How's your back?
Sorry. I couldn't find a photo of needles in a back.
The point is (no pun intended) outlined by the Press Association: "People who suffer from lower back pain should get access to treatments including acupuncture and manual therapy, a health watchdog said today. The National Institute for Health and Clinical Excellence (Nice) published new advice for those working in the NHS but admitted current access to the therapies varied across England and Wales. Key treatments recommended in the guideline include patients taking part in a tailored exercise programme for up to 12 weeks.
There's much more on the thinking at NICE here.
What do you think?
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As I've already commented elsewhere on the Blog, I (and my father) have had very positive outcomes from acupuncture in the treatment of pain, including back pain. As to manual treatment, my back responded very well to the ministrations of an osteopath - far better, in fact, than to physiotherapy. I think it's another case of 'horses for courses'.
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It's not lower back pain, but a relative of mine had a frozen shoulder and none of the conventional treatments worked. Three sessions of acupuncture cured it.
She also has regular osteopathy treatment to prevent recurring stiffness in her back and shoulders.
Of course she pays for all this. Would the NHS have been better paying for the "alternative" treatment rather than the "conventional" treatment?
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Here you go, Eddie
http://www.flickr.com/photos/ggvic/2864311951/sizes/m/
The image is licences under Creative Commons Attribution.
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If my lower back (or come to that my upper back) hurts, so far I have been lucky enough to have on hand someone a few inches taller than myself who feels no embarrassment about clasping his hands over the section of my spine nearest to the pain, and hugging me hard one vertebra at a time. Sometimes immediately, sometimes after two or three tries, there is an audible though quite quiet "crack" and it all stops hurting.
The trick seems to be that the hugging must be slightly from above rather than horizontal.
It's a lot cheaper than any other treatment, and I don't have to make an appointment and hurt for several days before it gets fixed.
This might not be a good treatment for someone of six-foot-five, of course, or someone who lacks a friendly and shock-proof milkman or similar person... :-)
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Oooh - a hedgehog.
:-D
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Very interesting. I also have family experience where acupuncture has apparently helped (for shingles). I suppose it's worth remembering that it's been around for a long looong time (much longer than our modern western medicine) so I can't help wondering if it wouldn't have just died out if it was all a load of mumbo jumbo :D
Of course, any scientist would tell you that individual stories don't really prove efficacy - who knows what would have happened without the treatment in an individual case? But one has to assume that NICE have based their advice on peer-reviewed blind trials.
In my experience NICE don't just include treatments willy-nilly. In fact there are many situations where their judgement has been questioned (I know of situations where recommended treatments in the US for example are not part of NICE guidelines in the UK). That would suggest that there really is recognised benefit both to the patient and to the NHS from acupuncture and manual therapy.
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Big Sis, glad to hear you can recommend acupuncture. Many seem to have benefited from this. I would never recommend any 'DIY' form of treatment or regime. This can result in further damage if not professionally carried out. However, the cost of private treatments has always been very prohibitive for the majority. The more 'free' effective treatments we can achieve from the NHS can only be a good thing. Might also get rid of some of the quackery medicine out there.
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Well, Joe, I was told (by the practioner - at the Royal Homeopathic Hospital, in London) that acupuncture works better for some people than for others, so I suppose that needs to be borne in mind. That much said, not all drug treatments work across the board, so I think the only way anyone can find out if it is the right treatment for their condition is by giving it a go.
I like your comment about DIY treatments - I couldn't imagine sticking needles into myself (or, at least, not intentionally!).
:o)
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oh dear - have to confess I do have to do that DIY sticking needles into myself intentionally lol!!! Not for acupuncture, but daily injections...
You'd be surprised how routine it becomes... just like brushing your teeth ;-)
I'll never forget seeing my usually very shy mother volunteering at a public event to have acupuncture needles 'applied' in front of an audience - and she said that she didn't feel any pain at all... whether that was from the adrenaline of going up on stage I don't know! From my own experience now, needles don't hurt nearly as much as you think they are going to!
