All posts in Back Pain

American College of Physicians New Guidelines Suggests Acupuncture to Treat Low Back Pain

Have back pain? You are not alone. Most of us have experienced back pain at one time or another. Not surprisingly, it’s one of the most common issues that send scores of people to see the doctor every year. But if you’re primed for walking out of the clinic with a prescription, you might be in for a little surprise. 

The Dope on Drugs  

Think you need over-the-counter or prescription drugs to treat low back pain? Not so, says the American College of Physicians (ACP). On February 14, the largest physician group in the U.S. released updated guidelines recommending people should treat low back pain with non-drug therapies instead.

Why, you asked? Well, as it turns out, that “trusty” bottle of acetaminophen (e.g. Tylenol®) you’ve been reaching for all these years simply doesn’t work for low back pain. The ACP also takes a stance against doctors prescribing opioid painkillers due to the serious addiction and overdose risks associated with them. Steroid injections, corticosteroid pills, and antidepressants also get a thumb down when it comes to treating low back pain.

Non-steroidal anti-inflammatory drugs (NSAIDs), including non-prescription meds like ibuprofen (e.g. Advil®, Motrin®), may be helpful as a secondary approach (after non-drug methods) for acute and subacute back pain (up to 12 weeks), but they are not recommended as the starting point. For chronic back pain, the guidelines also advocate only selecting NSAIDs if the non-drug approaches are insufficient, “and only if the potential benefits outweigh the risks for individual patients and after a discussion of known risks and realistic benefits with patients.”

Reframing Low Back Pain Treatment

There is definite shift in how doctors and patients view treating low back pain. Steven Atlas, an associate professor at Harvard Medical School who practices at Massachusetts General Hospital, applauds the new guidelines, and states, “We are moving away from simple fixes like a pill to a more complex view that involves a lot of lifestyle changes.”

Fortunately, there is a gambit of healthy ways to treat your low back pain. The ACP lists several non-drug options, including heat wraps, massage, yoga, exercise, multi-disciplinary rehabilitation, guided relaxation techniques, and yes, you guessed it, acupuncture. These great alternative therapies will not only provide pain relief, but also help you live a more active lifestyle.

But We Knew This, Right? Acupuncture to Treat Low Back Pain

I know it’s easy to reach for a pill. But all pills have some risks associated with use, especially when used in higher dosages or when used regularly. Acetaminophen puts your liver at risk. And NSAIDs can cause stomach or intestinal bleeding or heart attack or stroke. Plus, you are only masking the symptom, not fixing the problem. Why turn off the fire alarm if you aren’t going to also try to put out the fire?

It’s great to see that changes in policy guidelines are being offered to conventional medicine practitioners, based on evidence. Though this is the U.S. guidelines, it’s this kind of shift in understanding that can lead to changes in how we deliver healthcare, financially support treatment options, and eventually also improve the health of more and more people. We still have a way to go, but for this one update, I say “Hooray!”

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March is National Kidney Month

kidneys National Kidney MonthWhen patients come in to address particular organ health, they most often mention their heart, their liver, their lungs, or the various organs of their digestive system and reproductive system, but rarely does someone ask me about their kidneys. Your kidneys do a lot of work for you, but I doubt you think much about them, unless you have kidney health issues. This month is National Kidney Month, so I ask you to think about this hard working duo, and consider how you can keep them healthy.

What do your kidneys do?

Your kidneys filter about 200 litres of blood daily. You know that the kidneys help eliminate waste products and excess fluid from your body, but did you also know that your kidneys are needed to:

  • Regulate your blood pressure
  • Produce an active form of vitamin D 
  • Control the production of red blood cells

In Traditional Chinese Medicine, we look to the TCM Kidney system when issues arise for bone and joint health, low back pain, issues with fear and anxiety, fatigue, edema, reproductive health, menopausal symptoms, and more. If you’ve experienced trauma, ongoing chronic stress, or have been told you have adrenal issues, we consider the Kidneys for that too, as the adrenal glands sit atop the kidneys.

How do kidneys malfunction?

There are many reasons why your kidneys could find themselves in trouble. Things that can increase your risk include smoking, diabetes, high blood pressure, urinary tract infections that travel to the kidneys, a family history of kidney disease, and aging. Some are just born with congenital issues affecting the kidneys, and those of Aboriginal, Asian, South Asian, Pacific Island, African/Caribbean, and Hispanic descent are at higher risk.

Though most aren’t aware of it, estimates are that up to two million Canadians have chronic kidney disease (CKD) or are at risk for it.

