An interesting study has reached my hands about acupuncture and the neural mechanism for the cause and treatment of Low Back Pain (LBP). I would like to share some interesting outputs which might be good for you either if you’re an acupuncturist, a patient or you don’t believe on TCM at all.
Low back pain (LBP) is one of the most frequently encountered musculoskeletal disorders in today’s society. LBP is defined as pain and discomfort, located in between the costal margin and the inferior gluteal folds, with or without referred leg pain. LBP is categorized according to duration as acute (less than 6 weeks), sub-acute (between 6 and 12 weeks), or chronic (more than 12 weeks).
LBP interferes with activities of daily living, work performance, and is a major reason for people to seek medical consultation. This disorder contributes to a substantial burden on individuals, employers, the healthcare system and society in general. According to a report published by the World Health Organization (WHO) in 2013, back pain, together with neck pain, was the second highest cause amongst the 20 leading non-fatal health outcomes from the year 2000 to 2011.
LBP is very common, and yet is a very complex multifactorial disorder with much possible etiology. These originate from injuries, trauma or fractures to the anatomical structure; lumbar spine degeneration; and disc herniation or nerve entrapment. Other causes associated with an increased risk of LBP, include infections, autoimmune diseases, orthopedic diseases or tumors, but less common.
The prevalence of LBP is significantly higher for women affected by overweight (Spleen deficiency causes Qi deficiency increasing stagnation), low level of social support, sedentary lifestyle (Yang deficiency increases stagnation) smoking (Lung Yin deficiency causes Kidney Deficiency and Liver Yin Deficiency) and lower income groups.
The mechanism of pain is a very complex process, due to the involvement of multiple layers of the neural circuit, from the stimulation of the receptors to the chemical reaction in the CNS. The perception of pain is called nociception, and it is initiated by nociceptors present at free nerve endings. The nociceptors, part of the architecture of neural circuits, are spread all over the body, from the superficial layers of skin to the deeper tissues and internal organs.
The goal of LBP treatment is to control or reduce pain, to improve structure impairment of the spine and to return to the normal life activities as soon as possible. Most current international guidelines recommend pharmacological management for pain relief of LBP, including paracetamol, non-steroidal anti-inflammatory drugs (NSAIDs), muscle relaxant, opioid analgesics, epidural steroid, anticonvulsants, antidepressants, and corticosteroids, among others. However, most of these pharmacological treatments produce limited pain relief and are accompanied by serious side effects, such as drowsiness, dizziness, addiction, allergic responses, reversible reduction of liver function, and negative impacts on gastrointestinal functions.
The major problem with this approach is that pain may be temporarily relieved but the source of LBP is not identified and alternative treatments of LBP are required. These include multidisciplinary rehabilitations based on physiotherapy, spinal manipulation, exercise therapy, massage therapy, cognitive-behaviour therapy, yoga, tai-chi, and acupuncture.
Focusing on acupuncture, consists of insertion of thin needles into the muscle, on specific acupuncture points placed along meridians to treat a variety of conditions.
The insertion of needles involve putting them locally on the area of pain or distally, far from the pain but still capable to treat the condition. Interestingly, acupuncture points were rediscovered by researchers in western medicine. A study done by Kellgren in 1938 reported that intramuscular injection of sterile saline caused pain at locations away from the injection site.
Inspired by this study, Travell et al. realized that pressure applied to specific points (later defined as trigger points) relieved pain from shoulder and arm pain.
Based on my own experience as acupuncturist, the best points to treat LBP are the following:
- DISTAL POINTS: they’re usually effective for non-traumatic LBP which relates to Kidney Deficiency and a combo of Heart-Kidney Disharmony. The most effective distal points are Kidney 4, distal point, to regulate the Kidney Yin and Yang when it is unbalanced and when the pain is non-traumatic.
- LOCAL POINTS: they’re usually effective for traumatic LBP which relates to By Syndrome, Qi and Blood Stagnation. The most effective local points are DU4, DU5, DU6, DU7, DU8 and DU9. Local points from the Bladder, Kidney and Liver channels also work on the condition.
Heating is usually necessary during treatment for traumatic LBP injuries as By Syndrome is usually common. However if the person has Excess Heat, High Blood Pressure or a remarkable Yin deficiency, shouldn’t receive Heating or Moxa therapy as improvement would be very limited.
If LBP is related to Kidney deficiency or a Heart-Kidney deficiency, Salty flavor foods are an important part of healing your pain. They have a cooling effect, descending, softens hard lumps, reduces stiffness, detoxifies and helps with sore muscles. However, if the person has overweight, edema, high blood pressure and signs of TCM dampness, shouldn’t overdo.
