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The use of acupuncture for chronic low back pain recently got the once-over in the "New England Journal of Medicine", and it came out looking good.
As most know, acupuncture is a therapeutic intervention involving the insertion of metallic needles into or through the skin at specific sites. It most likely originated in China, where to this day it remains a fundamental part of a system that espouses an ancient physiological system (not based on the Western scientific research tradition) in which health is the result of harmony among bodily functions, and between the body and nature. A lack of internal harmony is believed to cause the blockage of the body's vital energy, known as qi, and which flows along certain meridians.
Tenderness on physical examination of the body is thought to be evidence of the blockage of qi; the insertion of acupuncture needles at specific points along the meridians is believed to restore the appropriate flow of qi. The pain-relieving effects of acupuncture appear to be based on neural innervation, as local anesthesia administered at needle insertion sites results in their blockage.
Acupuncture causes the release of endogenous opioids in the brainstem, subcortical and limbic structures. And it appears to mechanically stimulate connective and other tissues. However, the exact mechanisms underlying acupuncture's role in pain relief remain incompletely understood.
While acupuncture is rarely regarded as a first choice in the treatment of chronic low back pain, it appears useful as one approach among several in the multidisciplinary treatment of chronic low back pain. Before any treatment regimen is initiated, patients with chronic low back pain need a thorough evaluation to rule out cancer, infection, or a spinal condition that may require surgery.
Selection of insertion points for an individual patient will be based on the specific problems of that patient; of course, there are common sites used for chronic low back pain. Needles remain in place for up to 30 minutes, and are often stimulated by the acupuncturist, producing de qi, which is a dull, localized ache; and "needle grasp", a tugging sensation experienced by the acupuncturist as a needle moves against connective tissue. Needle stimulation can be enhanced with electrical current, or the application of herbs at the tip of the needle. It may take 12 sessions to see improvement, and if improvement is seen, "booster" treatments may be given monthly or every other month.
Alas, clinical trials of acupuncture versus "sham" acupuncture have shown both to be equally effective. It would seem that the clinical benefits derived from acupuncture are related to psychosocial factors, including a patient's expectations and the bedside manner of the acupuncturist.
Nevertheless, the American College of Physicians and the American Pain Society recommend that health care providers consider acupuncture as a viable treatment option for refractory chronic low back pain. Adding acupuncture to other treatments is more effective than other treatments alone.
The National Certification Commission for Acupuncture and Oriental Medicine and the American Academy of Medical Acupuncture are resources for finding a qualified acupuncturist in the community. For some with chronic low back pain, acupuncture may be the needle in the haystack of treatment options they have been seeking.
