Two days ago, I saw three patients with acute onset of back pain. All involved minimal exertion of back but severely painful, interfering with sleep and ambulation. One could not walk with back straight, needed to use hand support to get up from sitting position. The other held his back when he walked gingerly into office. The third one could not put on his socks because it was so painful to bend down. I did my usual: put acupuncture needles into NingGu, DaBai, RenZhong, ChengJiang and asked them to slowly loosen their back as I documented their history and physical findings on the chart. By the time I finished with their charting, they were able to bend down, walk with back straight and arm swings with significant relief of pain. I explained to them the good treatment results indicated that there were no structural damage to the back because structural damage would not be reversed with just 3-4 acupuncture needles. One patient played it safe and got X-ray done anyway, which showed totally normal spine.

 

This reminded me of another patient I saw several months ago who missed several days of work because of acute back pain suffered during weekend yard work. Husband had to physically carry her out of the car because it was that painful to move her back. Several acupuncture needles and moving cup later, she was like a new person and able to return to work the next day. No recurrence since.

 

This is the reason I am so interested in complementary treatment to western treatment modality. Acute back pain like these are difficult to treat with traditional means of rest, muscle relaxants (eg Flexaril), pain killers. X-rays are invariably normal but I would order it just to make sure there is no rare occasion of compression fracture or bone metastasis or infection. Rest usually does not do the trick. Flexaril etc usually causes too much drowsiness without much relief and same is pain killer like Ibuprofen/Advil. Physical therapy is the go-to modality but if patient is in so much pain, he will not able to participate fully. Even with whole-hearty participation (2-3 times a week), the results are not always satisfactory.

 

If they do not get better quickly, then chronic pain developed and we have even less to offer. Physicians turn to strong pain killer like Oxycontin which provides short term pain relief. I read an interesting article in the New York Times yesterday. The author showed that Oxycontin is not only addictive, (every year about 18,000 die from Oxycontin overdose, the same numbers of death caused by breast cancer), but also detrimental to health when used long term. It inhibits the hormone balance (e.g. secretion of sex hormones) and causes long term health consequence. As a result, back pain is the number one reason people apply for long term disability in this country!

 

For patients who do not want to take long term pain killers, they would like to get MRI to see what is going on and entertains back surgery. But as I explain above, structural damage to disc like disc herniation happens over time and is seldom the cause of back pain. I saw frequently that when herniation occurs in both sides of spine, the more severe side actually has less pain. Spine surgeons now are much more careful in choosing whom they would operate because as one surgeon puts it: “The biggest reason for failed spine surgery is operating on the wrong patient.” Even with successful back surgery, some people never recover to the level before the onset of back pain. Initial pain relief can be followed by recurrence several years later.

 

My suggestion to my patients: come in when you first experience back pain and the sooner it is fixed the quicker the recovery. Do not ice it because it causes cold and dampness invasion of back and more difficulty expelling them later. After treatment, sleep on a hard surface instead of soft mattress. My hope is to avoid more patients going through the ordeal of back surgery. One stitch in time saves nine!

Monday, July 22, 2013 - 13:15