May 2007

Acupuncture Treatment of Low Back Pain

By Elliot Wagner, O.M.D., L.Ac., Doctor of Oriental Medicine

A few years ago I was recruited by the Kaiser Permanente Department of Research to work on a research project that was the largest acupuncture study yet done in the U.S. The purpose of the project, which Kaiser conducted with funding from the National Institutes of Health, was to test whether it could be demonstrated under controlled conditions that acupuncture is an effective therapy for low back pain, compared to conventional medical treatments. The results of the study have not yet been published, so I can't tell you the outcome. My point in relating this bit of my history is to help o put in perspective the use of acupuncture in low back pain treatment.

Kaiser patients with low back pain come to see their doctors by the thousands, and Kaiser is interested in the outcome of the study because it is on the look out for effective treatments for these people. In the San Francisco Bay Area alone, Kaiser doctors see patients for low back pain at the rate of about 30,000 a month — every month! It is a lot of low back pain, and Kaiser doctors have, essentially, three options to offer:

  • Anti-inflammatory medications — acetaminophen, ibuprofen and naproxen, for example.
  • Physical therapy, most of which consists of teaching exercises for the back and proper movement.
  • And, in serious cases, surgery

I cite Kaiser not only because of my experience there, but because, as the largest provider of health care in Northern California, it may serve to represent the practices, as well as the needs, of the entire health care system and of patients in general. Kaiser's interest in acupuncture is an acknowledgement that there are a lot of patients with low back pain, at Kaiser or elsewhere, who may not be getting the care they need.

Here are a few things to know about low back pain:

  • As painful as low back pain is to the individual patient, it is one of the most common human ailments. According to the National Library of Medicine, low back pain is the #2 reason that Americans see their doctor — second only to colds and flus.
  • The most common cause of low back pain is muscle strain. Approximately 90% of all acute (short term) low back pain is muscle strain. Most of these resolve by themselves in a few days.
  • The weight of the entire trunk rests on the vertebrae of the lower lumbar and sacral spine. There is more stress on these vertebrae and their associated muscles, tendons, and ligaments then on vertebrae farther up the spinal column. The sacrum sits between the two pelvic, or iliac, bones and is held together by the two sacroiliac joints. Many back problems occur where the lumbar and sacral regions of the spine connect, because this area of the spine is subject to a lot of stress
  • Other causes are osteoarthritis in the lumbar vertebrae; irritation of the spinal nerve roots, including those that join to form the sciatic nerve; a sprain of the ligaments connecting the joints of the low back; and damage to the spinal discs.
  • The severity of low back pain is often unrelated to the extent of physical damage. Muscle spasm from a simple back strain can cause excruciating back pain that can make it difficult to walk or even stand, whereas a damaged or degenerated disc can be completely painless. This is the reason why even sophisticated imaging techniques like MRI or CAT scan often cannot tell you precisely the cause or location of your pain.
  • Conventional treatment for low back pain is focused almost entirely on anti-inflammatories and active therapy: exercises, stretching, yoga. There is little available for people for whom those therapies do not work, or who cannot do them.

Enter acupuncture! In my practice at any given time, about one-quarter of patients are being treated for low back pain, and virtually every one of them tried acupuncture as a last resort, after conventional treatments hadn't worked. They are surprised at how well acupuncture understood the body well, and there is something wonderfully logical and systematic about how it works. Whether a patient is a young female athlete with an acute back strain, a retired professional suffering from the aches and pains that accompany aging, or a young mother in pain from lifting small children all day, they all benefit from the extraordinary capacity of acupuncture to target and relieve pain and restore normal functioning.