At The North Wales Spine Clinic we use the best treatment available for each individual patient. With a huge mix of complaints presenting in North Wales such as back pain, neck pain, shoulder pain, headaches, sciatica, trapped nerves, disc issues and sports injuries we really need to be able to offer varied and effective treatment plans. Whilst serving areas in North Wales such as Gwynedd, Conwy and Anglesey we use treatments such as Chiropractic, Acupuncture, Massage, Neuro-muscular and Core Stabilisation, OPT (Optimum Performance Training) exercise programmes, Osteopathy and Physiotherapy techniques.
The focus of this post is our use of Acupuncture for patients from Gwynedd, Conwy and Anglesey. We find Acupuncture useful for conditions such as back pain, headaches, shoulder problems, long-term pain and sciatica.
Many beliefs as to how Acupuncture works have been purported over the past two millennia, many still are in the common psyche. However modern research and experience is now beginning to suggest that it may be the traumatic effect of an Acupuncture needle that spark the bodies own natural healing cascade. In fact some researchers now believe that Cortisone steroid injections may be effective not because of the steroid that is injected but because of the effect of the needle on the soft tissues. Suggestions have been made that the nature substance injected makes little difference to the healing effect!
Think about that happens when you get a paper cut. It heals itself over time. Well the same is true of deeper tissue damage; the healing process is very similar. Small amounts of tissue damages (which is created by the sterilized Acupuncture needle) seem to incite a healing process in an area that has undergone long-term problems.
Research has shown that Acupuncture is significantly better than no treatment and better than standard medical care for back pain (Witt 2006; Haake 2007; Cherkin 2009; Sherman 2009a). It appears to be particularly useful as an adjunct to conventional care, for patients with more severe symptoms and for those wishing to avoid analgesic drugs (Sherman 2009a, 2009b; Lewis 2010). It may help back pain in pregnancy (Ee 2008) and work-related back pain, with fewer work-days lost (Weidenhammer 2007; Sawazaki 2008).
How can Acupuncture can help patients from Gwynedd, Conwy and Anglesey to reduce the problems of back pain, sciatica, shoulder pain, neck pain and migraines? Well, research suggests that Acupuncture has various effects on the human body in pain relief. It does this by:
- Providing pain relief – by stimulating nerves located in muscles and other tissues, acupuncture leads to release of endorphins and changes the processing of pain in the brain and spinal cord (Pomeranz 1987; Zhao 2008).
- Reducing inflammation – by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007; Zijlstra 2003).
- Improving muscle stiffness and joint mobility – by increasing local microcirculation (Komori 2009), which aids dispersal of swelling and bruising.
- Reducing the use of medication for back complaints (Thomas 2006).
- Providing a more cost-effective treatment over a longer period of time (Radcliffe 2006; Witt 2006).
- Improving the outcome when added to conventional treatments such as rehabilitation exercises (Ammendolia 2008; Yuan 2008).
- The National Institute for Health and Clinical Excellence guidelines on best practice now recommend that GPs offer a course of 10 sessions of acupuncture as a first line treatment for persistent, non-specific low back pain*.
National Institute for Health and Clinical Excellence clinical guideline 88 – Low back pain. www.nice.org.uk/CG88
* National Institute for Health Research, Health Technology Assessment Spotlight: Acupuncture for back pain. www.ncchta.org/publicationspdfs/Spotlight/AcupunctureSMLFL.pdf
Back Pain relief in North Wales
The most common complaint in Gwynedd, Conwy and Anglesey for muscular and skeletal pain is back pain. Back pain is highly prevalent in modern society. It is the UK’s leading cause of disability and one of the main reasons for work-related sickness absence. The condition affects more than 1.1 million people in the UK, with 95% of patients suffering from problems affecting the lower back. Back pain currently costs the NHS and community care services more than £1 billion each year*. Most lower back pain is caused not by serious damage or disease, but by minor disc damage, joint sprains, muscle strains, minor injuries, or a pinched or irritated nerves.
Our approach to back pain is multi modal that is we use a combination of what works for the patient in front of us from the most effective aspects of Chiropractic, Acupuncture, Massage, Neuro-muscular and Core Stabilisation, OPT (Optimum Performance Training) exercise programmes, Osteopathy and Physiotherapy techniques. Acupuncture often forms an important part of our treatment in the early stages of care in the form of pain relief.
