Chinese Medicine
Commentary on Assessment and Recommendations
Low Back Pain

Overview

This is a typical case of chronic back pain. 80% of back pain cases are muscle/ligament related and without obvious neurological red flags. In the clinic, most patients with chronic back pain cases have a predisposition towards or combination of other medical conditions such hypertension, diabetes, hyperlipidemia, skeleton-muscle-neuron-spinal system degeneration, antidepressants or pain medications associated medical conditions. Therefore, physical or emotional stresses usually are common triggers of recurrence.

Chinese medicine stresses a holistic view of low back pain, especially for chronic cases. Therefore, the approaches of its treatment are individualized (1, 2). In Chinese Medicine, the diagnosis and treatment of low back pain are based on the clinical evaluation of the patient’s symptoms, physical signs, and lab tests. Symptom differentiation is a key step to individualize the case. However, there is no pure type of symptoms seen in the clinic. In most cases, patients usually have a mix of two or three types because of the complication of the patient’s predisposition and the involvement of systems. The common types of low back pain are: 1) Blood stasis Type; 2) Cold Dampness Type; 3) Kidney Deficiency Type; 4) Heat Dampness Type. Chinese Medicine pays special attention to the tongue and pulse evaluation during clinical diagnosis.

Acupuncture

Acupuncture is a cost effective therapy for low pack pain and recent scientific and clinical investigations have demonstrated the efficacy and positive outcomes attributable to acupuncture for management of pain (2, 3, 4, 5, 6, 7). The literature suggests that acupuncture triggers the release of endorphins, brain-altering neurotransmitters, and neuropeptides which is supported by the facts that acupuncture may affect mood, energy and immunity of human body. Acupuncture can provides long-term relief of low back pain and is also able to enhance the function of lumbar-sacral-coccygeal muscles to improve the limited motion range due to pain (8, 9). In this very case, local acupoints has been mainly selected together with remote acupoints in multiple meridians. Attention is needed to four local muscles that are usually involved in the chronic low back pain (Quadratus lumborum; Gluteus medius; Piriformis; Iliopsoas) in order of involvement. In addition to its pain modulating effect, acupuncture directly improves circulation to the affected area.

Auricular acupuncture has been found very useful to help stress related pain and drug addiction/other kinds of withdrawl syndromes that are common in chronic back pain. Its mechanisms may involve in the regulation of brain neurotransmitters such as dopamine, nor-epinephrine, and Serotonin (10, 11).

Herbs

Chinese herbs are a very important modality in the treatment of chronic low back pain. In this case, a holistic-approach formula is designed to enhance Qi/Blood flow in meridians (hemodynamic condition in cardiovascular/muscle system), expel dampness/heat (pathological fluids and autoimmune reaction causing non-inflectional inflammatory), balance the Liver Yang and enhance Liver/Kidney Ying (sympathetic/parasympathetic balance and hormone/neurotransmitters balance). Furthermore, herb formulas contains vital nutrients such as trace minerals, vitamins, enzymes, co-enzymes, and phyto-hormones. They are essential for the recovery of damaged soft tissue, muscle, ligament, joints and nerve and neuron as well as to prevent skeleton-muscle-nerve degeneration (12, 13, 14).

Other Methods

Cupping is a unique treatment for pain related illness. Basically it is an assistant approach that will lead to the improvement of local circulation, lymph drainage, and spasmodic muscle (15).

Moxa is a procedure of burning aromatic herb Moxa to deliver heat to certain acupoints in order to enhance the circulation and expel cold devil of the local system. Moxa therapy is useful for cold type of low back pain with an impaired circulation (16, 17). However, it is not indicated for this very case due to its dampness heat type.

Tai Chi, or less commonly Taiji, is a traditional martial art that is widely practiced in oriental countries. It involves movement to enhance spine alignment and joint flexibility. Recent research indicates benefit for the prevention of bone loss in seniors. (18, 19).

