Nowadays the spinal pain problem is relevant. Almost every human faces back pain at least once in his/her lifetime. Spinal pain symptoms are the most popular reason for visiting a physician. Huge part of health care expenditures is aimed at the treatment of back pain. Traditional medicine provides a variety of opportunities for patients with back pain, although their effectiveness is different in each particular case. An individual approach to each patient in spinal diagnostics still remains a problem. These factors, however, lead to the popularity of oriental medicine. Other factors include accessibility, strong placebo effect and efficiency of some TCM methods even for chronic back pain treatment. This paper will focus on spinal pain symptom classification, causes, diagnostics, traditional and oriental medicine methods of back pain therapy. The comparison between the traditional treatment and oriental medicine in terms of efficiency of spinal pain therapy will be discussed.
Anatomically spinal pain is classified according to the segment of spine. There are cervical, thoracic, lumbar and sacral pains. Pain that lasts less than 6 weeks is considered acute; if it lasts from 6 to 12 weeks, it is considered sub-acute, and pain lasting more than 12 weeks is perceived as chronic. Patients with acute, sub-acute and chronic spinal pain have different predictions as for the recovery and rehabilitation. “Methods of diagnosis and treatment are also different” (Hasenbring, Rusu, & Turk, 2009). The term “non-specific back pain” is often mentioned in recent clinical recommendations that are devoted to spinal pain problems. This term defines the pain that is associated with musculoskeletal disorders with no signs of spine segments injury. Such definition is very convenient in case of acute pain, because in this case the treatment is limited to interruption of pain syndrome and returning to everyday activity. Low back pain or LBP, which is considered as the most common form of spinal pain, should also be mentioned (Cox, 2011).
Causes of spinal pain are divided into several groups: mechanical injuries, infection, cancer, metabolic disorders, rheumatic diseases, “reflection” pain and other reasons. Back pain can be caused by the spine changes (vertebras, intervertebral discs, joints, etc.), muscle injuries and diseases, nervous system disorders and pathologies of thoracic and abdominal cavities as well as mental disorder. However, musculoskeletal changes associated with stretching, traumatization, excessive overload of spinal muscles, ligaments and joints are the most common cause of acute back pain (Hasenbring et al., 2009). These changes can be triggered by different everyday activities such as heavy objects lifting, excessive spine twisting, tripping and falling. Heavy back injuries can be caused by falls from great heights, car accidents, back or top of the head strokes or penetrating injuries. The consistent excluding of local infection and systemic diseases, injuries and cancer makes the determination of spinal pain causes easier and more practical, except obvious cases. Back pain localization can significantly reduce the number of expected causes.
The diagnosis is carried out at the initial examination of the patient. Neurologist usually conducts examination in response to complaints from the patient such as local pain, causing deformation or limiting his/her mobility. Spine is explored in standing, sitting and lying down positions, both at rest and in motion. The incidence of the spine is determined by counting the number of vertebrae from certain anatomical landmarks or using a special scheme. Most attention during the survey is paid to posture, structural features of the body, the position of shoulders and the muscles near the spinal column. The palpation of the spine allows determining the location, degree and nature of pain. Tension of muscles near the spine needs to be checked as the majority of injuries and diseases of the spine are accompanied with increased muscle tone. Projection radiography, computed tomography and magnetic resonance imaging help determine the level of destruction, specify diagnosis and identify hidden pathologies. This diagnostics allows the physician to choose the most effective treatment.
Surgery, medicinal and non-medicinal methods are used for spinal pain treatment. Most people try to avoid surgery and only a minority of back pain patients requires a surgical intervention. Medicinal method is used when there is a need for analgesia and includes using paracetamol and non-steroidal anti-inflammatory drugs (NSAIDs/NSAIAs). However, the non-medical method is the most popular for back pain treatment and includes heat therapy, massage, back schools, physical exercises, and so on.
Back surgery is usually a hard choice. It is advisory only if all previous options have failed to provide any relief. Types of back surgery are different and include spinal fusion, disc replacement, foraminotomy, laminectomy and interlaminar implants. Despite the fact that risks of back surgery are usually low, they can be serious in some cases. Nerve damage, bleeding, disc herniation and hearth attack are considered as main risks in spinal surgery (Souter, Cregg, & Chong, 2012). It should be noted that the surgery does not provide significant improvement for all.