How do you know if your kidneys are struggling? One simple blood test you can get is called estimated glomerular filtration rate (eGFR). Check out this risk assessment online tool for National Kidney Month to see if you should ask your doctor for this blood test.

How do I keep my kidneys healthy?

  1. Hydrate. You don’t have to go overboard, but I find many of my patients are chronically dehydrated. Unless you are taking B vitamins (including in a multi)–in which case your urine is likely to be bright yellow–your urine can help you determine if you are sufficiently hydrated. It should be a very pale yellow. If it’s a dark yellow, you may be dehydrated. Keep in mind that diuretics, like some blood pressure medications and caffeinated beverages, can make you have to pee much more often, as can overactive bladder and prostate problems.
  2. Keep healthy eating and exercise habits. Both will help manage your blood pressure, diabetes, stress, and weight. Watch your salt intake. Yes, salt is important for our health, but many take in too much salt, as it’s found in so many processed foods. You can also overdo the “good salt” like sea salt and Himalayan salt, especially if you have high blood pressure. 
  3. Stop smoking. So many reasons to quit. Smoking damages your blood vessels, raises blood pressure, and increases your risk for kidney cancer. Acupuncture can help you quit smoking.
  4. Don’t overdo pain medications like Advil and Motrin (ibuprofen) and Aleve (naproxen). These non-steroidal anti-inflammatory drugs (NSAIDs) can cause kidney damage if taken too often. Acupuncture is best known for its ability to help treat and manage pain. Check out TCM for pain management options.
  5. Treat your diabetes, high blood pressure (click me), and urinary tract infections. Because these all increase your risk of kidney disease, it’s vital that you treat these health issues appropriately. Did you know that Traditional Chinese Medicine can help you not just treat the symptoms of these problems, but also work on getting to the source?
  6. Manage your stress. Stress can be a catalyst for disease. When the body is in chronic stress, it has a hard time healing. It doesn’t do a good job of simultaneously defending and repairing the body–often picking defending as its preferential course of action. There are many ways to cope with stress and support your adrenal glands. For more on adrenal fatigue click here.
  7. Come in for a Traditional Chinese Medicine (TCM) consultation. While I won’t be able to detect your GFR levels without lab results, your body may be giving clues that your kidneys need to be addressed. Plus, it’s better to work preventively than in response to organ failure. 

National Kidney Month

I have a friend who has a kidney transplant. He knows the challenges that come with dialysis, organ transplant, and ongoing health issues. I urge you to remember to pay attention to the health of your kidneys this National Kidney Month and beyond, and to register for organ donation. It’s easy to do. Simply start with clicking here.

Facing the Facts about Kidney Disease National Kidney Month

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Pain in the butt: Tax pain or sciatica?

meridians buttocksYou know the commercial. The one with the person pointing to his or her rear end, indicating that it hurts. The doctor then says that he cannot help with that, as it’s tax pain. Yes, it’s tax season. And no, I can’t help you with that. But I can help you with actual pain in the buttocks.

The most common cause of back side pain is sciatic nerve irritation. This kind of pain can originate in the low back or buttocks and travel down the back of the leg, even travelling as far as the foot. The cause can be a herniated disc, but any irritation of this nerve can create sciatica.

Sciatica is often sourced to an issue called piriformis syndrome, created by inflammation, scar tissue, adhesions, or tightness of the piriformis muscle, a small muscle that is located deep, under the larger gluteus muscles.

Acupuncture is one of the most effective ways of relieving sciatica. As you can see from the image here, there are many acupuncture channel points traditionally found on the buttocks. But, there are also extra points that we call “ashi” points (directly translated as “ah, yes” points—points that hurt when pressed), trigger points (specific points located in a tight ball of muscle found in a tight band of muscle), and motor points (a point where a motor nerve enters a muscle). Distal points—points away from the problem area—are also important, and chosen based on your particular symptoms and constitution.

In addition to relieving your pain by relaxing tight muscles, improving local blood flow, and supporting the healing of damaged tissues, acupuncture can also be very stress-relieving. So, though I can’t crunch numbers for you, I may be able to help you feel better about doing your taxes by reducing at least one pain in the butt.

Come in and try acupuncture—and ask me about biopuncture—to relieve your sciatic pain.

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A good night! G’night!

I recently purchased a new mattress. Ahhhh, how wonderful it is to sleep to well! The thing is, though, I didn’t really recognize that I wasn’t sleeping well until about a month before I decided it was time to buy a new bed. I was waking up feeling stiff. I was having some trouble falling asleep. These were symptoms that are unusual for me.

