Back Pain

Most of us suffer from back pain at some point in our lives. It can vary from the occasional ache to seriously affecting our everyday lives. Back pain, ache, cramps or tightness can appear suddenly, and last from a few days to a few months or in some cases years. It is one of the most common medical conditions.

The Health and Safety Executive takes an interest in back pain as it contributes to absenteeism from work, reduced productivity and inability to perform tasks. Orthodox treatment relies heavily on the use of anti-inflammatory drugs, and while these can be very helpful for some people there are many who can’t tolerate them e.g. some people with asthma, pregnant ladies.

Gentle effective treatment can be gained from acupuncture, alexander technique, and nutritional support. In most cases of back pain early treatment intervention produces both quicker pain relief and better long term results.

Causes of back pain
These vary but are often due to repetitive, prolonged or forceful movements or injury to bones, discs, nerves, ligaments, muscles and tendons of the back. Common causes include:

• stress related tension
• postural imbalance
  
• muscular strain
  
• spinal curvature – scoliosis and kyphosis are usually caused by longterm postural imbalance, but are sometimes present from birth
  
• osteoarthritis – from previous injury or general wear and tear
  
• obesity
  
• osteoporosis
  
• prolonged stress also sensitises the nervous system and affects pain perception

Less common causes include pregnancy, gynaecological problems e.g. pelvic inflammatory disease or endometriosis, other types of arthritis e.g. ankylosing spondylitis, viral infections e.g. shingles, bone disorders, or bladder and kidney infections.

Acupuncture for back pain
Individual diagnosis is required in order to determine the most effective treatment. Rather than giving one type of treatment for all aches and pains Traditional Chinese Medicine determines which treatment is suitable for each individual based on diagnosis of their underlying pattern of disharmony. Back pain can be caused by:

A number of treatment techniques may be appropriate such as acupuncture, moxibustion, cupping, gua sha or massage.

Research on Acupuncture treatment of Back Pain
The largest and most recent acupuncture treatment of chronic low back pain trial was conducted in Germany with 2,564 patients. After 6 months 45.5% of patients demonstrated clinically significant improvements in their functional ability scores, with the average number of days with pain decreased by half (Weidenhammer et al., 2007).

A randomised controlled trial (RCT) of 131 patients showed significant improvement with traditional acupuncture in chronic lower back pain compared to physiotherapy. Acupuncture was found to be superior to physiotherapy regarding pain intensity, pain disability, and psychological distress at the end of treatment (Leibing et al., 2002).

An RCT of older patients found that acupuncture is a safe adjunct treatment for chronic lower back pain, and resulted in fewer medication-related side effects (Meng et al., 2003).

Another RCT of 289 patients with non-specific low back pain lasting 1 to 12 months found evidence of benefit from acupuncture treatment at 24 months. 91% of the acupuncture group would seek further acupuncture (Thomas et al., 2006).

A meta-analysis of RCTs found on the whole acupuncture effectively relieves chronic low back pain. Their results suggest that acupuncture not only provides short-term amelioration but may also provide longer-term relief from chronic low back pain
(Manheimer et al., 2005).

Alexander Technique
For acute and chronic back pain, and postural problems, the Alexander technique may be beneficial. This method works to change your movement habits in your everyday activities. It helps to make you aware of balance, posture and co-ordination and helps you relearn the correct way to hold and to move your body and release muscular tension. For back pain due to recurrent tasks, an ergonomic assessment may help to break the cycle.

Nutrition and back pain

• Hydration levels affect the intervertebral discs which cushion the bones of the spine. If you are dehydrated your back health and pain levels will be worse.
  
• Essential fatty acids, especially omega-3’s, are required to maintain nerve health, reduce inflammation, and benefit osteoarthritis and rheumatoid arthritis. Omega 3 fatty acids are obtained from oily fish, flax seeds, pumpkin seeds, and walnuts.
  
• Glucosamine Sulphate acts to help repair damage in osteoarthritis. Scientific studies have been sufficiently positive that glucosamine is now available on NHS prescription.

