Patients may Be denied effective treatment for low back pain in the UK

The National Institute for Health and Care Excellence (NICE) are an advisory body which advise medical practitioners in the UK. NICE issue so called evidence based guidelines which advise on treatment protocols for most medical conditions including low back pain. Although UK based, practitioners including physiotherapists in other countries consult the guidelines.

The guideline on the treatment of low back pain (CG88) published in 2009 included medical acupuncture for persistent non specific low back pain. This meant that medical acupuncture could be offered by the NHS and as a result many patients would have benefited from this effective and safe form of treatment.

The randomised control trial (RCT) was designed mainly for use within the pharmaceutical research. Simplified, an active pill and a dummy or ‘inert’ pill are compared for effectiveness. The active pill has to perform significantly better than the dummy pill for the effect not to be considered a placebo.

This RCT model suits the pharmaceutical industry because it’s easy to create a dummy pill. But when the RCT is applied to medical acupuncture, how do you create a credible dummy needle?

Last Saturday the 6th of February, Lorraine and I presented Integrating Medical Acupuncture in the treatment of Low Back Pain, a one day masterclass at Mount Merrion Chartered Physiotherapy.

We ran the course last November and due to the good feedback and the fact that we could not accommodate all booking enquiries, we decided to repeat the course sooner rather than later.

Once again we were pleased to welcome physiotherapists who had taken time out of there weekends and travelled many hours in some cases to join us. A real commitment to further education, this is what makes us strong as a profession.

Last weekend on Saturday the 7th of November 2015 I had the pleasure of delivering the third in a regional series focussing on the integration of medical acupuncture in the treatment of low back pain. I suppose I should not have been surprised how quickly the course filled given how challenging low back pain can be to treat. We are all looking for those added skills which might make the difference between a successful or unsuccessful course of treatment.

Myofascial pain syndrome (MPS) is clinically defined as a regional pain syndrome characterised by muscle pain caused by myofascial trigger points (MTrPs). Often overlooked or misdiagnosed, pain due to MPS is common and may range from an annoying dull ache to debilitating pain capable of mimicking nerve root irritation, osteoarthritic type pain and even visceral pain.

Peripheral intramuscular nociceptors can become sensitised by mechanical ischaemic and/or peripheral inflammatory factors resulting in a physiological cascade involving the the release of excess acetylcholine by the motor end plate. This in turn leads to the development of a contraction ‘knot’ within the muscle, commonly referred to as a MTrP. This localised contracture has been proposed to further impair local circulation resulting in an energy crisis which in turn results in further nociceptive sensitisation and so the cycle continues.