So, I thought about it. Was I stressed? Not particularly. Was I exercising too hard? No, consistently the same. What else could be going on? … Oh. My mattress was 15 years old!

When I went shopping with my husband for a new one, I asked how long a mattress normally lasts. I was told that it depends on the quality, but probably 7 to 12 years. Well, even new, our old mattress was not on the top quality list, that’s for sure! So, how did we manage to get 15 years out of that thing?

I think that part of it was staying healthy. Eating right. Exercising regularly. Getting tune up treatments.

It makes sense that a body that is well cared for is going to be able to handle stressors more readily. Does it cost money to be healthy? Yes, but in the long run it’s probably saving me lots of money too. No pharmaceuticals. No trips to the hospital. Very few sick days off of work. Few injuries. And a cheap mattress and box spring that lasted us for 15 years!

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Winning at Joint Health

One of the top reasons why people come to see me is for problems with one (or more) or their joints. Joints that are swollen. Joints that hurt. Joints that don’t move properly. Or for prevention of any of the above for someone who is active and would like to stay that way.

Most of us think of the knees, elbows, hips, shoulders, wrists, and ankles when we think about joints. But think, as well, of all the little joints in your fingers and toes (phalangeal joints) and your hands and feet (the metacarpals and metatarsals); the joints between every vertebrae along your spine; the joints of your jaw (temporomandibular joint—TMJ), and even those of your skull.

These joints work hard!

Like every hard working organism, they are not alone. They have support. Perhaps it’s just because the hockey playoffs are on now and I have sports on the brain, I’m going to use sport as an analogy.

The game can be called Kinesiology. My initial degree was Kinesiology, the study of human movement. The aim of the game is to move when called to action and stabilize when called to stop. Movement occurs at the joints and the team members are bones, cartilage, bursa, menisci, synonvial joint fluid, ligaments, tendons, and muscles. Each of these team members has a role to play.

Bones, whether flat, long, or irregularly shaped, end at least one side in a joint. Cartilage, and bursa help buffer friction and impact. Synovial joint fluid also helps with these roles as well as with lubricating the joint. Ligaments help prevent too much movement of the joint that would otherwise result in injury. Tendons and muscles move the joints. When one of these teammates has a problem, the joint has a problem.

According to Traditional Chinese Medicine, each of these players is connected to an organ system. Kidneys regulate the bones and cartilage. Liver rules the tendons and ligaments. Spleen controls the muscles.

You might think of these organ systems as the coaches. High level teams often have more than one coach! Even these coaches do not function on their own. There are other organ systems that must function properly in order for them to do their job, just as a general manager, owner, and fans will impact the coaches.

So you can see that joint health is incredibly complex. Traditional Chinese Medicine considers this complexity and addresses the joint itself as well as all the players and participants that allow the joint to function properly. We do so by making a proper assessment and then using acupuncture, Chinese herbs, supplements, and other modalities to treat the individual, not just the “problem” joint(s). You win when you can move without pain and restriction!

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Is Pain Stopping You? Learn about Pain Management

One of the most common goals for the new year is a decision to be more active. I started day one of January first with an invigorating Polar Bear swim! One of the most common blocks to being more active is pain. Pain management is where I can help.

Acupuncture can be very effective to treat pain from many causes, from injury and surgery recovery, to arthritis, to menstrual cramps, to headaches, to migraines, to digestive disorder pain, and more. Check out my website for more specific information for each of these types of pain: http://www.activetcm.com/pain_management/

There are a multitude of supplements both online and in stores with claims to cure your pain, but which ones are right for you? First of all, that depends on your type of pain. Is it from muscle injury? Joint degeneration? Nerve impingement? Internal organ disease? Immune system imbalance? Hormonal imbalance? All of the above? None of the above?

Because there are so many causes for pain and because pain is such a subjective experience, it is important to get a proper assessment. That usually starts with a complete and thorough consultation determining when/how the pain started; what aggravates the pain; what alleviates the pain; what concurrent medical issues there might be; what the health history indicates; whether lifestyle, emotional, mental, or spiritual aspects are big contributors (they always contribute something!); and more.

Some common supplements that may crossover treatment for several different kinds of pain include magnesium, fish oils, and coenzyme Q10.

