According to Dr (TCM) John Tsagaris, acupuncture is an ancient tool that triggers responses from the body to address a health concern, including inflammation and pain.
The technique has been recorded to regulate energy and focus on assessing the pathological underlying causes of a disease in order to allow the body to have the capacity to heal itself.
In modern medicine, acupuncture has been vastly applied in treating pain-related conditions and has become a very popular treatment for lower back pain and a variety of symptoms associated with it.
So how does acupuncture work?
There is a minefield of scientific, clinical and theoretical explanations on how acupuncture works. However, at the time, the Chinese just knew it works and that was enough to explore its potential in treating disease.
Nowadays, the technique has been accepted and has been used for some time – including in many NHS general practices – as well as most pain clinics and hospitals in the UK. In addition, it has been acknowledged by many private insurance companies where they cover the fees for a certain number of treatments.
Lower back pain affects about 1.1 million people in the UK, with a lot of patients suffering on a daily basis. The benefits of acupuncture for the condition include:
The reduction of pain, especially via spinal manipulation (SMT), cupping and other Chinese medical tools, due to their muscle-relaxant localised effect. This may facilitate micro-circulation of pain-killing chemicals, such as endorphins and opioids, and as a result, help to reduce pain.
Acupuncture is clinically valid for acute pain too, such as post-operative pain (POP), neuropathic pain, pain from tooth extractions and extraction of impacted wisdom teeth, with studies taking place in Japan despite the numerous factors to influence the therapeutic results.
Acupuncture may inhibit neuro-degeneration via expression and activation of BDNF (Brain Neuro-Trophic-Factors). Moreover, it has been reported that acupuncture can increase ATP levels at a localised level (Adenosine triphosphate is known as the main energy source for cells in the body). In addition, it may activate monocytes (a type of white blood cell) and increase the expression of BDNF via the stimulation of ATP, speeding the relay of electromagnetic signals. It also may release immune system mechanisms in the body to address localised neuro-inflammatory related pain.
What do clinical studies suggest?
Via a volume of clinical studies, acupuncture has been thoroughly examined for its effect on lower back pain with inconclusive results. This takes into account factors such as Sham acupuncture (non-traditional acupuncture, used as a control in scientific studies to determine whether or not the effects of a treatment are actually due to the actual acupuncture treatment), the doctor-patient relationship, placebo effect, the frequency of treatments, acupuncture modification etc. All this may significantly affect the results of the treatment.
Clinical evidence, however, indicates that low back pain improved after acupuncture treatment for at least six months. The effectiveness of acupuncture – either traditional or Sham – was almost twice that of conventional therapy.
After a large number of studies – including 30 randomised control trials that looked at the use of acupuncture alone – the authors of the draft guidelines concluded that although acupuncture is effective, the evidence overall demonstrated that it was no better than a placebo.
True vs non-true acupuncture: A debate
Such controversy raises a big debate, not on the therapeutic outcome regardless, but on the comparison of ‘true’ or ‘non-true’ acupuncture, where in clinical practice the pain relief of the patient needs to be a priority, rather than the rationale and scientific evaluation of the treatment.
Currently, lower back pain costs the NHS about £1Billion yearly, and the need for a cost-effective alternative is essential to help patients, as well as the NHS which is suffering from overwhelming problems from all directions.
Going back some time (1998), the direct healthcare costs of all back pain in the UK were estimated at £1623 million, with approximately 35% of these costs related to services provided by the private sector. The expense today is no doubt way out of manageable levels.
Currently, NICE (National Institute for Health and Care Excellence), recommends not considering acupuncture as a treatment option for musculoskeletal pain associated problems, as well as no use of osteopathy, chiropractic, ultrasound, transcutaneous electrical nerve stimulation, routine use of opioids and spinal injections for low back pain. These are also excluded from the document, which opened for consultation on March 24 2016, claiming that exercise alone can solve the particular health concern.
It needs to be stated that the same institution in 2009 was proudly endorsing acupuncture for lower back pain management. Instead, NICE nowadays recommends physical exercise therapy.
Exercise therapy, spinal manipulation (SMT) and acupuncture may all have a role in the clinical management of patients with chronic lower back pain (LBP). The overall evidence relating to the benefits of any of these is not clear despite NICE suggestions. However, there is no comparative benefit of one of these over the others.
Acupuncture and future clinical integrity
Acupuncture, in particular, is poorly represented in the current literature and evidence of equivalency between acupuncture and Sham acupuncture has doubted its validity in regards to the use and mechanism of action of the method as well as for its future clinical integrity.
The fact is that here in the UK it is estimated that low back pain is a cause of 37% of all chronic pain in men and 44% in women.
Therefore, acupuncture can be a cost-effective therapeutic tool used for the modest improvement of symptoms associated with lower back pain and the well-being of the patient. Alleviating symptoms and making the patient feel better should be criteria enough for assessing the effectiveness of acupuncture for pain relief in clinical practice.
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