Self-help tips
Some people are more susceptible to back pain than others. To avoid back pain avoid slouching, holding an object in a static posture without support, twisting, bending awkwardly, lifting, carrying, pushing, pulling beyond your capabilities and overuse or continuous repetitive movements.

For a recent injury

• Rest and use a cold compress such as a gel pack or a packet of frozen peas for 10 minutes several times a day for the first 24 hours. This will alleviate pain and minimize internal bruising in the muscles.
  
• When using a cold pack or ice on an injury be careful not to burn your skin – either keep the ice moving, or wrap it in a protective towel or tea towel.
  
• After 48 hours alternate the cold compress with a heat pad, for 10 minutes each
  
• Remember that while rest will help settle severe symptoms, prolonged rest will weaken the back muscles
  
• Continue with normal activities gently where possible

For longer term care and prevention of problems

• Ensure your bed has a firm, comfortable mattress
  
• Take regular gentle exercise to strengthen your abdominal and back muscles
  
• Use relaxation techniques or meditation to counteract muscular tension and stress
  
• Get support wedges or cushions for the car and office chair
  
• Chairs which move and tilt as you move are better for your back and joint health – it may be worth the investment
  
• Limit your daily time spent at the computer, take regular breaks
  
• Consider techniques to improve your posture
  
• Get shopping delivered – food delivery companies will usually carry things right to your kitchen
  
• If you do have to carry anything try to distribute weight evenly between both arms
  
• When coughing or sneezing, pull in your abdominal muscles to support your back
  
• If you have to lift anything keep your feet wide apart, bend from the knees, keep your neck relaxed, your back straight, and the object you are lifting close to you centre of gravity
  
• Ask for help when you need it – many injuries occur when we try to be brave and do too much
  
• Lose excessive weight
  
• Drink plenty of water
  
• A balanced diet with a good intake of omega 3 and omega 6 oils will help keep your back strong and supple.

Warning signs with back pain
You should see your doctor if you have back pain with:

• a history of recent injury
  
• inflammation, redness or swelling of the back
  
• pain radiating down the legs
  
• pain that does not show any sign of improvement
  
• constant pain which is not better in any position
  
• fever
  
• weight loss
  
• a history of having taken steroid medication for some months
  
• a history of being in a recent car accident – whiplash injury often goes undiagnosed but can cause longterm problem if left untreated

You should call an ambulance if you have back pain with:

• chest pain
  
• loss of bowel or bladder control, inability to pass urine, or numbness around the genitals or anus.

References
Health and Safety Executive. (2007). Back Pain. http://www.hse.gov.uk/msd/backpain/wkp.htm

Leibing E, Leonhardt U, Koster G, Goerlitz A, Rosenfeldt JA, Hilgers R, Ramadori G. (2002). Acupuncture treatment of chronic low-back pain -- a randomized, blinded, placebo-controlled trial with 9-month follow-up. Pain. Mar;96(1-2):189-96

Manheimer, E., White, A., Berman, B., Forys, K., and Ernst, E. (2005). Meta-Analysis: Acupuncture for Low Back Pain. Annals of Internal Medicine Volume 142 • Number 8: 651 - 663

Meng, C.F., Want, D. Ngeow, J. Lao, L. Peterson, M. and Paget, S. (2003). Acupuncture for Chronic Low Back Pain in Older Patients: A Randomized Controlled Trial. Rheumatology. 42: 1508 – 1517

NHS Direct. (2007). Back Pain. http://www.nhsdirect.nhs.uk/articles/article.aspx?articleId=234

NIOSH. (1997). Facts: Work-Related Musculoskeletal Disorders. http://www.cdc.gov/niosh/muskdsfs.html

Thomas K J, Macpherson H, Thorpe J, Brazier J, Fitter M, Campbell M J, Roman M, Walters S J, Nicholl J. (2006). Randomised controlled trial of a short course of traditional acupuncture compared with usual care for persistent non-specific low back pain. British Medical Journal. 333:623-6. http://bmj.com/cgi/content/short/333/7569/623?etoc

Weidenhammer W, Linde K, Streng A, Hoppe A, Melchart D, (2007), Acupuncture for chronic low back pain in routine care: a multicenter observational study. Clin J Pain.2007 Feb;23(2):128-35.