, acupuncture will not relieve the symptoms.
The acupuncture treatment of disc pathology is similar to that for arthritis and myopathy causing similar symptoms. Before subjecting a patient to the hazards of laminectomy or even a myelogram for disc pathology, acupuncture should be given a chance to relieve the symptoms. It may relieve muscle spasms which are aggravating the condition. It should be remembered that a person may function well and be pain-free despite disc pathology. Acupuncture is safer than many diagnostic procedures, including myelograms. It is also safer than traction and bed rest since such inactivity may result in thrombosis of leg veins.

Surgical intervention is seldom necessary for degenerative disc disease. Subsequent spinal fusion is often performed about two years after disc surgery if the patient attempts to lift anything heavy or engages in strenuous exercise. Many of these operations are unsuccessful and leave the patient with worse pain and disability. Some patients have five or more laminectomies, each time desperately hoping that the next surgical procedure will bring relief but actually having more residual pain and disability after each operation. Before attempting surgery, a physician should remind himself that all surgery destroys tissue and may lead to infection, other undesirable side effects, a period of pain, discomfort, and disability for his patient. He should also remember that all chemical anesthetics are poisonous and potentially lethal.

Most symptoms of lumbar disc pathology can be relieved by six to ten acupuncture treatments. The acupuncture points can be used bilaterally and potentiated with 50—150 microamperes of pulsating current. The standard acupuncture points can be combined with points for depression or other problems as indicated. Usually 12-16 needles should be inserted for each treatment.

BACKACHE

Almost everybody suffers from backache occasionally because it can result from normal activities. The most frequent cause of backache is muscle strain from hard work or strenuous exercise. Usually this type of backache is relieved by a few days of decreased activity. Backaches which are extremely painful or last more than a few days require thorough diagnostic studies to determine whether they are caused by a condition which might require prompt medical or surgical treatment, such as tumors, fractures, kidney, or gall bladder disease. Tumors of the spinal cord may cause severe backache but are often benign, and it is important to diagnose and remove them surgically as early as possible. Acupuncture will not give lasting relief from backaches caused by such conditions.

Spinal disc pathology—slipped or degenerative discs—may produce severe pain in the neck or lumbar area and radiate down the arms or legs. Cervical disc pathology is often caused by “whiplash” injuries in automobile accidents. Pain from a slipped lumbar disc may come on suddenly when a person bends over and then hurts too much to straighten up again immediately. Bed rest with traction is considered conservative treatment for slipped or degenerative discs, but it is often unsuccessful and may lead to thrombosis of the leg veins. Surgery for slipped and degenerative discs is hazardous and sometimes makes the backache more severe. Even if disc surgery relieves the pain, the relief may last only two years and then have to be followed by a spinal fusion. This is likely to produce malalignment of other parts of the spine and result in more slipped discs. Surgery on the spine also encourages the development of osteoarthritis there, which increases pain and disability.

Some patients have had as many as ten back operations before coming to the Washington Acupuncture Center for relief of backaches. They explain that each time before surgery they were persuaded that one more operation would relieve their pain. Many patients found temporary relief of back pain by taking increasing doses of narcotics and became addicted to them. The narcotics spoiled their appetites and made them too depressed to eat properly. Malnutrition, therefore, frequently accompanies backaches and taking drugs for pain relief. On the other hand, some people eat and drink excessively in an attempt to compensate for their pain and related depression. Obesity puts an added strain on the back and increases pain. Patients with backache should be treated with appropriate diet and vitamin therapy along with acupuncture.

Any injury to the back from automobile accidents, falls, or other trauma may result in osteoarthritis of the spine with pinching of spinal nerves. Surgery for this condition may give temporary relief but will lead to more arthritis with increased pain later. Any of the drugs which relieve the symptoms of osteoarthritis may have dangerous and even fatal side effects.

Rheumatoid arthritis of the spine, spondylitis or Marie-Strümpell disease may begin spontaneously, especially in young men, and can be crippling as well as painful. It is generally aggravated by surgery but may be considerably relieved by acupuncture. Cortisone or its derivatives may relieve the arthritis symptoms but create a drug dependence more dangerous than narcotic dependence. Corticoid drugs suppress the patient’s adrenal glands, and a fatal adrenal crisis may result if they are discontinued abruptly. Corticoids also cause fluid retention and predispose people to diabetes. Most of the drugs which relieve the pain and stiffness of arthritis have undesirable side effects. Phenylbutazone (Butazolidin) can cause fatal aplastic anemia. Even aspirin causes stomach ulcers.