References:

1. Sherman K J, Hogeboom C J, Cherkin D C. How traditional Chinese medicine acupuncturists would diagnose and treat chronic low back pain: results of a survey of licensed acupuncturists in Washington State.Complement Ther Med 2001 Sep; 9(3):146-53
2. Sherman KJ, Cherkin DC, Hogeboom CJ. The diagnosis and treatment of patients with chronic low-back pain by traditional Chinese medical acupuncturists. J Altern Complement Med 2001 Dec;7(6):641-50
3. Sato, T., Takes hige, C., and Shimizu, S. Morphine analgesia mediated by activation of the acupuncture-analgesia-producing system. Acupunct. Electrother. Res. 16: 13-26; 1991.
4. Shang, C. Singular Point, Organizing Center and Acupuncture Point. Am. J. Chinese Med. 17: 119-127; 1989.1
5. Takeshiga, C., Nakamura, A., Asamoto, S., and Arai, T. Positive feedback action of pituitary 3-E on acupuncture analgesia afferent pathway. Brain Res. Bull. 29: 37-44; 1992.
6. Takeshige, C., Oka , K., Mizuno, T., Hisamitsu, T., Luo, C.P.,Masao, K., Mera, H., and Fang, T.-Q. The Acupuncture point and Its Connecting Central Pathway for Producing Acupuncture Analgesia. Brain Res. Bull. 30: 53-67; 1993.8
7. Takeshige, C., Sa to, T., and Komugi, H. Role of peri-aqueductalcentral gray in acupuncture analgesia. Acupunct. Electrother. Res. 5: 323-337; 1980.5
8. Moffett JK, Torgerson D, Bell-Syer S, et al. Randomised controlled trial of exercise for low back pain: clinical outcomes, cost and preferences. British Medical Journal July 31, 1999;319(7205):279-283.
9. Carlsson C, Sjund B. Acupuncture for chronic low back pain: a randomized placebo-controlled study with long-term follow-up. Clinical Journal of Pain 2001;17(4):296-305.
10. Greif R, Laciny S, Mokhtarani M, Doufas AG, Bakhshandeh M, Dorfer L, Sessler DI. Transcutaneous electrical stimulation of an auricular acupuncture point decreases anesthetic requirement. Anesthesiology. 2002 Feb;96(2):306-12.
11. Russell LC, Sharp B, Gilbertson B. Acupuncture for addicted patients with chronic histories of arrest. A pilot study of the Consortium Treatment Center.
J Subst Abuse Treat. 2000 Sep;19(2):199-205.
12. Asano K, Matsuishi J, Yu Y, Kasahara T, Hisamitsu T. Suppressive effects of Tripterygium wilfordii Hook f., a traditional Chinese medicine, on collagen arthritis in mice. : Immunopharmacology 1998 May;39(2):117-26
13. Zheng S, Yang H, Zhang S, Wang X, Yu L, Lu J, Li J. Initial study on naturally occurring products from traditional Chinese herbs and vegetables for chemoprevention. : J Cell Biochem Suppl 1997;27:106-12
14. Kosuge T, Yokota M, Sugiyama K, Mure T, Yamazawa H, Yamamoto T. Studies on bioactive substances in crude drugs used for arthritic diseases in traditional Chinese medicine. III. Isolation and identification of anti-inflammatory and analgesic principles from the whole herb of Pyrola rotundifolia L. Chem Pharm Bull (Tokyo) 1985 Dec;33(12):5355-7
15. Ju Huadong, 30 cases of frozen shoulder treated by needling and cupping, International Journal of Clinical Acupuncture 1998; 9(3): 327–328.
16. Hitosugi N, Ohno R, Hatsukari I, Mizukami S, Nagasaka H, Matsumoto I, Komatsu N, Fujimaki M, Nakashima H, Satoh K, Sakagami H. Diverse biological activities of moxa extract and smoke.In Vivo 2001 May-Jun;15(3):249-54
17. Chiba A, Nakanishi H, Chichibu S. Thermal and antiradical properties of indirect moxibustion. : Am J Chin Med 1997;25(3-4):281-7
18. Yoshimura N, Hashimoto T, Sakata K, Morioka S, Kasamatsu T, Cooper C.
Biochemical markers of bone turnover and bone loss at the lumbar spine and femoral neck: the Taiji study. : Calcif Tissue Int 1999 Sep;65(3):198-202
19. Yoshimura N, Hashimoto T, Morioka S, Sakata K, Kasamatsu T, Cooper C. Determinants of bone loss in a rural Japanese community: the Taiji Study. Osteoporos Int 1998;8(6):604-10