Dr Maggie Ju Acupuncture Harley street and Kensington

If you don't have pain, you can never imagine how terrible to live with a pain. Chronic pain is a common condition in adults and almost everyone has experienced chronic pain at some points of their life. Pain can happen anywhere of the body from the head to the toes.

Pain relief with acupuncture:

Acupuncture is a therapy in which thin needles are inserted into the body to relieve the pain.

Acupuncture is a valuable treatment for chronic pain conditions such as tension headaches, migraines, facial pain, neck pain, back pain, chronic pelvic pain, bladder pain, chronic abdominal pain, shoulder pain, arm pain elbow pain, wrist pain, hip pain, thigh pain knee pain, leg pain, ankle pain, kidney stone, and others etc, you name it. Acupuncture needles creates micro-injury and stimulates nerve endings located in muscles and other tissues leading to the production of endorphins and other neuro-hormonal factors and anti-inflammatory substances and releasing vascular and immunomodulatory factors. Acupuncture increases local blood circulation and improves muscle stiffness, joint mobility and swelling. Also brain and spinal cord processing pain has been altered.

Clinical investigators have found that patients with chronic pain often have lower-than-normal levels of endorphins in their spinal fluid. Acupuncture activates endorphin systems and there are higher levels of endorphins in cerebrospinal fluid following acupuncture. 

 

Upper back pain

Upper back is the region between the shoulder blades, or between the neck and the waist. This is so called thoracic back pain. The pain is this region is very common. Symptoms can vary from person to person. The pain can be mild or more severe which might affect daily activities and sleep. It could be a sharp pain in one spot or a general achiness that comes and goes. The pain can be referred up to the neck, shoulder, down to the low back and around to the abdomen. There may be other symptoms associated with the pain such as acid reflex, bloating, stomach-ache, tight chest etc. In most of cases, the pain is nonspecific which means the cause is not clear or unknown. Pain in the upper back is usually the result of poor posture, muscle overuse, or injury.

Stooping in a chair over a desk is a good example. This may cause a loss of strength in the muscles. Over time, the weakening of muscles may lead to pain in the area as they experience strains or irritation; the pressure from gravity and the body itself pushes on the spine, neck, discs, and ligaments and can lead to pain and other complications. Overusing back muscles is another common cause of upper back pain. repeating the same motions over time may cause muscle strain, tightness and irritation. A traumatic injury at the upper back can also lead to back pain after the injury is healed.

Low back pain

95% of back pain occurs in the lower back.  About 80 percent of adults experience low back pain at some point in their lifetimes. It is defined as non-specific low back pain, if there is no cause found. Non specific low back pain is from mild to severe, from a dull, burning, constant ache to a sudden, sharp or stabbing pain in the lower back region. The pain can be also shooting pain to the legs or up to the back or forward to the abdomen.

 

Acupuncture is very effective for non specific low back pain and it helps patients with low back pain reducing lumber surgery rate. . There is a research investigated the association between acupuncture treatment and lumbar surgery rate in patients with LBP. The participants in this study were all newly diagnosed LBP in Korea between 2004 and 2010 and they were allocated into two groups: acupuncture group and control group. The lumbar surgery rate in the two years following the first visit (control group) or the first acupuncture session (acupuncture group) was calculated. 130,089 patients were included in each study group which is not a small sample study. The result has shown that the lumbar surgery rate was significantly lower in the acupuncture group than in the control group.

In the US, the National Institute of Clinical Excellence (NICE) recommends acupuncture therapy for persistent, non-specific lower back pain.  A 2017 clinical practice guideline (guidance for health care providers) from the American College of Physicians (ACP) included acupuncture among the nondrug treatment options for management of both acute and chronic low-back pain. 

In the UK, with 2.3 million acupuncture treatments carried out each year, acupuncture is one of the most popular complementary therapies practiced today. Acupuncture can be extremely beneficial for back pain, providing long term pain relief and reducing inflammation.