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I can highly recommend Pilates.
Wonderful.
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Charlie - my SO agrees with you.
He's tall and spindly (admittedly a bit less spindly than he used to be!) and swears that since starting Pilates, not only is his back pain reduced but he's also grown an inch ;o)
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My partner (a dentist) also practices acupuncture and has used it on willing guinea pigs to see if it can help patients to relax before treatment. It does not work for everyone of course but can be helpful.
I also get the treatment in the comfort of my own home for occasional shoulder and neck pain.
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I meant human guinea pigs of course.
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G 11
I've "done" Pilates for years now - because of (then) chronic back pain which an observant Physician in New York, after (you understand) x-rays, scan, blood-tests etc. proclaimed was due to my "poor posture".
The Doctor recommended Pilates and he was so right. after four sessions (and here I clutch wood, its' been 15 years) I've never had another twinge.
And, it's cost money over the years - for clothing alterations apart from anything else! I too have "grown", almost as much as your SO; my body shape has changed AND the shape of my feet has changed... True. Nothing unusual I'm told.
But I feel good (for someone of my age) and, I feel fit.
Can't praise Pilates enough. I should have trained and set-up my own studio.
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I'm not convinced that the NHS is geared up to this.
When I hurt my neck last year there was an 18 week wait to get on a waiting list for physio. I went privately and was seen within 3 days and pretty much sorted within 3 weeks. It was a similar situation a few years ago when I pulled something in my lower back. My neighbour injured her lower back last week and can't get physio on the NHS.
In this area the PCT have set up "self help" books in libraries to prop up a mental health service which is lacking. I have a feeling that it could end up being DIY acupuncture too.
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Who was that fusty old professor. I have suffered for back pain on and off for 20 years. I have always found a quick visit to the osteopath (usually no more than 3 visits) combined with accupuncture works wonders. Hurrah that the NHS has started accepting evidence of alternative medicine.
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I have a degenerative spinal disorder called spondylolisthesis.
I have constant, chronic pain and am registered disabled.
I use a wheelchair to travel further than 100 yards.
All the needles in the world stuck into my back wouldn't ease my pain.
Exercise and sport.....? Manipulation.....?
They would see off what little mobility I have left!
I'll leave alternative treatments to those who have some hope of recovery from back pain.
I have no such hope, so allow me the drugs my GP prescribes - and for which I have to pay.
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I was badly incapacitated by chronic lower back pain.
I tried chiropody, exercise machines, acupuncture and a very expensive consultant as directed by my GP. But nothing made any significant difference.
In desperation I eventually paid for a private MRI scan and based on the results was able to finally get invasive treatment on the NHS which (touch wood) has totally resolved the problem.
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I was diagnosed with arthritis of the spine in 1990. After 5 years on various painkillers and 2 Cortizone injections into the spine, nothing worked and I was beginning to get stomach problems from all the painkillers. By 1995 the arthritis had spread to my wrists and elbows and I was told I could expect to be in a wheelchair within 10 years-I had already given up working having spent 4 years on incapacity benefit. When I hit rock bottom I called on my GP and he suggested I try accupuncture - on the NHS. I have been a member of a Pain Clinic since 1995 - I have two 6 week sessions of accupuncture each year and am now currently a gardener. I still have arthritis, no wheelchair in sight and a new lease of life. I am thankful for this treatment and would recommend it to anyone in pain.
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I'm a physiotherapist trained in the use of acupuncture. I have, in fact been using this for 25 years now and I, along with around 7,000 other physios, work within the NHS. Why all this talk about extra expense? There's a fully trained workforce already there. As to whether it works or not, physios have to pay for their own training. Clearly 7,000 of us think it works.
While the origins of this technique are Chinese and involve some quite alien ideas, the reason it is so widely used by physiotherapists is because the scientific evidence is so strong.
Save your scorn for other "complementary "therapies, acupuncture is already integrated within normal clinical practice in out-patient rehabilitation departments across the country and rightly so.
