Acupuncture: East meets West

A HAIR-THIN needle pricks the skin. What happens next depends on who you ask. A traditional Chinese practitioner will tell you that acupuncture manipulates the body’s vital energy, Qi (pronounced chee), balancing the opposing forces of Yin and Yang. When Yin and Yang are in harmony, Qi flows freely along pathways called meridians and you stay healthy, but when the Qi gets blocked you become ill. Inserting needles into points along a meridian unblocks Qi and restores the body’s healthy balance.

Western scientists explain it differently. They say inserting needles at acupuncture points stimulates the nervous system to release morphine-like substances that block pain signals. It may also trigger neurotransmitters and neurohormones, which influence such dynamic systems as circulation and the immune response.

Ever since acupuncture caught on in the West, we’ve been seeking to replace the Eastern mysticism with hard facts. But clinical trials so far have produced a disappointingly mixed bag of results that don’t seem to back up the anecdotal claims for the wonders of acupuncture. There might be a steadily building case for clinical relief of some types of pain and nausea. But the inconclusive studies still outweigh the positive ones.

Antibiotics could “Cure 40% of Chronic Low Back Pain”.

Up to half a million patients with chronic low back pain may be suffering from an infection that can be treated with antibiotics.

If proved true, the revolutionary theory about the cause of one of the commonest and most debilitating ailments should win its discoverer the Nobel Prize, one surgeon said today.

However, the paper describing the research based on just 162 patients was turned down by the leading medical journals such as the Lancet and BMJ. It was published today in the European Spine Journal.

Researchers claim the treatment could be suitable for up to 40% of patients with severe, long term pain for whom the only alternative is surgery.

However, it is not as simple as replacing the painkillers with antibiotics. The treatment requires an MRI scan to detect distinctive “Modic” changes in the spinal column – named after the doctor who first observed them in the late 1980s – which are indicative of bacterial infection.

Mindfulness Based Stress Reduction “Body Scan”

Whiplash study says no benefits from intensive treatment

Intensive whiplash treatment is no better than standard care, a study suggests.

The study, in the Lancet looked at the treatment of more than 2,700 people with mild to moderate whiplash.

No additional benefits were seen in those who had more intensive care – which included suggesting a rapid return to normal activities.

A Canadian expert said the study showed the lack of benefit from “unnecessary treatments”.

Whiplash injuries cost the UK economy about £3.1bn a year, mainly due to the expense of treating those with chronic symptoms (between 30-50%) and their subsequent need to take time off work.

Long-term problems can include pain from even the smallest movement, difficulty sleeping and even being unable to work.

Let go of outdated paradigms and stop dwelling on Biomechanical tissue-based models when treating Back Pain.

This was the message from CSP fellow Dr Mick Thacker, director of the ‘Pain: Science and Society’ MSc course at King’s College London.

Giving a keynote lecture, Dr Thacker advised delegates to move away from purely mechanical-based therapies for back pain patients, and become more aware of the role of neuro-immnunology in relation to pain.

“Traditional physiotherapy has based its management of back pain on anatomical, tissue-based principles and biomechanics”, said Dr Thacker.

Yoga: A Cost-Effective Treatment for Back Pain Sufferers?

Specialised group Yoga Classes could provide a cost-effective way of treating patients with chronic or recurrent low back pain, according to the UK’s largest ever study of the benefits of Yoga.

Led by the University of York, and funded by Arthritis Research UK, the study provides an evaluation of a specially-developed 12-week group yoga intervention programme compared to conventional general practitioner (GP) care alone.

The results published in Spine, show that the Yoga intervention programme — “Yoga for Healthy Lower Backs” — is likely to be cost effective for both the UK National Health Service and wider society.

The cost assumed for yoga intervention is important in determining whether this is an efficient use of NHS resources. As Yoga classes are not currently available through the NHS, the researchers examined a range of possible costs.

They conclude that if the NHS was to offer specialist yoga and managed to maintain the cost below £300 per patient (for a cycle of 12 classes), there is a high probability (around 70 per cent) of the yoga intervention being cost effective.

Researchers also found that those taking part in the yoga programme had far fewer days off work than those in the control group. On average, a control group participant reported 12 days off due to back pain, whereas those in the yoga group had four days off. 

Gene flaw linked to Low Back Pain

Scientists have identified a gene flaw linked to disc problems that are a common cause of lower back pain.

The UK study, published in the Annals of Rheumatic Diseases, looked at 4,600 people and found the PARK2 gene was linked to age-related disc problems.

A third of middle-aged women have problems with at least one spinal disc – and the condition is known to be inherited in up to 80% of patients.

Experts said finding the gene could lead to new treatments being developed.

Back pain costs the UK about £7bn a year in sickness leave and treatment costs, but the causes of the condition are not fully understood.

In lumbar disc degeneration (LDD), discs become dehydrated and lose height, and the vertebrae next to them develop bony growths called osteophytes, leading to lower back pain.

The King’s College London researchers carried out MRI scans of all those in the study and looked at differences in their genetic make-up.

Whiplash Injuries & Trigger Points

Persistent muscle pain following whiplash is commonly considered the result of poor psychosocial status, illness behaviour, or failing coping skills. However, there is much evidence that this persistent  pain may be due to neurophysiologic mechanisms involving peripheral and central nerve sensitisation. Myofascial trigger points may play a crucial role in maintaing this sensitisation. Recent research suggests that the chemical environment of myofascial trigger points is an important factor. Several consequences are reviewed when central pain mechanisms and myofascial trigger points are included in the differential diagnosis and in the management of patients with persistent pain following whiplash.

Pain really is “All in the Mind”

Doctors and nurses have known for many years that some people are more sensitive to pain than others. Now brain scans of people experiencing the same painful stimulus have provided the first proof that this is so. But the scans also suggest that how much something hurts really is “all in the mind”.

“We saw a huge variation between responses to the same stimulus,” says project leader Bob Coghill of the Wake Forest University School of Medicine in Winston-Salem, North Carolina. “The message is: trust what patients are telling you.”

Back Pain linked to shrinking Brain

BACK pain has a mysterious link with brain damage. Brain scans have shown that patients with chronic lower back pain have lost grey matter from two brain areas. Scientists are not yet sure whether this is the cause of back pain or the result, but the finding could lead to new drug treatments for backache that target the brain rather than the back or spine.

The discovery was made by Vania Apkarian of Northwestern University in Chicago, when he and his colleagues scanned the brains of 26 patients who had suffered lower back pain for at least a year. Some had damage to their sciatic nerve, which emerges at the base of the spine, while the others had no known injury. The team found that all the patients had lost grey matter in two brain regions known to be important in pain perception.