America officially recommends Acupuncture for low back pain… Will Australia follow suit? South Brisbane Acupuncturist Michelle Blum explores.

Low back pain is one of the most frequently reported pain conditions in adults world-wide. In the United States (US) alone, 25% of adults reported experiencing low back pain in some capacity within the last 90 days1.

Whether it’s a dull ache, shooting pains down the leg, numbness or acute injury, lower back pain hurts. In those suffering, reaching for pain killing medications and anti-inflammatories is often second nature.

The pharmacological arsenal for the day-to-day management of lower back pain includes; nonsteroidal anti-inflammatory drugs (NSAIDs) acetaminophen, opioid drugs, skeletal muscle relaxants, systemic corticosteroids and medications that act on the nervous system such as benzodiazepines, anti-depressants and even anti-seizure medications2.

Whilst the burden of the opioid epidemic cannot be understated, household drugs such as NSAIDs are an understated risk factor in the development of kidney disease, gastrointestinal ulcers3, leaky-gut syndrome4 and liver damage5.

The effects of lower back pain are far reaching, with negative consequences for workplace productivity, loss of wages and costs to the healthcare system. On an individual level, chronic pain conditions such as low back pain are associated with reduced quality of life and higher rates of depression6 in many people.

Never has the need for an effective, safe treatment for low back pain been higher!

A systematic review conducted by the Agency for Healthcare Research and Quality (AHRQ) examined the evidence and efficacy of common treatments for lower back pain including:

  • Pharmacological drugs
  • Psychological therapies
  • Physical rehabilitation
  • Spinal manipulation
  • Acupuncture
  • Massage
  • Exercise therapies

They evaluated each treatment in regards to the following outcomes:

  • Reduction of elimination in of low back pain
  • Improvements to mobility and function
  • Improvements to quality of life
  • Return to work
  • Frequency of low back pain episodes
  • Patient satisfaction
  • Adverse effects

How does Acupuncture perform in low back pain?

In acute and subacute cases of low back pain, acupuncture demonstrated a decrease in pain intensity with an increase in overall improvement compared to NSAID therapy. That means improved pain outcomes, without the risks associated with pain medication2.

In chronic low back pain, acupuncture reduced pain severity immediately following the treatment as well as for up to 12 weeks after the session2. When evaluating changes to low-back function, researchers found that acupuncture was associated with improved function compared to NSAIDs, analgesics and muscle relaxants and the placebo (non-penetrating acupuncture needles)2

Based on the review of evidence, The American College of Physicians (ACP) developed the following recommendations for clinical treatment of low back pain:

Recommendation 1

“Given that most patients with acute or subacute low back pain improve over time regardless of treatment, clinicians and patients should select nonpharmacologic treatment with superficial heat (moderate-quality evidence), massage, acupuncture, or spinal manipulation (low-quality evidence). If pharmacologic treatment is desired, clinicians and patients should select nonsteroidal anti-inflammatory drugs or skeletal muscle relaxants (moderate-quality evidence). (Grade: strong recommendation)2

Recommendation 2:

For patients with chronic low back pain, clinicians and patients should initially select nonpharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence). (Grade: strong recommendation)2

Recommendation 3:

“In patients with chronic low back pain who have had an inadequate response to nonpharmacologic therapy, clinicians and patients should consider pharmacologic treatment with nonsteroidal anti-inflammatory drugs as first-line therapy, or tramadol or duloxetine as second-line therapy. Clinicians should only consider opioids as an option in patients who have failed the aforementioned treatments and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients. (Grade: weak recommendation, moderate-quality evidence)2

Australia does tend to take its lead from the US – will health care providers take these recommendations into consideration when addressing the four million Australians who experience back pain?

In the meantime, consider booking an acupuncture treatment to relieve your low back pain.

Reference List.

1.       Deyo RA, Mirza SK, Martin BI. Back pain prevalence and visit rates: Estimates from U.S. national surveys, 2002. Spine (Phila Pa 1976). 2006. doi:10.1097/01.brs.0000244618.06877.cd

2.       Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017. doi:10.7326/M16-2367

3.       Marcum ZA, Hanlon JT. Recognizing the risks of chronic nonsteroidal anti-inflammatory drug use in older adults. Ann Long-Term Care. 2010.

4.       Bhatt AP, Gunasekara DB, Speer J, et al. Nonsteroidal Anti-Inflammatory Drug-Induced Leaky Gut Modeled Using Polarized Monolayers of Primary Human Intestinal Epithelial Cells. ACS Infect Dis. 2018. doi:10.1021/acsinfecdis.7b00139

5.       Sriuttha P, Sirichanchuen B, Permsuwan U. Hepatotoxicity of Nonsteroidal Anti-Inflammatory Drugs: A Systematic Review of Randomized Controlled Trials. Int J Hepatol. 2018. doi:10.1155/2018/5253623

6.       Sheng J, Liu S, Wang Y, Cui R, Zhang X. The Link between Depression and Chronic Pain: Neural Mechanisms in the Brain. Neural Plast. 2017. doi:10.1155/2017/9724371

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