Various congenital defects of the spine may require surgical correction if severe, but acupuncture can often relieve the pain associated with minor congenital malformations. The body can adapt to considerable bony deformity without pain or significant disability.

Osteoporosis is decalcification of the bones including the spinal vertebrae and is usually found in people past 40. This condition may cause compression fractures of vertebrae with a loss of height and pain from pressure on the spinal nerves. It has been treated with sex hormones without much success in proportion to the undesirable side effects of such therapy. Megavitamin and appropriate mineral therapy may be more effective and is unlikely to produce undesirable side effects. Acupuncture can relieve the pain from this condition and can be given along with nutritional therapy.

Multiple myeloma is a malignant plasmocytoma which should be diagnosed and given appropriate anticancer treatment as promptly as possible. It causes destruction of the vertebrae and severe pain. Cancer of any part of the body can metastasize to the spine and cause severe pain. Acupuncture should not be used to treat any type of cancer or malignancy. However, it can be used in place of narcotics to relieve severe pain while other appropriate treatment is being given, but it may have to be repeated once or twice a day to relieve the pain of terminal cancer.

The acupuncture treatment of backaches usually includes the following standard points regardless of the cause of the backache, but the skilled acupuncturist will add other points or omit some of these depending on the location and cause of the pain and his evaluation of the patient as a whole before each treatment. Lasting relief of pain from muscle strain or sprain, disc pathology, scoliosis, kyphosis, spina bifida, or any type of arthritis is usually obtained by the time six to ten treatments have been given. Many patients experience relief from pain during their first treatment by a highly skilled acupuncturist. More acupuncture treatments may be required to control pain from malignancies or other progressive disorders.

Reflexology & Back Pain

A study conducted at the Hospital of Beijing College of Languages investigated the effect of reflexology treatment on acute lower back pain. Twenty patients between the ages of 35 and 55, all of whom were teachers or office workers, and suffering from lower back strain participated in the study.

The reflex points on the patients’ feet were treated for a maximum of ten treatments and the results analysed. All of the patients reported that the treatment had effectively eliminated their pain; 5 of the patients obtained complete relief after only one treatment, 10 after 3 to 4 treatments and a further 5 after 5 to 7 treatments. No analgesics or other medications were used throughout the course of treatments.

Although a small scale study, it adds to the growing body of evidence confirming that reflexology has extensive therapeutic value beyond the realms of mere relaxation and stress management.

Xiao Zhenge, Hospital of Beijing College of Languages Reflexology Research Reports 2nd Edn. Compiled by K Walker. Association of Reflexologists.

Alternative therapies & Back Pain

Researchers at the Department of Rheumatology, Tel Aviv Sourasky Medical Center, Ichilov Hospital, Tel Aviv University, Sackler Faculty of Medicine, Israel recently evaluated the benefits of alternative treatments for patients suffering from chronic back pain.

Acupuncture, Chiropractic and Alexander technique were evaluated by patients and a pain specialist. At admission to the study, the patients were asked to complete a questionnaire concerning their socio-demographic background and disease history. They also underwent a psychological evaluation based on a questionnaire and an interview. The patients were evaluated at the end of the four week program and after 6 months of follow up.

The results showed that the patients in the treatment group experienced significant improvement in the pain rating, pain frequency and analgesic drug consumption, and this was maintained for a period of 6 months. The best outcomes were seen in those patients who had the lowest predominance of psychological factors, a high level of motivation and family support. Poor results were found to be associated with a divorced marital status and unemployment, diffuse complaints, post surgery status, a high predominance of psychological factors,and personality disorders.

The report concluded that patients with chronic back pain seem to benefit from this proposed multidisciplinary approach. The improvement was maintained for a period of 6 months. And, most significantly, the outcome of the therapies was clearly related to psychosocial factors.

Elkayam O; Ben Itzhak S; Avrahami E; Meidan Y; Doron N; Eldar I; Keidar I; Liram N; Yaron M Multidisciplinary approach to chronic back pain: prognostic elements of the outcome. Clin Exp Rheumatol (ITALY) May-Jun 1996, 14 (3) p281-8