The Back Pain Blog

As reported in the U.S.News and published in the Archives of Internal Medicine, a study has been carried out using a group of 638 back pain sufferers and four different treatments;

• The first group received individualized acupuncture treatment from a practitioner,
• The second group received a ’standardized’ acupuncture regimen,
• The third group received a sham acupuncture treatment where toothpicks housed in needle guide tubes were used (so the participants could not visually recognize the difference),
• And the fourth group received only drugs typically taken for back pain.

The volunteers in the study received 10 treatments over a seven week period. None of the volunteers had previously received acupuncture for back pain and all were allowed to continue taking their regular medication which consisted mainly of anti-inflammatory drugs and pain relievers.

The Results.

Interestingly, a week after the last treatment about three-fifths of those receiving the acupuncture, both the ’sham’ treatment and ‘real’ treatment, reported significant improvement in disabilities brought on by their back pain, compared with only two-fifths of those not receiving any real or simulated acupuncture.

This tells us that acupuncture succeeds in reducing pain levels for a good percentage of people, but what about those receiving the ’sham’ treatment? Unlike the acupuncture needles, the toothpicks did not penetrate the skin which raises the question of  “the acupuncture’s purported mechanism of action”.

The study co-author Daniel Cherkin hypothesizes that if acupuncture has a physiological effect, the stimulation of certain points on the skin may result in the same nerve-related benefits or it could be the placebo effect in which a patient’s belief in the treatment induces improvements. Pain relief may even result from a combination of the two, he says.

My Thoughts.

If you have read any of my previous posts you would know that I am a great believer in acupuncture as a pain reliever, although I have not found it to have any great lasting effects beyond a day or two of pain-free bliss. When I had my first session of acupuncture I had no preconceived notions of what it could do for me, all I knew was it involved a lot of small needles and probably some pain! I have to say that after that first visit I was impressed, the pain relief was immediate and made life all that much more bearable.

So how do we explain a number of the volunteer’s receiving the ’sham’ treatment noticing ’significant improvement in disabilities brought on by back pain’? As stated above, I think there is only two possible causes – the subject’s knew enough about the desired outcome for the brain to take control of their pain levels or surface stimulation of the skin was enough in a number of people to provoke a nerve response resulting in a pain decrease (something similar to the feelings we can get from a light massage). Either way there is no ‘hard evidence’ here that says the traditional acupuncture methods don’t work.

To my way of thinking this study proves nothing other than if your acupuncturist is out of town you may be able to get some form of relief from the humble toothpick! I mean we could go on forever doubting the technique used by acupuncturist’s but could hundreds of years of Chinese generations have got it that wrong? I don’t think so and while it keeps on providing me with pain relief when things are really bad I’ll keep going back for more. Perhaps their time would have been better spent working on a cure for cancer or A.I.D.S., you know something actually useful.

Readers Thoughts.

I think this comment posted on U.S.News sums up the ‘misguided-ness’ ( a new word for the dictionary!) of the study;

The Facts

This study is not new. I have been reading these for years. As far as RCT’s are concerned this is actually a very good one given that it included a standard treatment branch as opposed to simply control and treatment. It is nice to see researchers getting out of their box. In the end however it is not possible to study such a dynamic animal as chronic pain and a holistic treatment approach that understands that the body and the mind are intimately connected.

Anyone who reads or posts to this article should have an understanding of how incredibly complex chronic pain is. We are not just speaking about pain. We are speaking about living with pain, losing work, changing the dynamics of the household when someone cannot fully contribute, possibly loss of income, loss of sleep and stress; which all have a psychological component that triggers very real chemical responses in the body that prevent healing. Being one of my specialties I could go on but the real controversy seems to center on the placebo effect and sham acupuncture.

The answer is quite simple. The sham acupuncture was not sham at all. The toothpicks touched the skin. The skin contains 3 afferent sensory nerves that signal the CNS as well as modulate the sympathetic and parasympathetic nervous system specifically the vagus nerve.

The toothpicks stimulated the cutaneous nerves to send a signal to the spinal cord activating the spinal neurons that secrete enkephalin and dynorphin that inhibit pain messages. Then the signal continues up to the midbrain and pituitary that activates the raphe descending pain-inhibitions system which secretes monoamines, serotonin and norepinephrine that further inhibits pain through a couple different mechanisms that gets quite complicated. If you are interested see Biomedical Acupuncture for Pain Management.

