Acupuncture Therapy: An Effective Intervention for Acute Low Back Pain

Abstract

Acute low back pain is a relatively common case in the emergency department, and the currently used therapeutic measures can hardly meet the need for immediate relief of patients’ low back pain and functional impairment. This study examines the scientific validity and feasibility of acupuncture intervention in the emergency department for this condition and attempts to provide new treatment ideas that can enrich the treatment of acute low back pain. The text demonstrates the scientificity of acupuncture intervention in acute low back pain from three aspects, including the effectiveness of acupuncture therapy in treating the disease and clinical experimental studies and basic research; it also shows the specific acupuncture points and operation steps required for acupuncture therapy in the form of diagrams, which makes acupuncture therapy operable in clinical use. The use of acupuncture therapy should be attempted in future emergency clinical practice with the aim of promoting its use in the treatment of acute conditions.

Keywords: Acute low back pain; Acupuncture; First aid technology; Prompt treatment

Introduction

Acute low back pain (ALBP) is one of the more common acute pains in the emergency department, which refers to simple acute lumbar sprain or non-specific acute low back pain excluding lumbar fracture, tumor and spinal slip. The cause is mainly mechanical external force damage, such as lifting heavy objects, twisting the lumbar region, or prolonged sitting, operating vibrating tools, etc. ALBP has become the leading cause of activity limitation and work absenteeism worldwide, causing a huge economic burden to society and will become the leading cause of disability in the global population [1].

Due to the few studies on the molecular biology of ALBP, there is a lack of targeted drug interventions, mainly based on physical therapy, exercise therapy, and anti-inflammatory and analgesic treatment [2]. Although it can temporarily alleviate the symptoms, it cannot meet the demand for rapid relief of pain and discomfort of patients. In contrast, acupuncture therapy in Chinese medicine for analgesia has been widely proven [3-5], especially in the treatment of ALBP as a safe and efficient intervention, and is gradually accepted by the majority of patient groups [6-9], and 20.0% of the guidelines in the last 20 years in Europe and the United States for low back pain recommend the application of acupuncture therapy [10].

Study on the Effectiveness of Acupuncture Therapy Intervention for ALBP

In the management of ALBP, pain and low back dysfunction are the predominant symptoms, which are mostly treated symptomatically with opioids for analgesia; however, opioids have short-term side effects of constipation, nausea and increased risk of fracture [11]. In the clinical practice guidelines for acupuncture in low back pain, acupuncture is recommended as a high-quality intervention for the treatment of ALBP [12]. In terms of evidence provided by evidencebased medicine, Wu B et al. [13] found better safety and efficacy of acupuncture interventions for ALBP based on evidence provided by reticulated meta, especially manual acupuncture deserves clinical promotion, while Su X et al. [14] found that acupuncture was effective in improving VAS scores and ODI scores in patients with ALBP through meta-analysis, thus positively improving patients’ low back pain and functional impairment symptoms. We will demonstrate the effectiveness of acupuncture therapy intervention in ALBP in terms of clinical experimental studies and cellular molecular mechanisms.

Clinical Experimental Study of Acupuncture Therapy Intervention for ALBP

In terms of clinical experimental studies, the effectiveness of acupuncture in the treatment of ALBP has also been verified. For example, Su JT et al. [15] found that carpal and ankle needling could provide immediate analgesia in comparison to sham acupuncture and concluded that carpal and ankle needling analgesia is mainly achieved through neuroreflex modulation. In addition, the floating needles in acupuncture therapy have also been studied and confirmed to have better efficacy. For example, Li NG et al. [16] found that floating needles can efficiently treat ALBP and achieved satisfactory clinical efficacy, while a study further compared the difference in the effect of floating needles and general analgesics on ALBP and concluded that the efficacy of floating needle therapy intervention in this disease is due to analgesic drugs [17], in addition to the exploration of the timing of the immediate analgesic effect of floating needles [18], which concluded that floating needle therapy has a positive The immediate analgesic effect of floating needle therapy on ALBP was found to be more rapid and the analgesic effect was stronger and more sustained compared with traditional acupuncture. In addition, the Chinese Journal of Emergency Medicine has more clinical research literature reporting cases of efficient intervention of acupuncture therapy in ALBP [19-22], which also confirms our view. It is evident that acupuncture has made greater progress in clinical studies, and the efficacy has been verified.

Study on the Mechanism of Acupuncture Therapy Intervention in ALBP

Regarding the research on the evidence of molecular mechanism of acupuncture intervention for ALBP taking effect, it is believed that acupuncture can reduce serum inflammatory cytokine levels and inhibit early inflammatory response, thus effectively relieving ALBP lumbar pain symptoms [23-25]. In contrast, Li G [26] found that acupuncture of lumbar pain points combined with McKenzie therapy was clinically effective in patients with ALBP and significantly relieved their pain symptoms, which may be related to the reduction of serum osteoprotegerin, DKK-1 and sclerostin levels.

In addition, in the study of brain mechanism of acupuncture for ALBP, Liu ZP et al. [27] observed the alteration of intracerebral pain matrix of ALBP by acupuncture supported by functional magnetic resonance imaging (fMRI) technique of brain and concluded that acupuncture can cause S1 and S2 signal alteration in brain, while intracerebral S1 and S2 can process pain sensory components, so acupuncture can play a role in the treatment of ALBP. In conclusion, acupuncture can produce certain effects on the peripheral and central parts of the body making it possible to rapidly relieve low back pain in ALBP patients.

