Chronic Lower Back Pain

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In the United States, chronic low back pain (LBP) is the most common cause of activity limitation in people younger than 45 years and the second most frequent reason for physician office visits. It also ranks as the fifth common cause of hospital admission

Table 16.2 Acupuncture points commonly used in clinical acupuncture studies.

• LR3 Taichong: On the dorsum of the foot, in the fossa distal to the junction of the first and second metatarsal bones, 2 in. proximal to the margin of the web of the toe; this acupuncture point has been used in migraine and adjunct for lithotripsy studies

• SP6 Sanyinjiao: 3 in. directly above the tip of the medial malleolus, in the fossa posterior to the medial margin of the tibia; this acupuncture point has been used in migraine headache, colonoscopy, and labor analgesia studies

• ST36 Zusanli: In the fossa 1 fingerbreadth lateral to the anterior margin of the tibia and 3 in. inferior to the acupoint Dubi (ST 35), which is located at the lower border of the patella, in the depression lateral to the patellar ligament; this acupuncture point has been used in osteoarthritis, migraine, colonoscopy, and postoperative pain studies

• LI4 Hegu: On the dorsum of the hand, between the first and the second metacarpals, at the midpoint of the radial margin of the second metacarpal bone; this acupuncture point has been used in adjunct for lithotripsy labor pain, colonoscopy, migraine, neck, and shoulder pain

• PC6 Neiguan: On the palmar side of the forearm, 2 in. above the transverse crease of the wrist and between the tendons of the flexor carpi radialis and palmaris longus muscles; this acupuncture point has been used in migraine, angina, nausea, and vomiting studies

• GB20 Fengchi: At the posterior lateral aspect of the neck, in the fossa between the superior margins of the trapezius and sternocleidomastoid muscles; this acupuncture point has been used in migraine, neck, and shoulder studies

• GV20 Baihui: At the middle of the vertex, on the line connecting the apexes of the two ears. This acupuncture point has been used in labor analgesia and migraine studies

• SP6 (San Yin Jiao, the sixth point on the spleen channel): On the medial side of the lower leg, three-finger breadth superior to the prominence of the medial malleolus, in a depression close to the medial crest of the tibia. This acupuncture point has been used in colonoscopy, labor analgesia, and migraine studies

• LR3 Taichong; On the dorsum of the foot in a depression distal to the junctions of the first and second metatarsal bones; this acupuncture point has been used in adjunct for lithotripsy, migraine, and labor analgesia studies

(www.ninds.nih.gov/disorders/backpain/detail_backpain.htm). Most importantly, LBP is the third most common indication for surgical procedures. In average, about 2% of the US workforces are compensated for back injuries each year. Both surgical and pharmacologic interventions have been prescribed as a treatment for patients suffering from LBP. There are a growing number ofclinical data supporting that acupuncture and related intervention may serve as a treatment for LBP as well. Carlsson and colleagues (Carlsson and Sjolund 2001) conducted a sham randomized controlled trial (RCT) study of patients suffering from chronic LBP and found that both manual and electrical acupuncture were superior to sham electrical stimulation in reducing pain, improving sleep patterns, and analgesic consumption. These effects were sustained 4-6 months post-intervention. However, they could only demonstrate these positive responses in women. As a result these investigators suggest that gender may have an effect on the therapeutic effect of acupuncture and related techniques. Leibing et al. (2002) found that LBP patients who received a series of 26 sessions of interventions, consisting of a combination of ear and body manual acupuncture and physical therapy, was superior to those of patients who received 26 sessions of standard physical therapy alone for the reduction of pain, disability, and psychological distress for 3 months. However, the beneficial effects of combined ear and body manual acupuncture were present, and at 9 months post-intervention there were no differences between the two study groups. The results of this study suggest that in order for a sustained clinical effect, "maintenance" acupuncture therapy may be indicated to sustain the prolonged benefit in patients with LBP. A similar observation was also noted in a more recent RCT that found that the combination of true acupuncture and conservative orthopedic treatment was superior to sham acupuncture combined with conservative orthopedic treatment or conservative orthopedic treatment alone. However, the beneficial effects lasted only 3 months (Molsberger et al. 2002). Sator-Katzenschlager et al. (2004) compared different acupuncture-related techniques and found that electrical auricular acupuncture is superior to semi-permanent press needle acupuncture in decreasing the severity of LBP and improving the psychological well-being, activity, and sleep for 3 months after treatment. Similarly, Meng et al. (2003) found that electrical acupuncture is superior to standard therapy such as non-steroidal antiinflammatory drugs (NSAIDs), muscle relaxants, paracetamol, and back exercises in elderly patients who suffer from low blood pressure (LBP). In summary, acupuncture and related interventions can serve as a short-term adjunct treatment for LBP management. This lack of long-term benefit may be related to quick degradation of acupuncture-induced endogenous endorphins and duration of treatment protocol and may require follow-up and additional treatment.

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