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Back pain

Back to the Future

I was a bit shocked when I recently exchanged e-mails with an old friend named Dana and asked her how her 11-year-old son Kevin was doing. Turns out, he narrowly missed a very serious injury. Here’s the story in Dana’s own words:

“I was pushing Kevin on a tire swing, gave it a mighty oomph, rope broke, Kevin went sailing about 20 feet and landed on his back. I about died, Jenny. He had the breath knocked out of him and was really scared. I was too. At first he was just trembling and didn’t want to move. I thought he COULDN’T move. After a minute of pure dread (for both of us) he wanted to stand up. I helped him to his feet and he was okay. Walking a bit wobbly, but okay. He was tentative for about an hour. Now he’s fine, but says his lower back hurts a little when he bends. I’m afraid he’ll have back problems later in life, but we’ll deal with that if and when it happens. For now, every time I look at him I’m grateful he can even walk. This may all sound over dramatic, but it was a sickening sight to see. Awful.”

So today’s e-Alert is for Kevin (should he need it in the future), and for anyone else right now who may be suffering from back pain .

Meta-thinking

Last year, researchers at the University of Maryland School of Medicine examined the effectiveness of acupuncture on lower back pain.

The UM team conducted a meta-analysis of 33 randomized, controlled trials that compared the results of acupuncture with sham acupuncture (placing needles at spots that generate no response), or no additional treatments, or other active therapies that treat lower back pain.

Data from the trials was grouped into categories such as acute pain relief, chronic pain relief and style of acupuncture. Each category was then analyzed to assess diverse outcomes of pain, including functional abilities, overall improvement, return to work and painkiller use.

Noting that the quality and quantities of the trials varied, researchers found acupuncture to be “significantly more effective than sham treatment or no additional treatment.” Furthermore, acupuncture was found to be just as effective as other active therapies (read: “pain killers”) in relieving chronic lower back pain. In cases where lower back pain was acute the data was inconclusive.

All in the head

The University of Maryland researchers focused their trial on lower back pain studies, so the data didn’t include a remarkable acupuncture study from Harvard Medical School that I told you about in the e-Alert “Stuck on You” (4/7/04). In that study researchers investigated the body’s response to acupuncture with functional magnetic resonance imaging (fMRI), which reveals changes in blood flow, as well as fluctuations in blood oxygen.

Manipulation of needles was performed on a specific acupuncture point on the hand in 13 healthy subjects. When fMRI was used before, during and after acupuncture treatments, clear changes in the imaging occurred in several different areas of the brain in 11 of the subjects. These imaging changes indicated a decrease of blood flow, described by the researchers as a “quieting down” of the regions of the brain associated with pain, mood and cravings.

One of the researchers – Harvard Medical School radiologist Bruce Rosen – told the Associated Press (AP) that the regions of the brain affected in the test are particularly susceptible to a brain chemical called dopamine, which he describes as a reward chemical. Mr. Rosen speculates that when the blood flow is reduced, the resulting dopamine activity triggers the release of endorphins, which are chemicals that relieve pain.

If you try, certify

A few years ago I was experiencing enough discomfort from chronic back and neck pain that I screwed up my courage, overcame my aversion to needles, and underwent acupuncture therapy.

To my great relief – literally – I felt at most a very mild sensation from the acupuncture needles, and sometimes felt nothing at all. But my pain pretty much disappeared. When it was over, I wondered why I had waited so long to try it.

If you’d like to try acupuncture for yourself, it’s very important to locate an experienced and board-certified acupuncture practitioner. You can find a listing of certified acupuncturists on the web site for the National Certification Commission for Acupuncture and Oriental Medicine (nccaom.org). Using your Zip Code, you can easily search for practitioners in your area who have national board certification.

Sources:
“Early Acupuncture” cartoon, Mark Parisi, Off the Mark, offthemark.com
“Meta-Analysis: Acupuncture for Low Back Pain” Annals of Internal Medicine, Vol. 142, No. 8, 4/19/05, ncbi.nlm.nih.gov
“Acupuncture Modulates the Limbic System and Subcortical Gray Structures of the Human Brain: Evidence from fMRI Studies in Normal Subjects” Human Brain Mapping, Vol. 9, No. 1, ncbi.nlm.nih.gov

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