Using acupuncture in the treatment of chronic back pain: A case study of a seventeen years old girl
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Abstract
A seventeen-year-old girl attended a clinic with complaints of chronic low back pain. She had been in this state of pain since the age of thirteen years. The pain had been worsening in the past three months before she attended the clinic. Acupuncture treatment method was suggested to help relieve the back pain. At first, she was reluctant to buy the idea because she had never gone through the procedure before. After education about what the process entailed including details of the risks and contradictions involved she gave in. She was determined to ease her pain and therefore signed the consent forms together with her aunt since she is a minor. She was exposed to three acupuncture sessions which were not frequent. However, the method successfully eased her pain. This report reveals that acupuncture method is successful in the short term treatment of chronic low back pain.
Introduction
Low back is a significant health problem that is classified under the musculoskeletal disorders. According to the National Ambulatory Medical Care Survey data about 2.3% of patients who visit the physicians do so due to the low back problems (Deyo, Mirza, & Martin, 2006, p. 2725). Apart from the severe spinal problems, most of the issues reported in the primary care are unspecified low back problems (Oakes & Bassett, 2015, p. 46). Back pain is known to be a significant cause of disability among adults (Vas, Perea, Mendez, Silva & Galante et al., 2006, p. 3). Research shows that the cost of treating low back pain in the US accounts for about £12.3 (Supriya, 2018, p.1). This indicates low back pain is indeed a serious health problem that needs intervention. The health problem is also widespread even among the professional footballers in the world. The occurrence of low back pain among various individuals can have a serious technical, social and financial impact. Evidence from research reveals that there are better results associated with acupuncture if the patients are grouped into the five major classifications. However, such kind of groupings is not common in medical practice (Karayannis, Jull, & Hodges, 2012, p. 24). The medical cost of treating lower back pain has led to a lot of debate about the best method that can be used to cure it.
This paper presents the case study of a seventeen-year-old girl who is suffering from lower back pain. The method of treatment selected is acupuncture. Acupuncture is a popular method of treating and reducing pain that has been very successful in treating various types of diseases. The rationale for using it in the treatment of lower back pain is that it has proven to work in managing lower back pain. The clinical reasoning for using acupuncture is because it has proven to be very useful in the treatment of low back pain. Some research groups have shown that this method of treatment works effectively and as an inhibitory effect on the management of pain. In a particular case study, acupuncture was used in the treatment of lower back pain for a certain footballer. The 23-year old footballer had this persistent problem for five years. The issue became worse due to the straight line running. The footballer was exposed to an eight-session acupuncture treatment program for two weeks. Also, he was subjected to stretching, strengthening, some exercises and postural education. After the completion of the acupuncture treatment program, the footballer reported a decrease in pain of 75% which was measured using the Numerical Pain Rating Scale (NPRS). This pain was reduced during running, and he managed to go back into the full squad training (Wilson & Hallas, 2018).
Further, some extensive research involving many studies has revealed that acupuncture is indeed very effective in relieving pain from chronic lower back pain. It is justification for the use of the method in the treatment of LBP. Some research reveals some conflict in the use of acupuncture and many of the trials incorporated poor methodology. This conflict at some point hindered the use of acupuncture in the treatment of low back pain (LBP) in many clinical settings (Manheimer, White, Berman, Forys, & Ernst, 2005, p. 660). However, after the introduction of the National Institute of Clinical Excellence (NICE) guidelines, the use of acupuncture has been very famous among the patients and the doctors. Its use continues to reveal success in pain relief for patients with low back pain. Various evidence reveals better results for patients with particular characteristics such as a young age and education of more than ten years (Witt et al., 2006, 490-492). A recent study conducted by Oakes & Bassett (2015, p. 38) revealed that individualized acupuncture treatment sessions were more effective than group therapy in 51 individuals who were suffering from low back pain.
Case study description
Patient profile and past medical profile
The case study presents a seventeen-year-old girl. The girl complains of central pain in her lower back. She indicates that the lower back pain either occurs on her right or left side of the lower back. Sasha (not her real name) describes that the pain feels like a constant bruise though there are no signs. Standing for an extended period, bends or lifts something heavy, the pain increases. According to her, when she took painkillers or rested, the pain reduced. This description indicates that there is a mechanical component that exists in the patient’s problem (Refshauge & Gass, 2004, p.65). When Sasha turns in bed at times, she experiences sleep disturbance. However, she can fall asleep again once she settles in a comfortable position. A notable thing about this patient is that she reported a history of sporadic Low back pain from the age of thirteen years. However, her past treatment only included the use of painkillers.
When the patients came to the clinic for examination, the pain was too much. She explained that this pain had been so for the past three months. The pain had pain continuous for the period though no investigation had been conducted before her coming to the clinic. The pain was too much especially in the morning and worsened as the day progressed. Also, the pain was accompanied by lots of sneezing. This kind of pain made her feel very tired. We conducted screening for yellow and red flags which were not present. Sasha is a university student who worked part-time as a sales representative. It involved a lot of standing which worsened the situation. It made it too hard for her to continue working. Sasha indicted that she often went to the gym for exercises when she was not working or attending classes. Postures that took more than 30 minutes aggravated the pain including extended gym exercises.
