Acupuncture: An Intensive Study In Chronic Low Back Pain
Acupuncture with needles or toothpicks has the same outcome in treating chronic low back pain (CLBP), according to an article published in the May 11, 2009 issue of the Archives of Internal Medicine. "CLBP is a national problems, costing Americans $38 billion annually in medical expenses, and $19.8 billion in productivity losses. [1] Self-assessed personal health status declined, despite rising spine care costs. [2]
The Archives study evaluated the impact of acupuncture on pain and suffering and lost function in patients with CLBP. It was a randomized controlled trial (RCT), utilizing four testing arms:
• Standard acupuncture followed Chinese tradition-needles, meridians, twirling, but no moxabustion.
• Individualized acupuncture, allowing the acupuncturist to "veer off the meridian highway," by varying the topical placement, insertion depth, and twirling of the needles.
• Sham acupuncture simulated the process of standard needling, using toothpicks and pressure to create a subjective impression of needle insertion along standard paths.
• Usual care-subjects were allowed to seek non-acupuncture care, such as primary medical prescribing for NSAIDs or narcotic analgesics, physical therapy, healing touch, massage, spinal adjustments, back manipulations, etc.
The study was innately weakened by difficulty "blinding" the acupuncturists, less so their patients, to the type of acupuncture administered in each trial. Attempts to control bias, i.e. masking telephone interviewers appeared sound.
Computer-assisted telephone interviews at eight, 26, and 52 weeks after experimental treatment revealed significant reduction in pain at 8 weeks for all four groups.
Mean function scores followed out to one year for individualized, standard, and sham acupuncture groups showed sustained significant improvement in function, compared to those patients in the usual care cohort (P < .001).[1] One year after treatment of CLBP patients, standard, individual, and sham acupuncture treatments showed no statistical differencrs among themselves. [1]
Discussion
Acupuncture comes to us from ancient and modern day Chinese practitioners of the craft. "Disease and pain result from imbalance of yinandyang,two primal forces of nature balanced in the human body through acupuncture." [3] ("Vital spark?" [4])
"Classic" acupuncturists insert thin needles at loci along 12 paired and two unpaired "meridians," running head to toe in/on the body. Meridians are said to connect vital organs and tissues. Inserted acupuncture needles are twirled intermittently during a treatment. Moxa (mugwort) may be applied to a needle top and ignited, a process called moxabustion, believed to stimulate the immune system. [5]
Are meridians road maps, delineating channels of vital energy flow? Should they be conceptualized as imaginary geographic meridians, e.g.the 97th, which plotted the Meridian Highway, running from Canada to Laredo ion 1920? Do they have substance? At least one physician reports their location:
"Conceptually, acupuncture Principal Meridians course through the myofascial layer of the body and send branches to one another and the organs they influence. Recent literature has described the concept of "myofascial meridians" as anatomical pathways that transmit strain and movement through the body's muscle and fascia." [6]
"The strong correspondence of the distributions of the acupuncture and myofascial meridians provides an independent, anatomic line of evidence that acupuncture Principal Meridians likely exist in the myofascial layer of the human body." [6]
Various Western theories attempt to account for acupuncture's effectiveness:
A Focal "meridian" stimulation improves systemic function.
B Acupuncture increases endorphin release.
C Acupuncture interrupts nociceptive thalamic input.[3]
Human touch has an impact on any healing encounter. Some medical practitioners check the radial pulse during every patient visit. Seeing the "healing touch" in most forms of therapy is not difficult. Human touch is so important that the 4-lane highway to various forms of alternative care is paved by a paucity of "hands on" care in traditional practice.
Many symptoms devolve from the central nervous system and take root in the soma. Much good can come from chiropractic (Greek chiro "hand" + praktikos "practice"), therapeutic massage, physical therapy, acupuncture, acupressure, and more.
Could it be that "real" and "sham" acupuncture only reflect a continuum of positive organic and vital response to palpatory interventions, where therapeutic touch is the independent variable, and forms of acupuncture are dependent variables?
Acupuncture, a specialized form of healing contact, controls distressing symptoms and dysfunction seen in chronic low back pain; needle and non-needle forms of this "healer's touch" appear effective.
References
[1] May 11, 2009 issue of the Archives of Internal Medicine
[2] Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299(6):656-664.
[3] The World Book Encyclopedia. 1987
[4] ] http://en.wikipedia.org/wiki/Vitalism
[5] n.wikipedia.org/wiki/Moxibustion
[6] Peter T. Dorsher, PT, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Jacksonville, Florida. "Myofascial Meridians as Anatomical Evidence of Acupuncture Channels." Medical Acupuncture. 2009;21(2):91-97. doi:10.1089/acu.2009.0631. Address correspondence to: Peter T. Dorsher, MD, MS Department of Physical Medicine and Rehabilitation
Mayo Clinic 4500 San Pablo Road, Jacksonville, FL 32224
Describe New Article Submission here.
Notes:
[1] May 11, 2009 issue of the Archives of Internal Medicine
[2] Martin BI, Deyo RA, Mirza SK, et al. Expenditures and health status among adults with back and neck problems. JAMA. 2008;299(6):656-664.
[3] The World Book Encyclopedia.
|
|
[Watch page ]
|
EditText of this page
(last edited June 23, 2009)
|