Sciatica sufferers in Conwy, Gwynedd and Anglesey
Many patients from Gwynedd, Conwy and Anglesey present with sciatica or more accurately – lumbar Radiculopathy. This syndrome involves nerve root impingement and/or inflammation that has progressed enough to cause neurological symptoms (e.g. pain, numbness, paraesthesia) in the areas that are supplied by the affected nerve root(s) (Tarulli 2007). Posterior sciatica involves pain that radiates along the posterior thigh and the posterolateral aspect of the leg, and is due to an S1 or L5 radiculopathy. When caused by S1 irritation, the pain may radiate to the lateral aspect of the foot, while pain due to L5 radiculopathy may radiate to the dorsum of the foot and to the large toe. Anterior sciatica involves pain that radiates along the anterior aspect of the thigh into the anterior leg, and is due to L4 or L3 radiculopathy. Pain due to L2 radiculopathy is antero-medial in the thigh, and pain in the groin usually arises from an L1 lesion. Sciatica is almost invariably accompanied or preceded by back pain, and mobility is often affected (Koes 2007). Indicators for sciatica include unilateral leg pain that is greater than low back pain; pain radiating to the foot or toes, numbness and paraesthesia; increased pain on straight leg raising, and neurological symptoms limited to one nerve root (Waddell 1998).
The prevalence of lumbar radiculopathy is around 3% to 5%, and equally common in men and women (Tarulli 2007), and an estimated 5%-10% of patients with low back pain have sciatica (Health Council 1999). The annual prevalence of disc related sciatica in the general population is estimated at 2.2% (Younes 2006). In most patients, the prognosis is good, but up to 30% will have pain for one year or longer (Weber 1993, Vroomen 2000).
Conventional management includes advice to stay active and continue daily activities; basic exercise therapy; analgesics (e.g. paracetamol, NSAIDs, an opioid); muscle relaxants; corticosteroid spinal injections; and referral for consideration of surgery. However, there is a lack of strong evidence of effectiveness for most of these interventions (Hagen 2007, Luijsterburg 2007).
At The North Wales Spine Clinic our approach is based around helping patients from Gwynedd, Conwy and Anglesey who have sciatica to reduce symptoms quickly and then slowly build up a ‘toolbox’ of effective pain relieving rehabilitation exercises for long term results.
Persistent (chronic) pain is a widespread problem that affects around 8 million people of all ages in the UK (Chronic Pain Policy 2010). In 22% of cases, chronic pain leads to depression, and some 25% of those diagnosed with chronic pain go on to lose their jobs (Chronic Pain Policy 2010). In fact, around £3.8 billion a year is spent on incapacity benefit payments to those diagnosed with chronic pain (Chronic Pain Policy 2010).
The International Association for the Study of Pain has defined pain “as an unpleasant sensory or emotional experience resulting from actual or potential tissue damage…”. Chronic pain may be defined as pain that lasts beyond the usual course of the acute disease or expected time of healing, and it may continue indefinitely.
Typical chronic pain conditions include: osteoarthritis; rheumatoid arthritis; low back, shoulder and neck pain; headache and migraine; cancer pain; fibromyalgia; neuropathic pain (e.g. sciatica, trigeminal neuralgia, post herpetic neuralgia); chronic overuse conditions (e.g. tendonitis); and chronic visceral pain (e.g. irritable bowel syndrome, interstitial cystitis, endometriosis) (Singh 2010).
Often the issues behind long-term pain begin with tissue damage somewhere in the human body. Neurological pathways slowly mould to maintain the problem and what we see it a chronic pain syndrome. Breaking this syndrome requires a remoulding of the ability of the neurological system to report the correct information. Acupuncture forms an important early basis for this to occur at The North Wales Spine Clinic.
Frozen shoulder (adhesive capsulitis) is a common, painful and sometimes disabling condition that can last for months or years. It affects around 2% of adults (Lundberg 1969). The characteristic symptoms are pain, stiffness, and limitation of active and passive shoulder movements (particularly external rotation of the joint) (DTB 2000). They may be severe enough to interfere with everyday activity (e.g. driving, dressing or sleeping), and may prevent some patients from working.