Clinical assessments
Clinical assessments were done and indicated no sign of postural abnormalities when the patient was sited, standing or walking. Also, we found no sign of pelvic mal-alignment when the patient was standing. The range of motion around her hips was full. Rotation reflected the symptoms. The patient underwent tests like thigh thrust test and Patrick’s test. FABER test revealed the signs, though the patient reported no hip joint pain on the event of palpation.
Similarly, the patient underwent sacroiliac joint tests such as distraction. During this test, the sacrum thrust revealed similar symptoms, especially on the right side. Her core muscles exposed some weakness. Straight leg raise was done which revealed some normality. No neurological examination was conducted since there was no neurological sign. From the three tests conducted and the pain that Sasha experienced on the lumbosacral segment, it was evident that the patient could be suffering from SIJ dysfunction (Laslett, Aprill, McDonald, & Young, 2005, p.210; Szadek, Vander, Van, Zuurmond & Perez, 2009, P. 364). Since the patient was in so much pain it was hard to conduct a diagnosis. According to the examination, the clinicians speculated the possibility f either the SIJ dysfunction or the mechanical lower back pain.
The clinicians discussed with the patients about the proposed acupuncture treatment. The clinicians sought the informed consent to conduct acupuncture on the patient as a way of easing her pain. A discussion was held including educating the patient about what acupuncture was, and the effect that it will have on her problem further explanation was made about the clinical evidence of the success of using the method to treat lower back pain. This would ensure that the patient was fully aware of the treatment used and the expected outcome on her condition.
Treatment
From the diagnosis, the treatment plan was aimed at eliminating the pain that the patient was experiencing. The aim of the sessions was to reduce pain as close as to 0 while increasing the motion range. The patients first underwent manual therapy. The following session involved the use of acupuncture after manual treatment failed to achieve any improvement on the symptoms that the patient experienced. The patient then underwent a maximum of six physiotherapy sessions and three sessions of acupuncture within six weeks. Sasha had no prior experience in using acupuncture and was at first unsure if she wanted to go through the procedure. She wasn’t sure about how effective the process will be on her. Despite all this, she was willing to go ahead with the process because she was looking forward to the kind of treatment that would ease her pain. She was taken through what will happen throughout the procedure including the sensations during the procedure and after the treatment. She was also taken through the risks and contradictions of going through the process after which she signed the consent form. Since she was a minor, the form was also signed by her aunt who is her guardian before proceeding with the procedure.
The position of the patient during treatment was such that it exposed her lower back part. The clinicians used Classic Plus sterile acupuncture needles which had copper handles. The clinician inserted the needles manually by pushing them in and out until Sasha felt the same sensation as that which she experienced during the first manipulation. During all the three acupuncture sessions, the clinician was very careful not to cause any accidents especially due to curved needles. Thorough preparation was made in case any of these cases happened. Also care was taken not to cause any infection including washing of hands and avoidance of touching the shafts of the needles.
Treatment sessions
Treatment sessions
Acupuncture points
Length of time (minutes)
Size of the needle
Insertion depth
Aftermath effect (De qi)
First
BL 23 Shenshu, BL 24Qihaishu, BL 25
Daqangshu
20 minutes
4cm
15-20mm
Mild
Second
BL 23 Shenshu, BL 24Qihaishu, BL 25
Daqangshu, 3 HJJ (Huatuojiaji)
20 minutes
4cm
15-20mm
Strong
Third
BL 23 Shenshu, BL 24Qihaishu, BL 25
Daqangshu, LI 4 (Hegu)
20 minutes
4cm
2.5 cm
15-20mm
5-10mm
Mild-strong
Session 1
During this session, a re-examination was conducted which revealed a reduction of 40% in lumbar spine AROM for all the movements. The patients indicated that she experienced mild pain on the flexion of the lumbar spine. However, she was cautious when making any form of movements. The re-assessment findings were normal apart from the feeling of tenderness and stiffness which were mild. The clinician ensured to examine the area before carrying out acupuncture to ensure that there were sensory issues which could result in a contradiction. The clinician ensured that the patient experienced the pinprick sensation after inserting the needle after which he manipulated the needle by twirling it and pushing it in and out. At this point, Deqi was achieved. The patient reported having felt some sense of drowsiness which is normal.
Session 2
The second session was carried out after two weeks. The patient reported that there was soreness on the part where acupuncture was conducted for one day. However, she said that symptoms subsidized after some time. This kind of improvement lasted for 6 to 7 days. Some positive results were experienced since the patient reported that there was a reduction in the lumbar spine AROM one of the sides. The patient reported that he felt some sense of tenderness on the lower lumbar spine. The final acupuncture session was a success which gave the patient the go-ahead to continue with the process. The deqi that was achieved during this stage was quite stronger that than the previous session.
