According to the American Association of Neurological Surgeons back pain is experienced by 75-85% of all Americans (2021). Structures of the lower back include the five lumbar vertebrae L1 through L5 and the discs which act as a cushion in between each vertebra, ligaments hold the vertebrae in place and tendons attach the muscles of the lower back to the vertebrae. The lower back also includes nerves that branch out of the spinal cord. According to the National Institute of Neurological Disorders, low back pain is either acute or chronic (2020). Low back pain that lasts a few days to weeks is considered acute. The recovery for acute conditions can take a few days to a few months to resolve with no lasting loss of function. According to the National Institute of Neurological Disorders, chronic low back pain is defined as lumbar pain that lasts for more than 12 weeks (about 3 months) (2020). Chronic low back pain can take months to years to heal, sometimes with lingering lifelong pain. Some causes of low back pain include sprains or strains, traumatic injury, fracture, herniated disc, sciatica, lumbar spinal stenosis, and abnormalities of the spine such as scoliosis. Other diseases or conditions such as intravertebral disc disease, spondylosis, arthritis, and other inflammatory diseases, fibromyalgia, endometriosis, pregnancy, kidney stones, tumors, and infections are also contributing factors for low back pain (2020).

I have treated numerous patients suffering from low back pain with acupuncture. The primary causes of low back pain in Traditional Chinese Medicine Theory are Cold Dampness Invading the back channels, Qi and Blood Stagnation, Damp Heat Invading the back channels, or Kidney deficiency (Maciocia, 2011). Treatment results from acupuncture vary with each patient, with a multitude of factors including age, condition of the patient, underlying factors, and length of time pain has been present. When treating low back pain with acupuncture, I will usually start by trying the Master Tung method first. The Master Tung method consists of mainly distal points to get immediate relief. The most common Master Tung points I like are located on the hand. These points are called Ling Gu and Da Bai. I will stimulate the needles at these points using an up and down motion till the patient states they feel the needles. I will also needle supporting distal points such as Small Intestine 3 for unilateral pain level with the umbilicus, along with Bladder 62 if the pain radiates down the leg. I will also consider needling Yao Tong Xue, Bladder 40, Bladder 10, and Bladder 59. If I cannot get instant relief with this method, I will needle local points related to the painful area such as Yao Yan, Tun Zhong, Shi Qi Zhi Xia, any of the Hua Tuo Jia Ji points, Governing Vessel points 2 through 6 and Bladder points 20 through 37 and Bladder 49 through 54. Depending on the visit and the patient's condition I will sometimes use an electro stimulator to stimulate the points for a minimum of 15 minutes. I have found that stimulation is not always needed, and I usually do not try this on the first visit. I will also use a topical product such as Dr. Bob’s medicated oil, Yu Yin Bao Yao patches, or Woodlock oil.

For chronic low back pain that is not getting consistent improvement with acupuncture alone, I may recommend the patient use chiropractic adjustments or physical therapy in conjunction with acupuncture. If chiropractic services are needed in combination with acupuncture, I recommend the patient use a chiropractor they have used and trusted in the past and always acupuncture on a different day. On occasion, I have had patients come in for acupuncture because they were in severe pain from a chiropractic adjustment. I have found that if the patient is not relaxed when getting chiropractic treatment, they risk getting painful muscle spasms.

Acupuncture is effective at treating low back pain. Acupuncture is most often sought to treat chronic pain management, according to a recent study published in 2020 (Urits et al., 2020). This research published in Advances in Therapy showed acupuncture to have a substantial desirable effect (Urits et al., 2020). In this randomized controlled trial patients that received acupuncture had a reduction in pain at 3 months and up to 24 months (about 2 years) compared to the placebo. In another randomized controlled trial, 130 patients that received twice-weekly acupuncture for 6 weeks (about 1 and a half months) for their chronic low back pain reported lower scores for pain compared to those that received the sham acupuncture (Urits et al.,2020). Patients that received the sham acupuncture in this study did not have penetration of the needles. This research demonstrated that acupuncture has more than a placebo psychological effect and there is a physiological mechanism fundamental to the favorable outcome (Urits et al., 2020).