Magnesium

Though magnesium is found in a lot of foods, including dark leafy green veggies, legumes, and nuts, rates of deficiency are high in North America. In fact, approximately 68% of the US population consumes less than the RDA (recommended dietary allowance) of magnesium and 19% of the population consumes less than 50% of the RDA!

Magnesium deficiency can contribute to muscle cramps and tightness, migraines, fatigue, poor sleep, weak bones, menstrual cramps, and anxiety.

Supplementing magnesium is easy. Look for magnesium glycinate, bisglycinate, or citrate, avoiding magnesium oxide, which draws water into the bowels to act as a laxative (thus poorly absorbed). I most often recommend magnesium glycinate capsules or magnesium citrate powder.

Fish oils

It almost impossible not to have heard about omega 3 essential fatty acids. These “good fats” are often in the news because of their many health benefits, including reducing inflammation, improving heart health, decreasing joint pain, supporting healthy skin, and easing depression.

My mom also told me years ago to eat more fish so I could be smart. I admit I hated fish. Though I’ve now learned to like it, I still take fish oil capsules as I know that I cannot eat enough fish to match my busy and active lifestyle and supply me enough DHA and EPA (main components of the omega 3s from fish).

When choosing a fish oil, quality is key. Poor quality fish oil capsules may taste fishy because the oils are rancid. Inappropriately processed fish oils may not be as health beneficial because heat and light can destroy these delicate fats.

If you want to know more about which fish oils I prefer, feel free to ask me.

Coenzyme Q10

This powerful antioxidant can be your buddy and you can call him by his nickname CoQ10. He will help protect you; he can be your body guard. As an antioxidant, he assists in decreasing cellular damage. CoQ10 is also involved in making a key energy molecule called ATP. Thus, if your body doesn’t get or make enough CoQ10, you may feel fatigued and/or depressed and many of your body’s processes will not function properly.

Your body makes CoQ10 and we also consume it via oily fish, organ meats, and whole grains.

So, how do you know if you have enough? If you have high cholesterol, high blood pressure, or heart disease, you may benefit from taking CoQ10. Statin drugs so commonly used to treat high cholesterol contribute to lower CoQ10 levels, so if you are taking these drugs, talk to your health provider to determine if supplementing will benefit you.

CoQ10 has also shown great promise for treating migraines at dosages of 150mg-300mg daily. Once again, quality matters.

Questions?

As always, feel free to ask me. Contact me here.

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Pretend you’re sitting

In a previous post I wrote about how you can do an easy 5 minute pilates exercise using just a wall. The next exercise in this grouping is similar to a “wall slide” that is used to strengthen the quads (upper thigh muscles). The pilates style wall squat also has you mimicking sitting in a chair using a wall against your back, but also adds the element of posture and spinal alignment as you draw your abdominals in and up to push your back fully against the wall.

If you are new to this exercise, you can start with a higher position, imagining you are sitting on a bar stool with your feet on the ground instead of down to a full 90 degree angle at your knees.

Make sure to keep your head and shoulders in contact with the wall. Avoid tucking your pelvis underneath you. Check that your knees are directly over your toes and never past. This video has her using light weights to work out the upper body as well.

http://www.ehow.co.uk/video_4458561_standing-exercises-anybody.html

If you don’t have weights, you could use food cans. I’m sure that after my mention of a bar stool, someone might suggest cans or bottles of beer, but I’ll suggest you keep those containers sealed, at least until you’re finished this exercise.  I might use my dogs as weights. After all, I have 2 and they are about 10 lbs each! That’s a great workout challenge! 🙂

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Acupuncture for Pain

Some of the tons of research and articles on acupuncture to treat pain:

ARTHRITIS
http://www.webmd.com/content/article/95/103359.htm
Traditional Chinese acupuncture is “effective” at reducing knee osteoarthritis pain and improving function in people with knee osteoarthritis, say the researchers, who presented their findings in San Antonio at the American College of Rheumatology’s annual scientific meeting.

Arthritis Responds to Weather, Acupuncture United Press International – Oct. 19Washington Post – Oct. 19
Researchers told attendees at the American College of Rheumatology’s annual meeting that they have compiled valid data indicating changes in temperature or atmospheric pressure can cause increases in joint pain. Marc Hochberg, MD, MPH, a professor in the School of Medicine, says the studies ” . . . allow us to conclude that traditional Chinese acupuncture is an effective intervention for the relief of pain and improvement of function in patients with osteoarthritis of the knee.”

http://www.acupuncture.com/research/kneeosteo.htm
Acupuncture can ease the discomfort while waiting for an operation and perhaps even serve as an alternative to surgery. Seven patients have responded so well that at present they do not want an operation. (USD 9000 saved per operation).