 

The Sacroiliac Joint pain

The Sacroiliac Joints (SI joints) are located at the low back where the sacrum and ilium meet. The sacrum is the triangle-shaped bone near the bottom of the spine, just above the coccyx, or tailbone. The ilium, one of the three bones that make up the hip bones, is the uppermost point of the pelvis. The Sacroiliac Joints connect the spine to the hips. All the bones in the SI joints are connected by muscles and the joints are reinforced by strong ligaments. This network of soft tissues provides support and stability, limits movement at the joint, and assists with absorbing pressure. Small movements at the joint help with shock absorption when walking and lifting and forward/backward bending. The bones of the SI joints are jagged which help them stay in alignment. Spaces between the bones of the SI joints are filled with fluid providing lubrication. These spaces are also filled with free nerve endings, which send pain signals to the brain.

SI joint pain can occur. Other terms for SI joint pain include: SI joint dysfunction, SI joint syndrome, SI joint strain and SI joint inflammation. The SI joint is to account for 15-30% chronic lower back pain. Chronic SI joint pain persists for more than three months. Common symptoms include: pain in the lower back, pain in the buttocks, hips, and pelvis, pain in the groin, pain limited to just one of the SI joints, increased pain when standing up from a sitting position, stiffness or a burning sensation in the pelvis, numbness, weakness, pain radiating down into the thighs and upper legs.

Typically, it is dull, aching, lower back pain and can range from mild to severe. It may be felt all the time or worsen with certain activities. Lower back pain is typically felt only on one side, but in some cases may be felt on both sides. It can be a sharp, stabbing pain that radiates from the hips, buttocks, and/or groin and pelvis, up to the lower back, and down to the thighs. The pain is worsened when putting added pressure on the sacroiliac joint, such as climbing stairs, running, or jogging, and lying or putting weight on one side. Stiffness and reduced range-of-motion in the lower back, hips, pelvis, and groin may cause difficulty with movements such as walking upstairs or bending at the waist.

Hip pain

The hip joint is a ball and socket synovial joint. It is one of the most flexible joints in the body which allows a great range of movement. Because of hip joint, walking, running and jumping become possible. It supports the body’s weight and bears the force of the strong muscles of the hip and leg when standing, walking, running etc. The hip joints have very important roles in retaining balance, and for maintaining the pelvic inclination angle. Surrounding the hip joint are many tough ligaments that prevent the dislocation of the joint. The strong muscles and tendons of the hip region also help to hold the hip joint together and prevent dislocation. Hip pain is a common condition that can be caused by a wide range of problems. The precise location of the hip pain can help to find out the underlying cause. Hip pain on the outside of the hip referred to the upper thigh or outer buttock is usually caused by problems with muscles, ligaments, tendons and other soft tissues that surround the hip joint. Injury of ligaments, muscles and tendons and fasicas around the hip joints is a common cause of hip pain. Hip bursitis is a common condition for hip pain. Hip bursitis is an inflammation between the thighbone and nearby tendons. The pain is from outer side of the hip. Tendinitis: there are many tendons around the hip connecting buttocks to the hip bone. These tendons can get inflamed causing outer side of hip pain. IT band syndrome: IT band is a long band f connective tissue that runs from the hip to the knee on the outer side of the thigh. If IT band is injured and inflamed, it causes our side of hip pain. Tight gluteal muscles and IT band and they pull the bone that they attached causing pain on the hip. Hip pain can also a referred pain from low back.

Sciatic pain

The sciatic nerve is the longest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and runs through the buttock area down to the lower limb ending at the feet. The pain of sciatica is sometimes referred to as sciatic nerve pain. Sciatica is pain caused by irritating sciatic nerve. It is a syndrome involving nerve root impingement or inflammation that causes neurological symptoms in the areas that are supplied by the affected nerve roots. The pain of sciatica radiates out from the lower back, down the buttocks and into one or both of the legs, right down to the calf. The most prominent symptoms include unilateral leg pain radiating to the foot or toes that is greater than low back pain. The accompanied symptoms can include numbness, tingling, muscle weakness, loss of tendon reflexes. It may involve increased pain on straight leg raising and neurological symptoms limited to one nerve root. Sciatic pain can range from being mild to very painful and may last just a few days or for months or years. The pain often gets worse over time and may also be made worse by: sneezing, coughing or laughing, standing or sitting for a long period of time, bending backwards. Acupuncture is clinically effective, reduces pain intensity.