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NICE lower back pain: I have spent a fortune on acupuncture even though I have a fear of needles in desperation but it did not work. I would disagree with the 'expert' about 'bone manipulation' I have had excellent results with osteopaths. With lower back pain the problem is often not the bones themselves but the soft tissue connecting to the vertabrae so when I fail to follow the post treatment regime I am given, I will need treatment more frequently. One thing I have noticed is that the osteopath is far more accurate in diagnosing that the pain can be 'referred' meaning that the source of the problem is not where the pain presents but is a symptom of the body compensating for weakness further up or down the chain of connection. of course this means they take a 'holistic' appraoch in terms of the skeleton and connecting tissues. I understand for many that the word holistic SENDS A SHIVER DOWN THE SPINE of many conventional medics. I also suffer from myopia but then I'm not alone
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From my own experience, acupuncture works. I suffered from back pain several years ago and was sent for physiotherapy and hydrotherapy. My condition didn't improve until my doctor gave me a course of acupuncture which sorted it out after a few sessions. Of course, it might have cleared up spontaneously anyway - who knows? But as far as I'm concerned, it worked for me.
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I have been working for 15 years as a clinical aromatherapist treating people's bad backs with deep tissue massage and oils, people come to me when they have exhausted all NHS possibilities which are not many. Physios now do not do manual manipulation but relay on machines or range of movement stretches to aid the pain which is ineffective.
I do have a good success rate no matter what the professors or the doctors say because we heal holistically, something that your speaker does not fully appreciate, that is why one therapy does not fit all and why it shouldn't.
The best healing is when someone finds the right therapy to aid their symptoms which might not be the right one for another.
I know many people that have benefitted from acupuncture but again I know many that haven't and have come to me, this is not to say that acupuncture is wrong or is not working but that it is not for that person and that person needs to find another solution.
I wish that the medical industry would treat us this way instead of expecting that one drug will cure all which in evidence we know it doesn't.
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A few years ago my wife suffered from terrible back pain and could barely walk. She visited her GP who advised her to lie flat for six weeks (how practical is that?) and that nothing other than giving her pain killers would help. I immediately took her off to see a chiropractor who, after about 20 minutes got her walking freely and standing upright without pain; it was as if I had witnessed a miracle. A course of several follow up sessions has meant that she is now, touch wood, back pain free. Another friend who used to suffer agonies with his back is in the same state of relief after following my wife's advice.
The doctor that poured scorn on chiropody during your programme tonight is talking utter twaddle. There was no mumbo jumbo associated with the process and she was given the successful treatment that the NHS could not provide. If she had listened to her doctor she would still be suffering. As it is her back has given her no trouble since.
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The Alexander Technique has great efficacy, through recent medical studies, for the relief of back pain. Most people would put this under the title of Manual Practitioner but it is a much more sophisticated system of mind and body integration. It is also a preventative method rather than curative and therefore not classified as a therapy as such. Having brooched this, much of the work that Alexander Teachers receive, is from the medical profession when more conventional forms of therapy don't necessarily work. Including operations but not limited to operations.
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The Report calculates the total national cost savings of this initiative to be £77,000. For example, although the expected cost of acupuncture treatment is in the region of £25 million, the savings on injections is around £33 million. I do not know if all relevant costs have been factored in - regulatory bodies, training courses etc
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After being knocked down forty years ago on a pedestrian crossing ,I spent the next twenty years or more receiving (exspensive)treatment from endless harley st specialist in an effort to cure my severe and cronic back pain. Steriods, Physio & traction were all proposed but all were only able to provide short relief.Fifteen years ago I began acupuncture and now I am totally cured of any pain or discomfort. How diappointing to hear such a negative responce to this wonderful curing and healing treatment.
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After years of chronic lower back problems which the NHS was unable to relieve, I finally challenged my own prejudices and went to a complimentary therapist. This was an Australian thing called Bowen Therapy; a sort of gentle muscle manipulation. The results were not instant, but after a few sessions the pain was gone and hasn't returned. Was it a genuine cure of a placebo? Frankly I don't care. I can go about my daily business without stiffness or pain and that's all that matters.
