Back pain is the single leading cause of disability causing many Americans to miss work and daily activities. It can affect people of all ages, and is the third most common reason for visits to the doctor’s office behind skin disorders and osteoarthritis/joint disorders. That being said, most are unaware and/or unfamiliar with alternative medicine such as acupuncture to rectify all of these situations. While there is still so much left to learn in regards to acupuncture for all types of pain, research currently available clearly shows improvement for back pain with acupuncture treatment as opposed to conventional treatment options.
What Causes Back Pain?
The cause of back pain can be anything from a sports injury or a motor vehicle accident to bending over to pick up a pencil. However, there are many contributing factors that go into why something like picking up a pencil would cause the back pain.
These are also contributing common factors to back pain:
- Poor posture
- Arthritis
- Obesity
- Kidney stones
- Kidney infections
- Blood clots
- Bone loss
As you can see above, back pain can also be a result of a disease in the internal organs that may be happening even without someone’s knowledge. The back is a structure of bones, ligaments, joints, and muscles. You can strain muscle, tear ligaments, irritate joints, rupture discs which, again, can all lead to back pain.
How Does Acupuncture Work for Back Pain?
We, as acupuncturists know that acupuncture point stimulation activates the neural pathways to the spinal cord to deactivate the pain centers in the brain. We also know that it engages the body’s natural opioids making it the natural safe option for pain relief compared to its addictive opioid counterpart in the western world of medicine. In a nutshell, it revives the central nervous system. Many other biochemicals that are responsible for pain relief have been found to be released or managed by acupuncture stimulation.
Biochemicals released with stimulation are:
- ATP –
Adenosine Triphosphate, able to store and transport chemical energy within
cells.
- GABA
– Gamma-aminobutyric Acid, a neurotransmitter that sends messages through the
brain and nervous system, and regulates the communication between brain cells.
- Substance
P – SP – the main neurotransmitter associated with the sensation of pain. A
neuropeptide used by neurons to communicate with each other.
- Endorphins – produced by the central nervous system, these are neuropeptides and peptide hormones which activate the body’s opiate receptors. When these are released they minimize discomfort and pain, and can also bring about feelings of euphoria and general well-being.
Being the number one reason people seek out acupuncture, back pain is also improved with acupuncture in other ways involving messages to and from the brain.
Acupuncture works for back pain by:
- Stimulating the nervous system. Acupuncture point stimulation can release chemicals from the spinal cord, muscles, and brain causing natural pain relief.
- Releasing opioid-like chemicals naturally produced in the body. These pain-relieving chemicals naturally occur in the body and have similar contents to opioids such as hydrocodone and morphine for example.
- Releasing neurotransmitters. As stated above, these hormones send messages to manage various nerve endings. Acupuncture may activate some of the shut off pain.
- Triggering electromagnetic impulses in the body. By releasing endorphins, such impulses can aid in speeding up the body’s way of handling pain.
There are many acupuncture points that can be used for different areas of the back, each point coming with their own array of benefits. Below, explore some acupuncture points that are helpful for back pain in general.
Acupuncture points for back pain:
- KD3 –
Great Ravine – Taixi, on the medial aspect of the foot, posterior to the medial
malleolus in the depression midway between the tip of the medial malleolus and
the attachment of the Achilles tendon. Used for chronic back pain along with
other conditions like anxiety and insomnia amongst others.
- KD4 –
Large Goblet – Dazhong, on the medial aspect of the foot, posterior and
inferior to the medial malleolus in a depression anterior to the medial side of
the attachment of the Achilles tendon. Used for back pain from KD deficiency as
well as other conditions like cough, anxiety, and palpitations amongst others.
- KD7 –
Recover Flow – Fuliu, located 2 cun above KD3 on the anterior border of the
Achilles tendon, on the medial aspect of the lower leg. Used for back pain from
deficiency and/or stagnation as well as conditions like constipation, hemorrhoids,
and edema amongst others.
- ST31
– Thigh Point – Biguan, located on the anterior aspect of the thigh, on the 2
lines connecting the ASIS and the superiolateral corner of the patella and
level with the lower border of symphysis pubis in a depression with the thigh
flexed lateral to the sartorius muscle. Used for various types of pain
including back, knee, leg, and thigh amongst other conditions like muscular
dystrophy and arthritis.
- ST32 – Crouching Rabbit – Futu, on the anterior aspect of the thigh, on the line connecting the ASIS and the lower lateral border of the patella, 6 cun above the patella. Used for various types of pain including back, knee, leg, and thigh amongst other conditions like muscular dystrophy and arthritis.
