can-acupuncture-help-back-pain

Can Acupuncture Help Back Pain?

Yes it can.

Like everything else, it doesn’t work the same for everyone. But it’s a safe and gentle treatment option that’s certainly worth a try if you have ongoing back pain.

In the German Acupuncture Trials (Gerac) For Chronic Low Back Pain, “Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.” Most people received ten sessions over about five weeks, with 1162 participants in the study. (1)

‘Sham’ means that some patients received needling but not on official acupuncture points. Which poses the question of how much the specific acupuncture points matter, or if it’s just the needling itself that does the trick.

Traditional acupuncturists understandably won’t like that; but I must say that in practice I have seen good results with a variety of different methods. This has been found in other studies too (2), as well as a large systematic review involving nearly 18000 patients. (3)

 

How Does Acupuncture Work For Back Pain?

There are still different views on exactly how it works.

We know that acupuncture can cause the release of ‘feel good’ chemicals like endorphins, serotonin and dopamine. So, the simple explanation is that it causes the brain’s own ‘pharmacy’ to control pain better.

There is also evidence that the ‘twitch’ (4) that sometimes occurs when the needle is inserted, help the surrounding muscle fibers to relax more.

It also seems to reduce inflammation, promote nerve growth, and improve blood flow to the tissues which helps with healing in the longer term.

Whilst Chinese Medicine states that healing comes about through unblocking energy flow in the meridians of the body, Western science thinks more in terms of the brain and nervous system.

Interestingly there may be an overlap between these two different models, which is explained well in Dr Daniel Keown’s excellent book The Spark in the Machine: How the Science of Acupuncture Explains the Mysteries of Western Medicine.

*Btw this is an affiliate link, so if you end up buying the book, we make a couple of bucks to buy a sandwich.

Dr Keown is a British medical doctor who also went on the Study Traditional Chinese Medicine in China. His understanding of both approaches gives him a unique perspective, and the philosophy he talks about is quite profound, right down to the creation of life itself.

But I digress.

He says that the Chinese meridian system is remarkably similar to what we in the West call fascia. Fascia is the membrane that wraps and surrounds and separates all the different organs and compartments in the body, and it’s made of collagen which conducts electricity very well.

The ancient Chinese knew about certain lines of fascia thousands of years ago, even though they are so thin they can only be seen with an electron microscope.

So, acupuncture does have something to do with the transmission of electrical signals in the body, and maybe the meridian concept isn’t so far-fetched after all.

 

Does It Hurt?

Usually not. In fact, often people do not even notice the needles going in, mainly because they are so fine, much finer than a standard syringe needle because there is no hollow tube for drawing fluid along (hence ‘dry’ needling).

Most of the pain receptors are on the surface of the skin, so with good technique the practitioner can flick the needles in so quickly that the patient just feels a tap.

You might get a brief sharp sensation, and sometimes a twitch or a deep aching feeling known as the ‘de qi’. It’s not really an unpleasant sensation though, more a signal that it’s doing something. And some people think that you need that sensation for it to be most effective.

Very occasionally however, you might get an area of skin with more nerve endings, where it does feel quite sore. In those cases, I usually take it out straight away, and just work on an area that’s more comfortable.

 

Is It Safe?

For most people acupuncture/dry needling is perfectly safe, as the needles are so fine that the area heals back up very quickly.

Caution is taken when a patient is on blood thinners like warfarin, but evidence suggests that the risk is very small. “Acupuncture appears to be safe in anticoagulated patients, assuming appropriate needling location and depth.” (5) In other words, if the practitioner knows what they are doing.

You might get minor side effects like localised soreness, bruising or a small pea-sized tender lump for a couple of days, where the needle has nicked a blood vessel, but these aren’t very common. And an ice pack on the area for ten minutes usually does the trick.

Like all forms of treatment, there are people who respond very strongly to it, and others who don’t respond at all. I have seen patients who became quite sore for a few days following acupuncture, and two who reported having acupuncture which set off sciatica for several weeks. This is very rare, but it’s worth noting that any form of treatment has potential to make things worse as well as better.

Serious injury from acupuncture is very unlikely if done by a qualified health professional who understands anatomy. Patients with conditions like epilepsy or diabetes should talk to their practitioner about any potential risks or side effects before having it.

 

When Is It Used?

I use it a lot in chiropractic practice, either alongside my usual care or as a standalone treatment option. Although technically what I do is called Dry Needling.

Dry needling is a simpler, Western version of acupuncture, which is not part of Traditional Chinese Medicine.

Eastern and Western medicine are very different in their approaches and understanding of how the body works. So dry needling is the Western attempt to replicate the successes of acupuncture without changing our way of thinking.

Whereas acupuncture in its true form is concerned with balancing energy flow in the body, dry needling is intended to reduce pain and improve blood flow and release tender ‘knots’ in the muscles known as trigger points. But it’s often still called acupuncture, as no-one’s heard of dry needling (and it sounds a bit off-putting).

If you receive it from a chiropractor, physio or osteopath, then it’s likely to be dry needling. This is learned as an additional skill and not usually a part of their core education. Although some practitioners and medical doctors have also studied Traditional Chinese Medicine, though they are rare. Dry needling is usually done alongside the practitioner’s standard treatment approach.

For example, I often use it when an area of the back is quite sore and tender to touch, so I don’t want to apply too much pressure or friction over the area and just aggravate the tissues. I also find it’s very helpful for headaches, neck pain and hip pain.

I will usually adjust my patient according to what they need on that day, then have them lay on the bench and dry needle them for a few minutes at the end of the session.

If you go and see an acupuncturist, i.e. a Traditional Chinese Medicine practitioner who practices acupuncture, then it will obviously be their main treatment method. They will assess you in their own way and explain how many sessions they recommend. Occasionally they may heat the needles, or even use a low current of electricity, though this is not the norm.

 

Conclusion

However acupuncture (or dry needling) works, the important thing is it does work for a lot of people.

So if you have back pain and haven’t tried it yet, you may find it very helpful. And as it’s such a gentle and low-risk treatment option, in my opinion, it’s worth a go.

 

Mike Cassidy-Hogg DC

Chiropractor

 

 

REFERENCES

(1) Haake M, MüLler H, Schade-Brittinger C, et al. German Acupuncture Trials (Gerac) For Chronic Low Back Pain: Randomized, Multicenter, Blinded, Parallel-Group Trial With 3 Groups. Arch Intern Med. 2007;167(17):1892–1898. doi:10.1001/Archinte.167.17.1892

(2) Cherkin DC, Sherman KJ, Avins AL, et al. A Randomized Trial Comparing Acupuncture, Simulated Acupuncture, and Usual Care for Chronic Low Back Pain. Arch Intern Med. 2009;169(9):858–866. doi:10.1001/archinternmed.2009.65

(3) Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012;172(19):1444–1453. doi:10.1001/archinternmed.2012.3654

(4) Langevin, Helene M., David L. Churchill, and Marilyn J. Cipolla. “Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture.” The FASEB Journal 15.12 (2001): 2275-2282.

(5) McCulloch, Michael, et al. “Acupuncture safety in patients receiving anticoagulants: a systematic review.” The Permanente Journal 19.1 (2015): 68.

 

Cover image photo by Katherine Hanlon on Unsplash

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