Buttocks pain

The buttocks are made up of three muscles: the gluteus maximus, gluteus medius, and gluteus minimus. Buttocks can become painful due to some conditions.

Buttocks muscle strain is a very common condition causing buttocks pain. If buttocks muscles are strained, it can cause muscle spasm and tendon injury and causes pain, swelling, tenderness and stiffness. Trigger points can be found in these muscles.

Many other conditions can also cause pain in the buttock. For example

Piriformis syndrome: Piriformis is a small muscle that is located deep in the buttock region. If this muscle is tense and inflamed, it can irritate and compress the sciatic nerve causing pain and tingling at the buttocks ot numbness.

Sciatica: The sciatic nerve is the longest nerve in the body and begins from nerve roots in the lumbar spinal cord in the low back and runs through the buttock area down to the lower limb ending at the feet. The pain of sciatica is sometimes referred to as sciatic nerve pain. Sciatica is pain caused by irritating sciatic nerve.

Slipped disk: A slipped disc or prolapsed or herniated disc is a condition in which the disc in the spine is torn and the central part inside comes out. This can cause pain at the buttocks.

Sacroiliac joint pain: sacroiliac joint is the joint between the triangular sacral bone at the base of the spine and the iliac or pelvic bone. If the area becomes inflamed, it causes pain at the buttocks.

Buttocks pain can be distressing especially no causes are found and nothing is shown on tests: the MRI show no problems, no tumor, no slipped disk, no nerve damage, no nothing. Blood test is normal: no sign of infection.

Osteoarthritis: Osteoarthritis in the low back, sacroiliac joint and the hip can cause buttock pain. The pain, when spreading from an arthritic joint, is often non specific.

Ligament and tendon inflammation: There are many ligament s and tendon at the buttocks. If these ligaments and tendons get strained and stretched, it will cause inflammation. A common way of stretching the ligament is by sitting with the low back unsupported in a slumped position. Coccydynia known as tail bone pain can also be caused by ligament and tendon inflammation around the tail bone.

Bursitis: There two main bursa in the buttock area_ the trocanteric bursa and the ischial bursa. If these bursa is inflamed, it can cause pain at the buttocks especially when sitting down.

Hamstring tendonitis: Hamstring tendon is inflamed in this circumstance causing pain at the buttocks which is noticeably when sitting down.

Groin pain

The groin is the area of the hip between the inner, upper thigh and lower abdomen. Five muscles (adductor brevis, adductor longus, adductor magnus, gracilis and pectineus) from the thigh originated here. Four abdominal muscle including transverses abdominis, rectus abdominis, external oblique and internal oblique muscles end there. Pain can develop in groin. Groin pain can be mild discomfort to severe pain. The most common cause of groin pain is muscle, tendon or ligament strain during exercise such as running, skating, kicking in soccer, or playing basketball or during doing work such as lifting, pushing, or pulling heavy objects. Groin pain may occur soon after an injury and it can also have swelling and bruising.  The pain may come on gradually over a period of time: weeks or even months. The pain may be worsened by continued use of the injured area. Overuse is another common cause for groin pain. This often happens when you do too much an activity or repeat the same activity day after day. It put too much stress on the area and can lead to muscle strains or tears or may cause swelling.

There are many other conditions which can cause groin pain, such as a bone fracture, a hernia, kidney stones, bladder infections, prostatitis or a testicle condition.

Groin pain not caused by an injury to the groin may be coming from other parts of the body such as leg muscles, ligments and tendons injury.

If you have groin pain, you need to see doctor and get it checked out. If the groin pain is caused by muscle, tendon and ligament strain, acupuncture is very effective to reduce the pain.