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?md=Retrieve&db=PubMed&list_uids=1288925&dopt=Abstract
Acupuncture to treat Rheumatoid Arthritis

ZHEREBKIN, Eastern Europe, conducted a randomised controlled clinical trial to study the efficacy of the multi-modality treatment of rheumatoid arthritis (RA) involving acupuncture (A) treatment.Methods: Measures assessed included the number of the inflamed joints, the joint index, duration of morning rigidity and a visual scale of pain.Results: Combining treatment of RA with Acupuncture was found to more effectively lower the values for the joint index and the visual scale of pain.Conclusions: The results of this trial indicated that acupuncture may improve the results of drug treatment.Zherebkin VV.

The use of acupuncture reflexotherapy in treating patients with rheumatoid arthritis. Lik Sprava 6: 175-7. Nov-Dec 1997. Acupuncture for Chronic Low Back Pain: A Randomized Placebo-Controlled Study With Long-Term Follow-Up. Articles Clinical Journal of Pain. 17(4):296-305, December 2001.Carlsson, Christer P. O. M.D., Ph.D.; Sjolund, Bengt H. M.D., Ph.D. Abstract: Objective: The authors sought to determine whether a series of needle acupuncture treatments produced long-term relief of chronic low back pain. Design: A blinded placebo-controlled study with an independent observer. The patients were randomized to receive manual acupuncture, electroacupuncture, or active placebo (mock transcutaneous electrical nerve stimulation). Subjects were examined and monitored by an investigator who was blinded to the treatment given. Setting: A tertiary-level pain clinic at a Swedish university hospital. Patients: Fifty consecutive patients (33 women, 17 men; mean age, 49.8 years) with chronic low back pain (mean pain duration, 9.5 years) and without rhizopathy or history of acupuncture treatment were included in the study. Interventions: Treatments were given once per week for 8 weeks. Two further treatments were given during the follow-up assessment period of 6 months or longer. Outcome Measures: The independent observer made a global assessment of the patients 1, 3, and 6 months after treatment. The patients kept pain diaries to score pain intensity twice daily, analgesic intake, and quality of sleep daily, and activity level weekly. Results: At the 1-month independent assessment, 16 of 34 patients in the acupuncture groups and 2 of 16 patients in the placebo group showed improvement (p <0.05).The authors found a long-term pain-relieving effect of needle acupuncture compared with true placebo in some patients with chronic nociceptive low back pain. (C) 2001 Lippincott Williams & Wilkins, Inc.

BACK PAIN
http://news.bbc.co.uk/2/hi/health/5345774.stm
Back-pain acupuncture ‘effective’

CAR ACCIDENT

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=6138957&dopt=Abstract
Acupuncture proved an effective form of therapy for treatment of accident patients with whiplash injuries, representing a valuable supplement to the field of rehabilitation.

http://rheumatology.oxfordjournals.org/cgi/content/abstract/37/10/1118
Both physiotherapy and acupuncture treatment groups improved in reduced pain, improved range of motion, and better overall health following treatment for chronic neck pain. Acupuncture was slightly more effective in patients who had higher baseline pain scores.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15732514&dopt=Citation
The high percentage of positive results in whiplash injury patients leads us to advocate acupuncture for balance disorders due to cervical pathology.

HEADACHES & MIGRAINES
http://www.healthy.net/scr/news.asp?Id=7667
Acupuncture as Effective as Drug Therapy for Migraines & Headaches

http://www.sciencedaily.com/releases/2005/07/050731232901.htm
Acupuncture Cuts Tension Headache Rates By Almost Half

NEUROPATHIC PAIN
ABUAISHA and colleagues, Department of Medicine, Manchester Royal Infirmary, University of Manchester, UK studied the use of acupuncture to determine its efficacy for pain relief for peripheral diabetic neuropathy.Methods: 46 diabetic patients suffering chronic painful peripheral neuropathy participated in the study. 29 (63%) patients were already receiving standard medical treatment. Patients initially received up to 6 courses of classical acupuncture analgesia over a period of 10 weeks, using traditional Chinese Medicine acupuncture points.Results: 46 patients completed the study. 34 (77%) showed significant improvement in primary and/or secondary symptoms (P <0.01). SOFT TISSUE INJURY
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=2761282&dopt=Abstract
Acupuncture treatment on soft tissue disease based on TCM syndrome differentiation theory is thus shown to be effective.

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