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Back pain can affect anyone at any age and most people will suffer from it at some point in their lives. It is the UK’s leading cause of disability and one of the main reasons for work-related sickness absence.
The condition affects more than 1.1 million people in the UK, with 95% of patients suffering from problems affecting the lower back. Back pain currently costs the NHS and community care services more than £1 billion each year*. Most lower back pain is caused not by serious damage or disease, but by sprains, muscle strains, minor injuries, or a pinched or irritated nerve. It can also occur during pregnancy, or because of stress, viral infection or a kidney infection.
How acupuncture can help
Research has shown that acupuncture is significantly better than no treatment and at least as good as (if not better than) standard medical care for back pain (Witt 2006; Haake 2007; Cherkin 2009; Sherman 2009a).
It appears to be particularly useful as an adjunct to conventional care, for patients with more severe symptoms and for those wishing to avoid analgesic drugs (Sherman 2009a, 2009b; Lewis 2010).
It may help back pain in pregnancy (Ee 2008) and work-related back pain, with fewer work-days lost (Weidenhammer 2007; Sawazaki 2008).
Acupuncture has in some meta-analyses been found superior to sham acupuncture (Hopton 2010) while in others the advantage was not statistically significant (Yuan 2008; Ammendolia 2008).
The sham interventions are not inactive placebos, but effectively different versions of acupuncture, so their value in evaluating treatment efficacy is highly questionable (Sherman 2009a). (See Table overleaf).
Acupuncture can help back pain by:
- providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and other neurohumoral factors and changes the processing of pain in the brain and spinal cord (Pomeranz 1987; Zhao 2008).
- reducing inflammation – by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007;Zijlstra 2003).
- improving muscle stiffness and joint mobility – by increasing local microcirculation (Komori 2009), which aids dispersal of swelling and bruising.
- reducing the use of medication for back complaints (Thomas 2006).
- providing a more cost-effective treatment over a longer period of time (Radcliffe 2006;Witt 2006).
- improving the outcome when added to conventional treatments such as rehabilitation exercises (Ammendolia 2008; Yuan 2008).
The National Institute for Health and Clinical Excellence guidelines on best practice now recommend that GPs offer a course of 10 sessions of acupuncture as a first line treatment for persistent, non-specific low back pain*
* National Institute for Health and Clinical Excellence clinical guideline 88 – Low back pain. www.nice.org.uk/CG88