In medicinal method muscle relaxants, opioid analgesics, NSAIDs and anti-depressants as injections are used to reduce pain. While NSAIDs still remain the basic drug, their long term use increases the risk of side effects such as gastrointestinal complications. Muscle relaxants and opioid analgesics can be used as an alternative to NSAIDs. Anti-depressants are used in chronic pain syndromes therapy. Risks of injection include nausea, vomiting, and pain at the injection site.
Non-medicinal method provides a wide range of back pain treatments without the help surgery or medication use. Bioelectric therapy, electrical nerve stimulation, spinal decompression and physiotherapy are main types of non-medicinal spinal treatment. These methods are a part of pain management that is used to effectively control the pain and the process of rehabilitation of patients.
Bioelectric therapy is used for the chronic and acute pain treatment. Bioelectric therapy relieves pain by blocking pain signals before they reach brain and also induces the endorphins production for pain relieving. Special computer program determines the dose of high frequency electric currents that are provided to the patient via the system of electrodes (Hasenbring et al., 2009). Since one therapy session does not provide pain relief, a number of sessions are needed. Bioelectric therapy helps in temporary ache control, and is typically used as a part of pain management program.
Spinal decompression changes the position of vertebral column, decreases the disc pressure and provides nutrient-rich fluids movement. A spinal stretching is used to achieve satisfying results. However, the effectiveness of nonsurgical spinal decompression is not confirmed by clinical research. This therapy will not be considered safe and efficient until the comparison research between spinal decompression and other surgical alternatives is done.
Physical therapy (PT) provides special procedures that prevent injuries and restore physical activity. In case of chronic pain, PT helps to reduce the intensity of pain. Different methods of physical exercises such as aerobic gymnastics, muscle stretching, etc. have similar clinical effectiveness. Active or passive physical therapy can be chosen to decrease the level of pain (Souter, Cregg, & Chong, 2012). Active PT is based on special strengthening, pain-relief or stretching exercises, while passive therapy includes manual therapy, TENS, heat or ice packs and other methods of treatment. Physical therapy is recommended for patients who cannot return to normal daily activities. However, most clinical recommendations do not indicate the exact timing of PT. According to National Institute for Health and Care Excellence, the patient should be sent to acupuncture sessions, manual or physical therapy if he/she is unable to return to normal daily activities after four weeks from the first back pain episode (NICE, 2009). Physical therapy must be carried out by an experienced specialist, which is skilled in rehabilitation treatment. Although in general TP is rather effective for back pain treatment, some aspects, such as massage and bed rest, are considered ambiguous by physicians.
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Oriental medicine or Traditional Chinese medicine (TCM) is based on several practices: herbal therapy and animal origin medicaments, acupuncture, dietetics and massage techniques. Chinese healing practices were established when medical science had not yet been separated from philosophy, and philosophy had been part of religion. Therefore, a person in this system is inextricably connected with its natural surroundings via chi or qi energy that circulates in his body and nature. A fundamental zang-fu theory describes all the internal organs and processes of the body in terms of male and female principles. Heart, liver, spleen, lungs and kidneys are considered as “zang” – a “female” (i.e. yin) organs, while stomach, intestines and bladder are “fu” – “male” (i.e. yang) organs (Jiuzhang & Lei, 2010). When the balance of yin and yang breaks down in particular organs or the whole body, the disease occurs. All human beings contain a balance of these two principles. The excess of yin can be threatened with special diet, which might contain more yang and vice versa.
Another theory considers human body as a cycle of five elements: fire, earth, metal, water and wood. The liver (wood), for example, was considered the mother of heart (fire), and kidney (water) was viewed as the mother of liver. Each organ in TCM is associated with a particular planet. Practically, this means that drugs should be taken according to certain time of the day and active phase of a specific planet (Jiuzhang & Lei, 2010). However, such theories cannot be considered a unique invention of Chinese doctors, unlike the Chinese acupuncture and herbal therapy, which can be considered truly unique methods of pain treatment.