Acupuncture is effective for chronic prostatitis/chronic pelvic pain syndrome

chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) presents as chronic pain in the region of the pelvis, and often associated to ejaculatory pain, urination pain lasting for at least 3 to 6 months. The benefits of acupuncture on CP/CPPS have been well established. How many sessions of treatments were required for this condition? A paper analysed existing data involved in ten studies of 329 participants. Overall, more acupuncture sessions received for CP/CPPS patients is associated with increased symptom relieving. After 6 sessions of treatments, the pain started to decrease; after 18 sessions of treatment significant improvement of pain was observed. The conclusion is that there is dose-response relationship between acupuncture sessions and CP/CPPS outcome. Prolonged acupuncture sessions were associated with less NIH-CPSI score. Six acupuncture sessions might be the minimal required 'dose' to reach its clinical effects.

References

Qin Z et al Ann Transl Med. 2019 Mar;7(6):116. doi: 10.21037/atm.2018.11.45.

Bladder pain/Interstitial cystitis (IC)

The urinary system, also known as the renal system or urinary tract comprises kidneys (two), ureters (two), bladder and urethra. Urine is formed in the kidneys and then passed through the ureters to the bladder where it is stored. When the bladder is not full of urine, the bladder is relaxed. When the bladder is getting full, it will let the brain know the need to pass urine. If the bladder is working normally, one can put off urination for some time. If there is something that goes wrong with the bladder, urination change is a sign of it.

Interstitial cystitis (IC)/bladder pain syndrome (BPS) is a chronic bladder condition. It is a feeling of pain and pressure in the bladder area and the symptoms have lasted for more than 6 weeks, without having an infection or other clear causes. Symptoms range from mild to severe. For some patients the symptoms may come and go, and for others they don't go away. The pain may be worse when the bladder is full and may be temporarily relieved after urination.  The pain could be worse during periods or after having certain foods or drinks. IC/BPS is not an infection, but it may feel like a bladder infection. Women with IC/BPS may feel pain when having sex.  This condition is poorly understood. Apart from the pain, it is also accompanied with problems of urination, such as sudden, strong urges to urinate, more frequent urination than normal, pain when passing water, waking up quite a few times during the night to urinate. The exact cause of interstitial cystitis isn't clear. Unlike other types of cystitis, there's no obvious infection in the bladder and antibiotics don't help.

Acupuncture helps with interstitial cystitis. A patient said that it was a nice feeling of standing on the beach without rushing to go to toilet.

Tailbone pain

Tailbone or coccyx is the lowest part of the spine and it is the triangular bony structure and consists of three to five different bones that fused together by joints and ligaments. It is surrounded by many tendons and ligaments. If the tailbone area becomes inflamed, it can cause tailbone pain or coccydynia. Soft tissue injury such as tendons and ligaments surrounding tailbone is the common cause of tailbone pain. The main symptom is pain and tenderness around the tip of the tailbone the area just above the buttocks. It is dull and achy most of the time, with occasional sharp pains. The pain is often worsened by sitting down, moving from sitting tostanding, standing for long periods, having sex and going for a poo. It may affect sleep and other daily activities. The pain can radiate to legs, buttocks and hips. Tailbone pain is often caused by an injury, such as sitting for a long time or bike rides, but it may have unknown causes.  Vaginal birth in women sometimes is the cause of tailbone pain.

 

Acupuncture improves nerve pain

The nervous system is involved in all body functions. There are three types of nerves: autonomic nerves, motor nerves and sensory nerves. Autonomic nerves are involved in internal organs activities such as heart rate, blood pressure, breathing, digestion and reproduction etc; motors nerves control the skeletal muscles and involved in the body motion; sensory nerves transmit signals to the brain and let feel pain and other sensations. These nerves can be damaged by many conditions, such as virus infections, tumors, and autoimmune disorders. The symptoms of nerve damage vary greatly depending on the location and type of the nerves affected. Nerve pain is a common symptom of sensory nerve damage. Other symptoms involved in sensory nerves are sensitivity, numbness, tingling, burning and problems with positional awareness. The location of pain depends on which sensory nerves are involved.

Acupuncture can help to improve nerve pain. For example, there were many researches showing that acupuncture helped trigeminal nerve pain, sciatic nerve pain, pudendal nerve pain and other peripheral nerve pain etc. Below are examples for acupuncture treatments for nerve pain.