There is no universally accepted definition of frozen shoulder and the cause is poorly understood (Naviaser 1987, Bunker 1997). It is thought that scar tissue forms in the fibrous capsule surrounding the shoulder joint (Bunker 1997), causing it to thicken and contract, so restricting shoulder movement. Frozen shoulder is most common in people aged 40–60 years and, in up to 20% of those affected, it will later develop in the other shoulder (Harryman 1998). Risk factors include female sex, older age, shoulder trauma and surgery, diabetes, and cardiovascular, cerebrovascular and thyroid disease (Speed 2006).
The aims of treatment are to relieve pain, minimise joint restriction and speed resolution of the condition (DTB 2000). Common treatment approaches include simple analgesics, nonsteroidal anti-inflammatory drugs, local corticosteroid injections and Chiropractic.
Migraine is a primary headache disorder manifesting as recurring attacks, usually lasting for 4 to 72 hours and involving pain of moderate to severe intensity (IHS 2004). Typical characteristics of the headache are unilateral location, pulsating quality, moderate or severe intensity, and aggravation by routine physical activity. Sufferers may also experience auras, photophobia, phonophobia, nausea and vomiting. Migraine is a common disorder (Olesen 2007); a UK follow-up study found the migraine incidence rate to be 3.69 cases per 1,000 person-years, and to be around 2.5 times higher in women than men (Becker 2008).
Many people with migraine can be adequately treated when the attacks occur, but some need prophylactic interventions, as their attacks are either too frequent or are insufficiently controlled in this way. Several drugs, such as beta-blockers, amitriptyline or sodium valproate, are used in the prophylaxis of migraine in an attempt to reduce attack frequency, but all these drugs are associated with adverse effects (DTB 1998).
References
Becker C et al. Migraine incidence, comorbidity and health resource utilization in the UK. Cephalalgia 2008;28:57-64.
Bunker TD. Frozen shoulder: unravelling the enigma. Ann R Coll Surg Engl 1997; 79: 210-3.
Chronic Pain Policy Coalition, 2010. About chronic pain [online]. Available:
http://www.policyconnect.org.uk/cppc/about-chronic-pain 2010 [online]. Available: http://emedicine.medscape.com/article/310834-overview
Harryman DT et al. The Stiff Shoulder. In: Rockwood Jr CA, Matsen III FA (Eds). The Shoulder. Second edition. USA: WB Saunders, 1998.
Hagen KB et al. The updated Cochrane review of bedrest for low back pain and sciatica. Spine 2005; 30: 542-6.
Health Council of the Netherlands: management of the lumbosacral radicular syndrome (sciatica): Health Council of the Netherlands, 1999; publication no. 1999/18.
IHS 2004. Headache Classification Subcommittee of the International Headache Society. The International Classification of Headache Disorders: 2nd edition. Cephalalgia 2004;24:1–160.
Koes BW et al. Diagnosis and treatment of sciatica. BMJ 2007; 334: 1313-7.
Luijsterburg PAJ et al. Effectiveness of conservative treatments for the lumbosacral radicular syndrome: a systematic review. Eur Spine J 2007 Apr 6;(Epub ahead of print).
Lundberg BJ. The frozen shoulder. Acta Orthop Scand 1969; 119: 1-59.
Managing migraine. Drug and Therapeutics Bulletin 1998;36:41-44.
Need patients be stuck with frozen shoulder. DTB 2000; 38: 86-8.
Neviaser TJ. Adhesive capsulitis. Orthop Clin North Am 1987; 18: 439-43.
Olesen J et al. Funding of headache research in Europe. Cephalalgia 2007;27:995–9.
Speed C. Shoulder Pain. Clinical Evidence. Search date February 2006.
Tarulli AW, Raynor EM. Lumbosacral radiculopathy. Neurol Clin 2007; 25(2): 387-405.
Vroomen PCAJ et al. Conservative treatment of sciatica: a systematic review. J Spinal Dis 2000; 13: 463-9.
Weber H et al. The natural course of acute sciatica with nerve root symptoms in a double blind placebo-controlled trial of evaluating the effect of piroxicam (NSAID). Spine 1993; 18: 1433-8.
Waddell G. The back pain revolution. Edinburgh: Churchill Livingstone, 1998.
Younes M et al. Prevalence and risk factors of disc-related sciatica in an urban population in Tunisia. Joint Bone Spine 2006; 73: 538-42.