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Tuesday, 26 November 2013

Chronic Low back pain – Treatment In Herbal and TCM medicine perspective

Low back pain is a Musculoskeletal disorders (MSDs, affecting over 80% of the population in US alone some points in their life. Chronic LBP (pain has persisted for longer than 3 months(1) prevalence in older adults was significantly higher than the 21-to-44-year age group (12.3% vs. 6.5%, p < .001). Older adults were more disabled, had longer symptom duration, and were less depressed(2)..Many older adults remain quite functional despite CLBP, and because age-related comorbidities often exist independently of pain (e.g., medical illnesses, sleep disturbance, mobility difficulty), the unique impact of CLBP is unknown. We conducted this research to identify the multidimensional factors that distinguish independent community dwelling older adults with CLBP from those that are pain-free(3).
VI. Treatments
B. In herbal medicine perspective
In a systematic review of randomized controlled trials to determine the effectiveness of herbal medicine compared with placebo, no intervention, or “standard/accepted/conventional treatments” for nonspecific low back pain, found that Two high-quality trials utilizing Harpagophytum procumbens (Devil’s claw) found strong evidence for short-term improvements in pain and rescue medication for daily doses standardized to 50 mg or 100 mg harpagoside with another high-quality trial demonstrating relative equivalence to 12.5 mg per day of rofecoxib. Two moderate-quality trials utilizing Salix alba (White willow bark) found moderate evidence for short-term improvements in pain and rescue medication for daily doses standardized to 120 mg or 240 mg salicin with an additional trial demonstrating relative equivalence to 12.5 mg per day of rofecoxib. Three low-quality trials using Capsicum frutescens (Cayenne) using various topical preparations found moderate evidence for favorable results against placebo and one trial found equivalence to a homeopathic ointment(58).
C. In traditional Chinese medicine perspective 
1. Acupuncture
In the study to investigate the efficacy of acupuncture for chronic low back pain of a
total of 640 participants (160 in each of four arms) between the ages of 18 and 70 years of age who have low back pain lasting at least 3 months recruited from integrated health care delivery systems in Seattle and Oakland, clarified that the value of acupuncture needling as a treatment for chronic low back pain(59). Others found that found there is little evidence for the existence of subgroups of patients with chronic back pain that would be especially likely to benefit from acupuncture. However, persons with chronic low back pain who had more severe baseline dysfunction had the most short-term benefit from acupuncture, according to the study of Characteristics of patients with chronic back pain who benefit from acupuncture(60).
2. Herbs
2.1. In a cross-sectional study carried out among 513 patients with CLBP in four hospitals affiliated with Yunnan University of Traditional Chinese Medicine, China, showed that they were eventually interpreted as (1) “Qi and/or Blood Stagnation,” which includes eight items such as piercing pain; activity limited by feeling of local heaviness, lumbar and flank stiffness with bending limitation and purple tongue, etc.; (2) “Cold/Damp,” which has seven items (for example, Cold/Damp pain, pallid face and greasy coating, etc.); (3) a part of “Kidney Deficiency,” which includes two items: “dull pain and recurrent vague pain”; (4) “Warmth/Heat,” which is related to three items (namely, purple tongue, yellow tongue coating, and burning pain). The four factors accounted for 12.7%, 8.2%, 8.2%, and 7.8% of the total variance, respectively. There are seven items with uniqueness over 0.8(61).
2.2. Herbal formula (Please consult with your traditional Chinese medicine practitioner before applying)
1. Shen Tong Zhu Yu Wan (Shen Tong Zhu Yu Pian)
a. promotes blood circulation and Qi, removes blood stasis and obstruction in the channels, alleviates blood-arthralgia and pain. It is used for shoulder pain, pain in the arm, lumbago, pain in the leg or pain in the entire body due to obstruction of the flow of Qi and blood in channels.
b. Ingredients
Ingredients: Radix Gentianae Macrophyllae (Qin Jiao), Rhizoma Chuanxiong (Chuan Xiong), Semen Persicae (Tao Ren), Flos Carthami (Hong Hua), Radix Glycyrrhizae (Gan Cao), Rhizoma Et Radix Notopterygii (Qiang Huo), Resina Commiphorae (Mei Yao), Radix Angelica Sinensis (Dang Gui), Rhizoma Cyperi (Xiang Fu), Radix Achyranthis Bidentatae (Niu Xi), Phertima (Di Long), Rhizoma Wenyujin Concisa (Jiang Huang), Rhizoma Corydalis (Yan Hu Suo)(61a).