Common Acupuncture Points and Body Surface Positioning for ALBP Emergency Department

According to the needs of emergency clinical practice, acupuncture interventions for ALBP should try to use acupoints that are simple to obtain, safe and have stable efficacy, such as Wrist ankle acupuncture (zone 5 and zone 6), Dong’s special points (Erjiao Ming, Zhongbai and Haibai), Houxi (SI 3) and Yanglao (SI 6) points, the most painful point of the lumbar region and the point of lumbar pain. In addition, combined with the operational requirements, they can meet the need for efficient emergency treatment of ALBP and achieve satisfactory results. The relevant acupoints positioning and operation are shown in Table 1.

  

    
Acupuncture points
    
Location of acupuncture points
    
Acupuncture operation
  
  

    
1. Wrist ankle acupuncture
    
Most of the lumbar pain areas    are in zones 5 and 6 of the human body, upper 5: the center of the back of    the wrist, i.e., the area of the "Waiguan "(SJ 5); upper 6: the    back of the ulnar margin on the little finger side; lower 5: the outer side,    against the posterior edge of the fibula. Mainly for arthralgia, ankle    sprains, etc. Lower 6: against the outer edge of the Achilles tendon.
    
After routine disinfection,    hold the needle handle with three fingers, with the needle body at a 30°    angle to the skin, and twist the needle handle lightly with the thumb so that    the needle tip passes through the skin quickly. After the tip of the needle    through the skin, that is, the needle is flattened, the tip of the needle    will then pick up the skin needle 0.2cm size of the mound, the needle body    close to the surface of the skin, along the longitudinal straight line    direction into the needle along the subcutaneous, the needle into the    subcutaneous length is generally 35mm, the requirements do not appear sore,    numb, swelling, pain and other sensations, the needle body to stay in the    subcutaneous tissue of the shallow layer, retain the needle 30min. acute    cases daily needle 1 time.
  
  

    
2. Dong's special points 
    
Erjiao Ming (in the central    line of the first knuckle of the middle finger on the back of the palm, with    two points taken in thirds between the two knuckles), Zhong Bai (between the    little finger bone and the ring finger metacarpal bone on the back of the    hand, 0.5 inch from the joint between the finger bone and the metacarpal    bone), and Xia Bai (between the little finger metacarpal bone and the ring    finger metacarpal bone on the back of the hand, 1.5 inches from the joint    between the finger bone and the metacarpal bone)
    
The patient is placed in a    seated position with the back resting on the back of the chair, a 1-inch    disposable acupuncture needle is used, the skin is sterilized, and the Erjiao    Ming point is first stabbed flat against the bone, slightly oblique to the    direction of the little finger, and then the Zhongbai and Xiabai points are    stabbed straight, while the twisting and lifting technique is performed to    make the patient feel sore, numb and swollen. For left-sided lumbar sprains,    the right side is needled; for right-sided lumbar sprains, the left side is    needled.
  
  

    
3. Houxi (SI 3) and Yanglao (SI    6) points
    
Houxi point (SI 3) (slightly    clenched fist, distal side of the posterior ulnar side of the 5th finger    metacarpal joint, at the head of the transverse palm stripe at the red and    white flesh interval).

      Nourishing point (SI 6) (with    the palm of the hand facing the chest, when the ulnar styloid process is in    the depression of the radial suture of the bone)
    
The 1-inch disposable    acupuncture needle was used, and the patient was asked to take a sitting or    standing position, with the elbow joints bilaterally flexed and the wrist joints    exposed. Before the operation, the acupuncture points and their surrounding    skin were routinely disinfected with 75% alcohol, and the patient was first    taken to one side of Houxi , Yanglao, and the needles were stabbed into the    two points about 15-20 mm, and given a strong stimulation technique of    lifting and twisting, to the extent that the hand appeared to be radiating to    the elbow or fingers, and the technique lasted about 1 min, and then the    patient was instructed to get up and do lumbar movements, such as forward    bending, backward leaning, and twisting, without excessive pain and as much    as possible, The whole movement was slow and even, and if the pain was    tolerable, the amplitude of the activity could be gradually increased, and    the duration of the activity was 5 min, and then the contralateral Houxi (SI    3) and Yanglao (SI 6) points were needled again, with the same technique as    before, alternately, for a total of about 30min.
  
  

    
4. The most painful point of    the lumbar region and the point of lumbar pain
    
The most painful point in the    lumbar region is at the back of the lower back, where the patient is in the    most pain by the practitioner's pressure.

      The point of lumbar pain is on    the back of the hand, when the midpoint of the transverse wrist and metacarpophalangeal    joint, between the second and third metacarpal bones and the fourth and fifth    metacarpal bones, 2 points on one side.
    
Patients take the prone    position, in the waist to find the most painful point, with 75% alcohol    cotton ball routine sterilization, take 0.35 mm × 40 mm sterile acupuncture    needle, vertical straight stab a needle, into the needle depth of 1 ~ 1.5    inches, and then this point as the center, up and down about 2 inches, the    tip of the needle pointing to the center, the angle of 45° oblique stab twist    into the needle, in order to get gas is good, the needle closed and then use    the finger to follow the skin around the needle body, in order to promote get    After starting the needle, the patient was instructed to take a standing position,    and the point of lumbar pain was selected for acupuncture with both hands,    and after routine disinfection with 75% alcohol cotton balls, a sterile    acupuncture needle of 0.35mm×40mm was taken, and the tip of the needle was    inserted at an oblique angle of 45° upward, and acupuncture was used to    obtain gas, Gradually, the needle was left for 30 min and started.
  

Table 1: Commonly used acupoints and body surface positioning for the emergency department of ALBP.