Session 3
The third session took place after three weeks. After this treatment was conducted, the patient indicated that he felt no pain for six days. The lumbar spine AROM had some improvement, though the patient remained very cautious during movement. The following week the lumbar spine AROM was full. However, the patient experienced some occasional pain especially if he stood for long hours or prolonged bending. The patient was happy with the results because of the reduced symptoms and wished to go on with the treatment. Nevertheless, the procedure could not go on since Sasha was to go back to work after the treatment and she did not want to experience drowsiness while at work. The patient was therefore discharged.
Clinical rationale for Point selection
Bladder (BL) 23, 24 and 25
These points were chosen so that they would give out a localized effect. It would happen if they produced some inflammatory exudates which in return causes to vasodilation. In return, vascular permeability is achieved (Sandberg, Lundeberg, Lindberg, & Gerdle, 2003, 115).
Huatuojiaji – 3HJJ
The clinician chose these points to increase the local effect.
Hegu – L14
This point usual has an analgesic impact especially on any musculoskeletal pain which is why it was chosen.
Discussion
The case study reveals that impact that short term effect that acupuncture can have on the treatment of chronic lower back pain which is in agreement with previous research (Manheimer, White, Berman, Forys, & Ernst, 2005, p.655). Though this study has revealed some successful, it can be hard to associate acupuncture as the only method in the treatment of chronic low back pain. One of the reasons for this is that there was no continuity in the procedure. The patient withdrew from treatment though she had earlier been told the benefits of follow-up treatments because of personal reasons. Past research shows that the success of the acupuncture method on some musculoskeletal disorders was when the treatment sessions took place regularly and frequently (Oakes & Bassett, 2015, p.44).
The patient indicated that she experienced a continuous onset of the lower back pain which us in support of the evidence that reveals favorable success under the same situation (Smedley et al., 2005, p.530). Also, some factors could have helped to increase the effect of the acupuncture which includes the physical therapy interventions. Medically, these of acupuncture and manual therapy during the same sessions is proven to be very successful. Though manual therapy can be used before or after acupuncture treatment, clinical evidence reveals that it is more effective if it is used before the acupuncture sessions.
Generally, it is evident that acupuncture is useful in the short term in treating chronic low back pain. When patients are in pain, they cannot go about their normal lifestyle. Acupuncture successfully helped to ease this pain and enabled the patient to go back to their healthy lifestyle. (Farr et al., 2005, p.150).
Despite the positive results, the study was not without some limitations. The study involved the treatment of a single patient. It is thus not clear if a group treatment would yield the same kind of results. Besides, the study included a short term follow-up since the patient withdrew from treatment for personal reasons. Future research should involve a larger sample and a long term follow-up of the patients and use of a robust technique. Also, the current study did not include the use of electro-acupuncture modalities. Various studies have shown that the EA is very efficient unlike the use of manual acupuncture. Future research should, therefore, focus on the use of electron-acupuncture.
References
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Karayannis, N.V., Jull, G.A. and Hodges, P.W., 2012. Physiotherapy movement based classification approaches to low back pain: comparison of subgroups through review and developer/expert survey. BMC musculoskeletal disorders, 13(1), p.24
Laslett, M., Aprill, C.N., McDonald, B. and Young, S.B., 2005. Diagnosis of sacroiliac joint pain: validity of individual provocation tests and composites of tests. Manual therapy, 10(3), pp.207-218.
Manheimer, E., White, A., Berman, B., Forys, K. and Ernst, E., 2005. Meta-analysis: acupuncture for low back pain. Annals of internal medicine, 142(8), pp.651-663.
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Sandberg, M., Lundeberg, T., Lindberg, L.G. and Gerdle, B., 2003. Effects of acupuncture on skin and muscle blood flow in healthy subjects. European journal of applied physiology, 90(1-2), pp.114-119.
Smedley, J., Inskip, H., Buckle, P., Cooper, C. and Coggon, D., 2005. Epidemiological differences between back pain of sudden and gradual onset. The Journal of rheumatology, 32(3), pp.528-532.
Supriya, T. K., 2018. Short Term Effect of Acupuncture in Chronic Low Back Pain: A Case Study. Journal of Yoga and Physiotherapy, 3(4): pp. 1-5.
Szadek, K.M., van der Wurff, P., van Tulder, M.W., Zuurmond, W.W. and Perez, R.S., 2009. Diagnostic validity of criteria for sacroiliac joint pain: a systematic review. The Journal of pain, 10(4), pp.354-368.
Vas, J., Perea-Milla, E., Mendez, C., Silva, L.C., Galante, A.H., Regules, J.M.A., Barquin, D.M.M., Aguilar, I. and Faus, V., 2006. Efficacy and safety of acupuncture for the treatment of non-specific acute low back pain: a randomised controlled multicentre trial protocol [ISRCTN65814467]. BMC complementary and alternative medicine, 6(1), p.14.
Wilson, J. & Hallas, T. 2018. Acupuncture for low back pain in a professional footballer. A Case Report. [Online]. Available at: https://www.oatext.com/Acupuncture-for-low-back-pain-in-a-professional-footballer-A-Case-Report.php
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