SOME CONSIDERATIONS IN THE TREATMENT OF CHRONIC LOW BACK PAIN THROUGH ADJUVANT ACUPUNCTURE

Chronic non-specific low back pain is the most common reasons people see a health care provider. It has been estimated that up to 80% of the world's population will suffer from back pain at some point in their lives, with the lower back as the most common location of pain. Although most episodes of low back pain last less than two weeks, research has shown that recurrence rates for low back pain can reach as high as 50% in the first few months following an initial episode. While there is no definitive way to resolve lower back pain, the use of acupuncture to treat this condition has increased dramatically in the past few decades, based in a large extent to placebo-controlled studies that have validated it as a reliable method of pain relief. Acupuncture is an established adjuvant analgesic modality for the treatment of low back pain. The National Institute for Health and Clinical Excellence guidelines, recommend acupuncture as a clinically effective treatment for chronic back pain. There were no adverse side effects; acupuncture significantly decreases pain intensity and improves psychological well-being, activity, and sleep in chronic low back pain patients. Once the needles are inserted in some of the appropriate points, endorphins, morphine-like substances, have been shown to be released in the patient's system, thus inducing local or generalized analgesia (pain relief). This work was a retrospective study of the electronic medical records of patients who received at least one session of acupuncture for low back pain. The electronic search retrieved 471 references on Medline from 1975 to 2013. Comparative controlled studies, such as randomized controlled trials and controlled clinical trials in patients with low back pain were found. Many studies presented preliminary findings of a double-blind, crossover trial comparing the effects of traditional with placebo acupuncture in relieving chronic low back pain. Different follow-up periods completed the trials. In the acupuncture studies, no significant difference was found between groups for Visual Analogue Scale for patient's global assessment (VAS), modified disease activity scale (DAS) or for the decrease in analgesic intake. Using Visual Analogue Scale readings as a measure of pain, some groups achieved a 55% overall reduction in pain level at the end of the trial, compared with initial baseline readings. CONCLUSIONS Although the results from many studies on acupuncture show that it may be beneficial to reduce symptomatic low back pain in patients from 24 hours to a follow up of four-month post treatment, the reviewers concluded that the poor quality of the trial, including the small sample size preclude these studies. The present findings should be confirmed by future studies that overcome the methodological limitations of the studies evaluated. The current evidence is encouraging studies in that acupuncture may be an effective adjuvant for symptom improvement or relieve pain in chronic low back pain.