Christer Carlsson, MD PhD
Department of Rehabilitation, Physical Medicine Unit, Lund University Hospital, LUND, Sweden
Chronic low back pain, with or without radiation to the leg, continues to be a big problem for many patients. There exist a lot of different treatments for this condition. Many sufferers try stimulation techniques like TENS and acupuncture. In the literature there are quite many studies concerning acupuncture and low back pain.
The author has shows a long term (>6 months) pain-relieving effect of acupuncture in a prospective randomised placebo-controlled study among patients with chronic low back pain of mainly nociceptive origin. This study will be summarised.
Different diagnoses that often seems to respond or don't respond to acupuncture will be addressed.
Practical application of different acupuncture methods will be described and some of them demonstrated.
First Western style acupuncture will be presented: Tender or trigger point acupuncture, segmental acupuncture, needles surrounding the painful area, superficial acupuncture, periosteal acupuncture and some words about auriculotherapy
Second, some traditional views will be summarised like the meridian principles, the eight principles, etiology and special points.
I shall present what I call advanced acupuncture:
Use, and combine, many different stimulation techniques
Triggerpoint acupuncture: Similar to dry needling technique when pure trigger point conditions are quite acute. Stepwise changes to more usual acupuncture by using distal needles in the reference zone and by letting the needles be inserted for 20-30 minutes.
Superficial acupuncture. The rosette technique. Perhaps in the beginning to an anxious patient. When there is suspicion of an increased sympathetic tone. Combine with usual technique if it is needed.
Periosteal acupuncture. By itself in the beginning. Sometimes a samll change to trigger point acupuncture. Perhaps give periosteal stimulation to some points and usual acupuncture for others.
Perhaps first stimulate the periosteum and then withdraw the needles to the usual position and let them be there for 20-30 minutes. Only after you know that the patient can stand that sort of treatment! Watch out for strong reactors!
Auriculotherapy and perhaps other microtechniques. Combine with usual de-qi acupuncture. Can be useful when strong and acute painful conditions, but usually electrostimulation is needed as well.
Electroacupuncture. Can be combined with any kind of acupuncture.
Combine with TENS use at home for the patients.
Be pragmatic! Use what makes results! Try, try and try!! Just as when we try different drugs. Use it individually.
However, remember: There are non-responders!