Additionally, once the sensations from the toothpicks reached the spinal cord several nerve pathways are excited that reaches the cerebral cortex which releases numerous neurochemicals that not only inhibit pain but also promotes homeostasis. Homeostasis is incredibly important because as I said before we are not just talking about pain. This is a human being whose thoughts and emotions influence their body and whose body in distress can influence their mind.

There are too many valid articles and scientific research to speak any further on this. Any one who does not believe in acupuncture can look up studies done with fMRI in which sham and placebos do not exist.

Lastly the term acupuncturist is a misnomer. Acupuncturists practice traditional Chinese medicine which incorporates other modalities such as herbal formulas, massage, tui-na, diet, exercise, lifestyle counseling, tai-chi, qi-gong etc. It is a complete system of medicine that with proper communication with other alternative practitioners and open minded Md’s strives to help people find health and balance in their lives.

Christopher Salah, DAOM., L.Ac.

In closing, have you tried acupuncture for pain relief? Did you find it gave you relief or where you disapointed in the results? Please share with us any thoughts you have on this subject (yes, toothpicks included!) .

Take Care,

Craig

I have put this list together from studying the literature we were given at a pain management workshop that I attended last year and from the advice I have received over the years from Physio’s, Chiropractors etc. Certainly these are not going to suit everyone and are not a substitute for pain medication, and although not ‘ground-breaking’ I hope that they will be of use to you in dealing with your pain and everything that comes with it.

Number One

Try To Accept Your Pain – yeah, I know, I thought you had to be super-human to do this when I first heard of it too!

What I have learnt, particularly in recent visits to a Psychologist is that accepting your pain is all about coming to terms with the changes in your life that have come about from suffering pain. As much as these changes might have put you in a situation that you don’t necessarily want to be in, you can find positives in each and every situation if you try.

Also it is about doing what you can to design your lifestyle to suit your condition, not banging your head against a wall trying to do things that you were able to before the onset of the pain. I personally had a lot of trouble coming to terms with my ‘new’ lifestyle but once I focused on the positives and started to look forward instead of backwards it did become easier.

Number Two

Exercise – this one I put off for as long as I possibly could. Why would I want to intentionally put myself through pain for no ‘apparent’ result?

You’ve probably heard it a million times but inactivity leads to muscle weakness which further adds to our pain. Naturally you must see your doctor before starting any sort of exercise or potentially strenuous activity but if you look around there are a number of exercise programs that are well suited to people suffering from back pain and they are usually nothing more than a series of stretches that you do daily or every second day until you can handle something a bit more ‘physical’.

I feel stronger in my core muscles from doing my exercises which as you can imagine must take some of the strain from my spine. There is a good book which explains the in’s and out’s of exercising with back pain, it is entitled The Bad Back Book and is available as a free download  from HERE.

Number Three

Don’t Be Afraid To Ask For Help – Help in any form can be a godsend when you are suffering in pain and you should not be afraid to ask for it.

Although we may feel like we have a handle on the situation we may in fact be struggling more than we like to admit. In this PREVIOUS POST I spoke about my almost dislike for going to see a Psychologist because, as far as I was concerned I was doing pretty good considering the situation I was in. After biting the bullet, and plenty of nagging from my wife, I went along and honestly it was the best thing I have done in a long time.

Not only did I realise that I was setting myself up for failure with the expectations I had for my immediate future, I was also not handling the emotional side of things very well at all. I really had things screwed up and after just three visits I am back on track and feeling so much better for it. Your Doctor or Public Health Centre should be able to organise any help you may need and believe me the right kind of help can make a world of difference.

Number Four

Relaxation – my favourite past-time! Seriously though if you can manage some time out to sit and relax you have a better chance of getting through the day without a major pain flare-up.

When I did the pain management course last year the first and last thing we did every session was have a five minute relaxation session and I have to say it does put you in a better frame of mind and relieving the tension in your muscles can also lessen your pain. I had a lot of trouble achieving a relaxed state with everything that was going on in my head but after practising for a while I found it quite easy to get into a completely relaxed state.

Running a warm bath (and locking the door!) or sitting alone once everyone else has gone to bed are good times to practice your relaxation techniques. There are many CD’s and Audio tapes available for a good price on the net and I suggest you try one to achieve the ‘ultimate relaxation’. Something the pain management course instructor preached religiously was not to give up, it may take many sessions until you can truly relax but it is sure worth it.

I hope that you have found some useful tips in Part One of this article and Part Two can be found HERE.

Please Take Care,

Craig