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Speaking from personal and professional experience, I would highly recommend the Alexander Technique. A recent NHS funded clinical trial established that it is highly effective. There is information about the trial on the BMJ.com website, just search on alexander technique wihin the BMJ website.
After suffering many years of back pain, the technique helped me to be virtually pain free. I was so impressed that I went on to train as a teacher of the Alexander Technique. After 3 years of full-time training I am now a practising teacher. To locate a teacher near you go to the stat.org website.
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I have just seen the footage on the news tonight regarding accupuncture and other therapies being available on the NHS and think it is a fantastic move forward in NHS health care what a shame though that the practioner being filmed applying the accupuncture needles had such filthy nails ...........
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Acupuncture does help but nof for everything. This NICE study is about treatments for non-specific low back pain. By definition, if it is non-specific then an accurate diagnosis has not ben made of the component(s) causing pain. If there is no accurate diagnosis then there can be no effective targeted treatment.
There is a lot of nonsense in this guideline which is not supported by expert clinicians. For example it suggests that MRI scans should only be done if a spinal fusion is being considered. There are a lot of effective treatments short of spinal fusion which can be indicated by an MRI scan.
NICE has undermined it's own reputation by publishing such a poor series of recommendations, which if followed,would be a step backwards. Complementary therapies are just that- complementary. They are not the way for the NHS to deal with all serious cliical problems ( and all conditions have the potential to be serious until an accurate diagnosis is made).
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I'm young, fit(ish) and healthy with no back pain; but I was just wondering out of curiosity...
Has anyone tried a TENS machine? As far as I understand it, it is supposed to transmit small electric currents through the skin to 'block' pain signals - but does it actually work? Reading the Wikipedia article on the thing, it seems scientists can't agree on whether it does reduce the intensity of pain beyond the placebo effect...
I'd assume that being an electronic gadget, it can't be worn 24/7, and the batteries would need replacing / recharging occasionally (but how often?)
As for acupuncture, I'm willing to accept that it may have some effect on the body, but I doubt it would have much impact on severe or chronic pain.
But the one "alternative" medicine I still can't get my head around is homeopathy - especially as in some dilutions you'd be lucky to have a single molecule of the toxin in the preparation, and the theory that the more you dilute the toxin, the more effective the preparation becomes (thereby completely defying logic)
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mittfh @ 32, I have a friend with serious back-pain (well, having had a total of sixteen vertebrae operated on over the past ten years, and three fractured at the moment awaiting treatment, really doesn't make for unpain) who is waiting for someone to provide her with homeopathic gin.
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There is an important distinction to be made between efficacy and effectiveness. Essentially people who go to see an acupuncturist for their LBP improve. It is kind of pointless (in my view anyway...) to pursue efficacy for complex interventions such as acupuncture, where the components of the treatment may interact and are notoriously difficult to separate. However, just because one accepts effectiveness does not mean that one accepts the doctrine or philosophy of the treatment that is a different question, one that at the moment at least it seems were unable to address.
Whilst the efficacy of interventions such as acupuncture has yet to be established its effectiveness has been and this is why its recommended in the guidelines. While for acupuncture and many LBP therapies, aggregate effect sizes are small to moderate, as Professor Underwood pointed out: sub-groups of patients often respond very well!
It is a shame Prof. Underwood did not get more of a chance to respond to some of Prof. Colquhouns more flippant comments... the almost ad hominem attack on patients, chiropractors, and chiropractic and acupuncture generally, was lamentable as it assumes patients dont know when they are better! Moreover, practitioners of these disciplines help many patients, as well as contributing invaluably to the growing body of evidence-based research.
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We have a tens machine. The other half likes it - I don't. Whether my skin is more sensitive I don't know, I just find the sensation horrid!