2. Liu Wei Di Huang Wan (Kidney Yin deficiency)
a. Liu Wei Di Huang Wan can replenish Yin due to the Yin insufficiency of the kidney. The kidney is the innate foundation of all organs with respect to the Yin-Yang principles, Qi essence etc.
b. Ingredients
Radix Rehmanniae Preparata (Shu Di Huang), Fructus Corni Officinalis (Shan Zhu Yu), Cortex Moutan Radicis (Mu Dan Pi), Rhizoma Dioscoreae Oppositae (Shan Yao), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis Orientalis (Ze Xie)(61b).
3. Jin Kui Shen Qi Wan (Kidney Yang deficiency)
a. Jin Kui Shen Qi Wan can replenish Yang due to the Yang insufficiency of the kidney. The kidney is the innate foundation of all organs with respect to the Yin-Yang principles, Qi essence etc.
b. Ingredients
Radix Rehmanniae Preparata (Shu Di Huang), Fructus Corni officinalis (Shan Zhu Yu), Rhizoma Dioscoreae Oppositae ((Shan Yao), Cortex Moutan Radicis (Mu Dan Pi), Sclerotium Poriae Cocos (Fu Ling), Rhizoma Alismatis Orientalis (Ze Xie), Cortex Cinnamomi Cassiae (Rou Gui), Radix Aconiti Lateralis Preparata (Zhi Fu Zi), Radix Achyranthis Bidentatae (Niu Xi), Radix Polygoni Multiflori (He Shou Wu), Fructus Lycii Chinensis (Gou Qi Zi),  Fructus Schisandrae Chinensis (Wu Wei Zi(61c).
D. TCM and conventional medicine baclofen 
According to the study of Reduction of chronic non-specific low back pain: A randomised controlled clinical trial on acupuncture and baclofen, after treatment, the baclofen, acupuncture and acupuncture + baclofen groups all had lower VAS and RDQ scores. Significantly higher reduction and improvement in VAS and RDQ scores were found in the acupuncture and acupuncture + baclofen groups compared to the baclofen group(62)
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Sources
Red flags*
Recent significant trauma, Milder trauma if age is greater than 50 years, Unexplained weight loss, Unexplained fever, Immunosuppression, Previous or current cancer, Intravenous drug use, Osteoporosis, Chronic corticosteroid use, Age greater than 70 years, Focal neurological deficit, Duration greater than 6 week(a)
(a) http://en.wikipedia.org/wiki/Low_back_pain 
(1) https://www.mja.com.au/journal/2004/180/2/management-chronic-low-back-pain
(2) http://jah.sagepub.com/content/22/8/1213.refs
(3) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2065872/
(4) http://www.ncbi.nlm.nih.gov/pubmed/20714283
(58) http://www.ncbi.nlm.nih.gov/pubmed/17202897
(59) http://www.ncbi.nlm.nih.gov/pubmed/18307808
(60) http://www.ncbi.nlm.nih.gov/pubmed/19772583
(61) http://www.ncbi.nlm.nih.gov/pubmed/21204636
(61a) http://www.yinyanghouse.com/store/catalog/herbal-supplements/shen-tong-zhu-yu-wan-shoulder-leg-back-pain-herbal-formula
(61b) http://www.activeherb.com/yinvive/
(61c) http://www.activeherb.com/yanvive/
(62) http://www.cmjournal.org/content/5/1/15