According to acupuncture, vital energy circulates in the human body through certain channels or meridians, just as the blood flows through the veins. Each channel is connected to certain internal organ. Most meridians run deep through the body, but at certain points they can be found on the skin surface. These points are called biologically active. With the help of pressing, puncturing and cauterizing of biologically active points, a skilled therapist can determine whether the channel works well or not. The most common stimulation mechanism of acupunctural points is thin metallic needles penetration under the skin. Needles are manipulated by electrical stimulation or manually.
In clinical practice, acupuncture is highly individualized and based on the philosophy and intuition; it helps to reduce postoperative and chronic pain, vomiting, nausea, and high blood pressure. Also it is used for getting rid of drug addiction and obesity treatment and is especially effective against back pain (cervical, low back) and migraines. Acupuncture has a number of variations which have their own characteristics and include electropuncture, moxibustion, acupressure, vacuum therapy, su-jok and massage (Jiuzhang & Lei, 2010). The mechanism of pain-relief still remains unclear. A vast number of theories explain acupuncture effect with pain impulse blocking, endorphins production or placebo effect and cultural background influence. Acupuncture remains a popular method of spinal pain treatment, despite the fact that there is no consensus about its efficiency.
Herbal treatment is widely represented in traditional Chinese medicine. Basically, herbal medicine is based on herbs, minerals, animal components and raw materials. Unlike chemical drugs, herbal medicaments are more easily absorbed by the body with few side effects and are not addictive. Decoctions and infusions and different teas are the most popular forms of herbal treatment. Patients who suffer from lower back pain and sciatica are diagnosed with bi syndrome. This syndrome means blocking qi energy and low back area pain. Therapy in this case focuses on kidneys and their condition and includes warming and dampness clearing procedures.
Traditional methods of spinal pain therapy, such as surgery and medicinal treatment are mostly used in cases of specific back pain. Non-medicinal methods are used in nonspecific spinal pain cases, which constitute the majority of back pain complaints. NSAIDs are more efficient than a placebo for acute and chronic pain treatment, but still can vary when compared to other means of treatment. The existence of risk factors and associated diseases must be taken into account when selecting NSAIDs. One needs to combine different NSAIDs to achieve better effect.
The most popular oriental medicine method for spinal pain treatment is acupuncture. The effectiveness of acupuncture as an anesthetic has been proven by clinical studies. According to medical researches, there is strong evidence of this method’s effectiveness as a part of nonspecific chronic low back pain treatment (Yuan et al., 2008). In long-term chronic back pain therapy, acupuncture is considered an alternative to analgesic drugs due to their side effects. However, it is almost impossible to organize a valid experiment where patients will not know what kind of treatment they undergo. Some researches that compared sham acupuncture with traditional one showed that there was no difference between them. Such a result can be explained by strong placebo effect and cannot be considered truly clear. Still, however, more researches are needed to compare acupuncture and traditional methods. The efficiency of herbal therapy has poor evidence in clinical studies. Herbal drugs and raw materials can cause unpredictable side effects when combined. Also, there is no governmental control of these medicaments.
The first episode of back pain often occurs in the third decade of life. High incidence is retained from the third to sixth decade. On the one hand, increased physical activity of young people predisposes the appearance of back pain episodes. On the other hand, the majority of health-seeking persons of working age may be associated with greater back pain influence on their daily activity compared to people of older age groups. Spine is predisposed to chronic back pain due to degenerative changes, even without high loads (Kopec, Sayre, & Esdaile, 2004). Acute, sub-acute and chronic character of pain defines the treatment and diagnosis methods.
Traditional methods of back pain therapy, which include surgery, NSAIDs and other analgesics, electrical nerve stimulation, bioelectric therapy and physiotherapy proved their efficiency for all types of spinal pain treatment. Acupuncture has recently become the most popular pain-relief method of TCM. Clinical studies proved its effectiveness in chronic low back pain syndrome treatment. Herbal therapy, however, requires more researches, as well as other methods of oriental medicine. A comparison between traditional and sham acupuncture showed that there was no significant difference between them. This result may indicate a strong placebo effect instead of real efficiency. Summarizing the above, it becomes clear that spinal pain treatment methods of TCM need to be used as a part of comprehensive program for chronic low back pain therapy.