These points are definitely good “stand-by” points to use and work with daily. As we all know, patients have seen benefits from these points and others for their chronic back pain along with others if they are willing to try. Acupuncture has grown its following over the years, but it is still fascinating that when those who have suffered from chronic pain, especially long-term, consider acupuncture a “last resort” option for care.
The Opioid Epidemic
The opioid epidemic has led many patients to turn to alternative and more conservative approaches to address their back pain. Respected health groups have also reconsidered the value of alternative care for the treatment of pain due to increasing concern on the dangers of opioids.
The opioid problem is greatly due to the fact that such medications are so much more readily available and easily accessible by prescription. A heavy weight falls on the healthcare system covering these types of prescription medications that are highly addictive and carry along deadly side effects. Not to mention that while opioids may provide some pain relief, the relief is temporary and does not treat the underlying issues or cause of the pain. This is, amongst other variables, what is dangerous and addictive about opioids. These medications mask the pain to a point where the patient can continue to do activity to a certain degree, but may ultimately is unsafe, can cause many harmful side effects, and lead to an unhealthy addiction. Which, again, patients and doctors alike are catching on to and seeking out/referring alternative care.
The American College of Physicians (ACP) updated its back pain treatment guideline in 2017 to include:
- Support for a conservative approach to care
- Cites heat therapy, massage, acupuncture, and spinal manipulation as nondrug, noninvasive options for back pain treatment
- Further states that only when these modalities provide little or no relief should patients move on to over-the-counter medicines
- Conclude that prescription opioids should be the last resort for those suffering from back pain as the risk of addiction or overdose far outweigh the (minimal, if any) benefits.
With concerns rising on the negative impact of opioids for pain relief, more and more individuals are turning to safer forms of treatment, such as acupuncture, for their pain management.
Research in Favor of Acupuncture
There have been many small-scale studies performed in regards to acupuncture for back pain and chronic pain in general. While larger scale studies are still needed, the ones that have been performed for acupuncture up to this point show favor in acupuncture treatment vs. no acupuncture treatment. There are two somewhat larger studies that have been done in the last decade that show there is a difference in acupuncture treated patients vs. placebo or no treatment.
The first study from 2009 was done with a team of researchers led by Dr. Daniel Cherkin from Group Health Center for Health studies in Seattle, and their work was funded by NIH’s National Center for Complementary and Alternative Medicine (NCCAM). The study featured 638 adults with chronic back pain who had never had acupuncture before. All adults were randomly separated into four groups: individualized acupuncture, acupuncture with general points good for back pain, sham acupuncture, and standard medical care. Those who received acupuncture including the sham acupuncture group received care twice a week for three weeks and then once a week for four weeks. The participants were assessed over the following year, and were questioned on their symptoms.
Out of this study the following was found:
- Researchers measured back-related dysfunction and followed up with patients about symptoms. At just 8 weeks of treatment, those in the acupuncture groups had improved considerably compared to the ones receiving standard care. Benefits also continued for a year, diminishing over time.
- No significant difference found the 2 acupuncture groups and the sham acupuncture group.
- Dr. Josephine Briggs, director of NCCAM says of the study “This adds to the growing body of evidence that there is something meaningful taking place during acupuncture treatments outside of actual needling. Future research is needed to delve deeper into what is evoking these responses.”
The other study is from 2012, and it was a large meta-analysis of 17,922 patients with chronic pain researching the results of acupuncture for these conditions including back pain. It involved 29 trials of those patients using available data in various forms of acupuncture as well as experience of acupuncturists to measure the effect of treatment on pain outcomes.
This study found amongst various types of acupuncture that:
- In the primary analysis, acupuncture was better than both sham and no acupuncture control for pain conditions.
- Acupuncture is an effective treatment of chronic pain, and a reasonable referral option.
- Exceptional differences between true and sham acupuncture indicate that acupuncture is more than just placebo effect.
- Results were modest and further, larger scale research needs to be done.
A Solution for Back Pain – Acupuncture
It is estimated that 80% of the population will experience back pain at some point in their lives, and while most people recover from it, reoccurrence is common, and the other percentage of people will end up with it becoming chronic or disabled. In addition, back pain costs Americans at least $50 billion in health care costs each year, and if you add in lost wages from missing work and decreased productivity, that number rises to more than $100 billion.
Acupuncture has come a long way in the last couple of decades with more and more research verifying its healing properties with little to no side effects unlike its prescription medication counterpart. Raised awareness of alternative treatment modalities as well as doing their part to aid in the opioid epidemic is slowly gathering a following of western medicine providers to refer patients to treatments like acupuncture for back pain. It is clear acupuncture is a viable option for those seeking relief from back pain, and the western world of medicine is catching on to its benefits.