Effect of Acupuncture on Pain Management in Patients Before and After Lumbar Disc Protrusion Surgery
- A Randomized Control Study
American Journal of Chinese Medicine, Wntr, 2000
by Richard Rong Wang, Volker Tronnier
Abstract: Management of acute and chronic low back and leg pain often includes the use of acupuncture. The effectiveness of this form of therapy is dependent upon compliance, which in turn is dependent on availability, response, treatment of proper acupoints, and the placebo effect. We hypothesized that classical acupuncture would be more effective than placebo acupuncture. One hundred and thirty-two patients with acute and chronic low back and leg pain were examined before and after surgery for lumbar disc protrusion. Diagnosis was based on CT and MRT findings. Patients received acupuncture drugfree throughout the study period. The visual analogue scale was used to assess pain intensity before and after (i.e. 30min. 60min. 2h and 6h) acupuncture. Classical acupuncture resulted in a significant reduction in pain that become increasingly stronger during the 6h study period. Placebo acupuncture lead to same early pain relief that did not reach statistic significant and then declined thereafter.
Low back and leg pain is one of the most common conditions afflicting mankind (Waddell, 1991). Approximately 60% of all adults experience significant low back pain at least once in their lives (Loeser et al., 1991). Ninety percent of them recover within 6 weeks regardless of treatment. Of those who do not recover, the majority require surgical management (Long, 1991). Some fail to respond adequately and develop chronic low back pain. In Germany, roughly 50,000 Inervertebral disc operations are performed every year (Finkbeiner, 1996). Patients with low back and leg pain are generally in their most productive years. Pain severe enough to prevent employment represents a significant loss to the work force (Loeser et al. 1991). Each year, 2%-5% of adults seek medical attention or take time off from work because of low back pain. The degree of disability caused by chronic low back pain varies greatly and is dependent upon many factors. These factors include obvious physical abnormalities, the patient's general attitude and behavior, the magnitude of psychological distress, beliefs about the pain, coping mechanisms, and secondary pain issues (Loeser and Volinn, 1991; Waddell, 1991). Although most patients with low back pain respond to conservative measures or surgery, some fail all conventional analgesic treatment, and few options currently exist for these patients (Butler, 1991; Deyo, 1991). They are often referred to pain clinics where goals include improved function providing satisfactory pain relief while reducing or eliminating the use of opioids (Rosomoff and Rosomoff, 1991). Recently, an electrostimulating therapeutic system incorporating acupuncture (electroacupuncture) has been used to treat patients with chronic pain (Thomas et al., 1992; Thomas et al. 1994). Many of these patients report satisfactory and sustained control of pain (Petrie and Langley, 1983; Cheng and Pomeranz, 1987).
Back pain due to an ongoing pathology is primarily pain of nociceptive origin maintained reflexively (Thomas and Lundeberg, 1994). The mechanism of analgesia from electrical stimulation is presumably due to stimulation of midline raphe nuclei near the periaqueductal grey (PAG) matter of the brain stem which send projections to the spinal cord, which inhibit spinal transmission of nociceptive information from the upper dorsal horn (Basbraum and Fields, 1979).