 

Pudendal neuralgia with acupuncture treatment

Pudendal neuralgia was first described in 1987. It is a severely painful and disabling neuropathic condition, affecting both men and women. This leads to a burning, tingling, or itching sensation in the clitoris/penis, vulva/scrotum, perineum, and rectum, especially when sitting. Symptoms are frequently on one side, however, in patients presenting with both sides, there is often a more affected side. The pain could be present in the lower abdomen, posterior thigh, and lower back. Another common symptom is the sensation of a foreign body in the vagina, perineum or rectum. Defecation and urination can also be painful. Urinary or fecal incontinence may develop from decreased sphincter tone if motor function is affected.

Acupuncture can help to reduce the pain.

Acupuncture for trigeminal neuralgia

The acupuncture that you get could be very different, if you see different acupuncturists. For example, a study analysed acupuncture points used for trigeminal neuralgia. In this study 180 papers were included and in these papers 148 acupuncture points were used and were distributed in 14 meridians. The most frequent used points are Hegu (LI 4), Xiaguan (ST 7), Fengchi (GB 20) and trigger points. Other points included crossing points, yuan-primary points and five-shu points. They were widely used, accounting for 65. 9%. As for the branch of trigeminal nerve, the top-3 selected acupoints were Yangbai (GB 14), Yuyao (EX-HN 4), Cuanzhu (BL 2) in the first branch, Sibai (ST 2), Quanlian (SI 18), Yingxiang (LI 20) in the second branch, Jiache (ST 6), Xiaguan (ST 7), Dicang (ST 4) in the third branch. It can be seen that right points need to be chosen to get best effects.

 

Acupuncture is effective for sciatica

Sciatica is a syndrome involving sciatic nerve root impingement or inflammation. The main symptoms include unilateral leg pain radiating to the foot or toes that is greater than low back pain and often associated with burning pain, numbness, and weakness of the leg; pain is increased on straight leg raising and the symptoms limited to one nerve root. Sciatica may be sudden in onset and may subsequently persist for days, weeks, even years. Acupuncture can help release sciatic nerve pain. This is suggested by recent research. A review studied 11 trials involved a total of 962 participants. The analysis suggested that acupuncture is effective for sciatica and the effect is better than pain killers. Their conclusion is that the use of acupuncture may more effectively relieve leg pain/lumbago and improve overall assessment of sciatica when compared with NSAID (ibuprofen, meloxicam, and diclofenac) treatment.

Acupuncture for chronic pain from shingles

Most people have chickenpox in childhood. When the illness has gone, the virus remains dormant in the nervous system being watched by the immune system. Once one’s immune system is compromised, the virus can be reactivated and cause shingles. Shingles is one of the most painful conditions. There is no cure for shingles and it can be unpleasant. In most case, the painful rash lasts 7-10 day and takes 2-4 weeks to fully heal. However about 25% of patients have pain lasting for more than one year. Unresolved pain can lead decreased quality of life, such as mood change, sleep disruption and depression etc. Hui F et al from University of Toronto studied three weeks complementary and alternative medicine including acupuncture to treat shingles related pain. The participants had a mean age of 69.8 years and had shingles related pain for a median of 4.8 months. Acupuncture points for acupuncture group were LI4, Liv 3 and ST36. After three weeks treatment, they found that pain score was significantly reduced in treatment groups. The pain reduction was maintained at 9 weeks after the treatment finished and one–two year follow-up.

Li et al studied 80 cases of shingles which were divided into two groups, acupuncture group and medication group. They found that  the therapeutic effect of electroacupuncture  was significantly superior to that of medication. After 10 treatments visual analogous scale (VAS) scores for of both groups reduced significantly. Both the VAS score and the crust formation time of EA group were significantly lower than those of medication group.

References

Tao S et al Zhongguo Zhen Jiu (2016) 36:207-11

Hui F et al Altern Med Rev (2012) 17:57-68          

Ursini T et al BMC Complement Altern Med (2011) 11:46

Li X et al Zhen Ci Yan Jiu (2009) 34:125-7

Qin Z et al Evid Based Complement Alternat Med (2015):425108. doi: 10.1155/2015/425108. Epub 2015 Oct 21.