Chiropractic treatment is effective at treating low back pain. According to a meta-analysis published in 2018 manipulation and mobilization used in chiropractic therapy were effective at treating chronic low back pain (Coulter et al., 2018). This systematic review covered fifty-one trials with nine trials providing comparable evidence to be used in the research. The research showed a statistically significant larger reduction in pain with chiropractic treatment compared to exercise or physical therapy. Follow-up at 3- and 6-months post-treatment also showed a greater reduction in pain with chiropractic treatment vs exercise and physical therapy. As this research demonstrated, the reduction in disability was 78% greater for manipulation or mobilization in chiropractic treatment compared to exercise and physical activity. Follow-up at 6 months post-treatment also showed a greater reduction in disability with chiropractic care vs exercise and physical therapy (Coulter et al., 2018). This meta-analysis has demonstrated the effectiveness of chiropractic treatment for reducing discomfort and disability among patients suffering from low back pain.

According to a recent study published in 2020, non-pharmacologic alternative therapies are most frequently used to treat muscular-skeletal pain (Urits et al., 2020). This research shows that 59-90% of the patients believe that alternative therapies are helpful in the treatment of their chronic pain. A multidisciplinary approach using physical therapy and chiropractic has been successful for my patients in the treatment of chronic low back pain. I searched 3 journals for studies on chiropractic therapy in conjunction with acupuncture and could not find one. This tells me that more research is needed. Demonstrated in a trial involving 750 active-duty military personnel, chiropractic care in combination with usual medical care showed improvement in low back pain intensity and disability than usual medical care alone (Goetz et al., 2018). This study proves that chiropractic care in conjunction with an additional modality for the treatment of pain has proven to be beneficial. More studies would surely prove that a multidisciplinary approach to chronic pain is healthful and advantageous.

References:

Low back pain. AANS. (2021). Retrieved November 2, 2021, from https://www.aans.org/en/Patients/Neurosurgical-Conditions-and-Treatments/Low-Back-Pain.

U.S. Department of Health and Human Services. (2020, April 27). Low back pain fact sheet. National Institute of Neurological Disorders and Stroke. Retrieved November 2, 2021, from https://www.ninds.nih.gov/disorders/patient-caregiver-education/fact-sheets/low-back-pain-fact-sheet.

Maciocia, G. (2011). The practice of Chinese medicine the treatment of diseases with acupuncture and Chinese herbs. Churchill Livingstone.

Coulter, I. D., Crawford, C., Hurwitz, E. L., Vernon, H., Khorsan, R., Suttorp Booth, M., & Herman, P. M. (2018). Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis. The spine journal : official journal of the North American Spine Society, 18(5), 866–879. https://doi.org/10.1016/j.spinee.2018.01.013

Goertz, C. M., Long, C. R., Vining, R. D., Pohlman, K. A., Walter, J., & Coulter, I. (2018). Effect of Usual Medical Care Plus Chiropractic Care vs Usual Medical Care Alone on Pain and Disability Among US Service Members With Low Back Pain: A Comparative Effectiveness Clinical Trial. JAMA network open, 1(1), e180105. https://doi.org/10.1001/jamanetworkopen.2018.0105

Urits, I., Schwartz, R. H., Orhurhu, V., Maganty, N. V., Reilly, B. T., Patel, P. M., Wie, C., Kaye, A. D., Mancuso, K. F., Kaye, A. J., & Viswanath, O. (2021). A Comprehensive Review of Alternative Therapies for the Management of Chronic Pain Patients: Acupuncture, Tai Chi, Osteopathic Manipulative Medicine, and Chiropractic Care. Advances in therapy, 38(1), 76–89. https://doi.org/10.1007/s12325-020-01554-0