It's very nice that NICE are thinking of making such things more accessible - but a shame sufferers of worse conditions have to go through numerous hoops and hurdles to get any help with more severe pain. I have Spondylitus and my treatment is going to a clinic once a year where one person asks me how I'm doing and another measures me to see how bad it's got! When I was first diagnosed I briefly had the impression that the NHS would sweep me away on a wave of intense physiotherapy and help me try and regain the movement lost in the ten years it went undiagnosed. I was given a sheet of paper with a few exercises on and that was it! Silly me.
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Sounds about right for the NHS.
Aroundabout the time I hit puberty, it was noticed that my handwriting speed was slower than average and I developed muscle fatigue after several minutes continuous writing (didn't help that I'm a left-hander and have an unusual pen-holding position), as well as 'jerky' eye tracking and slowness at running.
Cue several visits to medical professionals which usually involved stripping down to my underwear and parading up and down an empty corridor, as well as writing about half a page of text. All under the watchful gaze of the main doctor plus a couple of medical students...
I also had a lumbar puncture, which apparently revealed a higher level of protein in my spinal fluid than average (I was never given an interpretation). One doctor claimed I had an "immature nervous system", another claimed such a thing didn't exist, one claimed exercise would do me good, another claimed it would do me harm, another claimed I'd got a mild form of Cerebal Palsy (very unlikely as my symptoms were definitely not present from birth!).
Needless to say, the course of Occupational Therapy and Physiotherapy failed to materialise, so I thought "stuff this for a lark" and just got on with life (albeit with extra time and use of a portable wordprocessor in exams - the one positive aspect of the entire process!).
Obviously, the two main effects they noticed - running and handwriting speed - aren't much of an issue in my adult life, especially as I now work in an IT-related career :)
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mittfh, when I was about to give birth, I enquired about the hospital tens machine that had been previously offered as a possible painkilling device. It was unavailable. They had it, but the leads or something were missing, so it couldn't be used...
I have used one in the past during physiotherapy sessions on arm muscles. I think it's a horrible sensation. Like a mild electric shock. You wind it up till the tingling is noticeable. Wouldn't bother with it again. Maybe it helps some people. Most of my muscle problems (overuse syndrome from playing the harp )seemed to eventually go away again with time, regardless of the treatment / non-treatment.
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Speaking from mother's personal experience, I would highly recommend the Alexander Technique as an extremely effective way of treating lower back pain. Had it not been for the discovery of this Technique, I would never have been born as her back pain was so painful, the possibility of having a third child was practically non-existent. My mother no longer suffers from any back pain and is now an Alexander teacher.
It find it surprising that this alternative form of treatment has not even been raised in the recent news coverage.
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I've been having acupuncture for osteo-arthritis on the NHS since 1997. I've had it on wrists, back, knee and neck and it's worked every time. I've also been using a TENS machine for much longer. I have two. One which has leads, electrodes and a unit that fits on to my waste band and a small one which has electrodes on a unit that sticks directly to the affected area. These enabled me to extend my working life for a good few years.
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Four years ago I suffered severely with arthritis in my spine.I couldn't tolerate prescibed medicine and resorted to following suggestions in the book'Treating Arthritis the drug-free way'by Margaret Hills.
Within three months my sciatica had cleared up and I've never felt healthier.
I give free talks about my experiance to help fellow sufferers-in case community groups ,out there,are interested?
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I am outraged that the taxpayer now subsidises acupuncture.
Cancer patients are being refused medicine, but we are going to send thousands of GPs nurses and other NHS workers will now be sent on expensive training courses to learn about the 'treatment'
When paying National insurance the taxpayer should be asked 'Are you willing to pay extra for alternative treatments' I'm sure most people will say no
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Eirikur @ 41, unless it can be shown that nobody is ever helped by acupuncture it's not reasonable to assume it is of no use. Some posts here make it clear that for whatever reason some people have found that the sequence "accupuncture -> loss of pain" does exist. If it's a placebo, it seems to be a very effective one.
I would point out that every single person I know who had cancer and died as a result of that cancer was given conventional "treatment" and could be said to have died of either the cancer or the treatment, so I might prefer not to subsidise conventional cancer treatment through my National Insurance payments: it clearly didn't prevent their deaths.
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