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1007/s11726-010-0047-2
Clinical Study
Clinical Observation of a Combination of Acupuncture and Drug Administration for Non-specific Acute Lumbar Sprain
LIU Jing (), LI Ning () Jiangsu Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing 210028, P. R. China
69 24 1 5 20 50 mg 2 5 25 P0.01 AbstractObjective: To observe the clinical effects of a combination of acupuncture and drug administration for non-specific acute lumbar sprain. Methods: Sixty-nine cases were randomly allocated into a combination group, an acupuncture group, and a drug group according to the visiting sequence. Patients in the acupuncture group (n=24) were treated with acupuncture daily for 5 d, 20 patients in the drug group were treated with oral Diclofenac Sodium, 50 mg per time, twice per day, for 5 d, and 25 patients in the combination group were treated with methods in both the acupuncture group and the drug group. The Numerical Rating Scale (NRS) and the Roland-Morris Disability Questionnaire (RMDQ) were used to evaluate the therapeutic effects. Results: All patients in the three groups got improvement in pain and movement, the combination group had the best effects (P<0.01), and there was no significant difference between the acupuncture group and the drug group. Conclusion: Combination of acupuncture and drug has a better effect than single acupuncture or routine treatment of Diclofenac Sodium on acute lumbar sprain. Key WordsAcupuncture Therapy; Acupuncture Medication Combined; Low Back Pain; Sprains and Strains CLC NumberR246.2 Document CodeA Acute lumbar sprain is common in the clinic. The more severe the pain and dysfunction, the more inconvenience it brings patients in their work and life. The authors treated non-specific acute lumbar sprain with combined acupuncture and drug administration from January of 2007 to July of 2008, and compared the efficacy with single acupuncture and routine treatment of Diclofenac Sodium, now it is summarized as follows.
1 General Data
1.1 Inclusion criteria Acute lower back pain, restricted movements, or accompanied with radiating leg pain. The disease duration was less than 2 weeks, and there was no history of back pain in past 4 weeks before the onset. 1.2 Exclusion criteria Lumbar trauma, spine-derived pain (tumor, inflammation, infection, fracture, or syndrome of
Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 47
cauda equina); muscular weakness, sensory paralysis, weakness or hyperfunction of tendon reflex; history of peptic ulcer; recent medical history of nonsteroidal anti-inflammatory drug (NSAIDs) or anticoagulant, allergic history of NSAIDs; severe abnormal function of heart, liver or kidney.
Table 1. Comparison of general data among the three groups Groups Combination Drug Acupuncture n 25 20 24 Male/female 15/10 12/8 13/11 Age (years) 35.008.95 36.159.50 38.1710.21
1.3 Clinical data All 69 cases were out-patients, and randomly allocated into three groups based on the visiting sequence. There were no significant difference in gender, age and duration among the three groups.
different times to avoid information exchange among patients to make results exact.
3 Results
3.1 Evaluating indexes The Numerical Rating Scale (NRS, 0= no pain, 10= the most severer pain) was used to evaluate pain severity, and the Chinese Roland-Morris Disability Questionnaire (RMDQ) to evaluate the lumbar movement (0= free movement, and 24=no movement)[1]. Minimal clinically important change (MCIC) of NRS in non-specific lower back pain was 3.5-4.7 points in the report of Van der Roer N[2]. Ostelo RW considered MCIC of NRS as 2 points, and MCIC of RMDQ as 5 points for patients with lower back pain[3]. 3.2 Treatment results The data were expressed with x s, and analyzed with Student-Newman-Keuls test. After treatment, pain and movement of the patients in the three groups had improved, and the combination group proved better than the acupuncture group and drug groups (P<0.01). There was no difference between the acupuncture group and the drug group, but RMDQ in the drug group was less than MCIC in previous reports[3]. These results indicate that the combination of acupuncture and drug had a better effect on acute lumbar sprain than single acupuncture or routine treatment of Diclofenac Sodium.
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Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010
J. Acupunct. Tuina. Sci. 2010, 8 (1): 47-49 Table 2. Comparison of pain and movement among the three groups ( x s) Groups Combination Drug Acupuncture n 25 20 24 NRS Before treatment 6.660.97 5.980.87 6.251.07 After treatment 1.741.12 3.021.56 2.651.22 Difference 4.920.75
1)
RMDQ Before treatment 12.722.37 11.872.80 10.852.92 After treatment 4.442.57 6.252.99 6.452.44 Difference 8.442.65 1) 5.632.14 4.402.04
3.330.96 3.201.01
4 Disscusion
Acute lumbar sprain belongs to the category of lumbago, relating to the Kidney and the Bladder Meridians. Yaotongdian (Ex-UE 7) is an empirical point for treating acute lumbar sprain in the clinic. Weizhong (BL 40) and Kunlun (BL 60) are Xi-Cleft and Jing-River acupoint of the Bladder Meridian, respectively, and key points for lumbago. Yanglao (SI 6) is the Xi-Cleft of the Small Intestine Meridian, and an empirical point for treating acute lumbar sprain. Yanglingquan (GB 34) is the He-Sea acupoint of Gallbladder Meridian, the influential point of tendon in the eight influential points, and the point for treating tendon disease. Houxi (SI 3), Shenmai (BL 62), Waiguan (TE 5) and Zulinqi (GB 41) are all influential points, and could treat the disease in the running meridians. Diclofenac Sodium has been used to relieve pain for about 30 years in the clinic, and is recommended to treat acute lumbar sprain[4]. However, the routine dose has no satisfying effect in relieving pain and improving movement. The combination of acupuncture and drug had a
better effect on acute lumbar sprain than single acupuncture or routine treatment of Diclofenac Sodium in relieving pain and improving movement. Therefore, the patients suffer less, and the methods are valuable in clinical use.
References
[1] HE Gao, ZHANG Jian-xiang, SHEN Cai-liang, et al. Reliability of Chinese Roland-Morris Disability Questionnaire in Evaluating Lower Back Pain. Chinese Journal of Spine and Spinal Cord, 2005, 15(4): 242-244. [2] Van der Roer N, Ostelo RW, Bekkering GE, et al. Minimal Clinically Important Change for Pain Intensity, Functional Status, and General Health Status in Patients with Nonspecific Low Back Pain. Spine (Phila Pa 1976), 2006, 31(5): 578-582. [3] Ostelo RW, Deyo RA, Stratford P, et al. Interpreting Change Scores for Pain and Functional Status in Low Back Pain: Towards International Consensus Regarding Minimal Important Change. Spine (Phila Pa 1976), 2008, 33(1): 90-94. [4] Chou R, Qaseem A, Snow V, et al. Diagnosis and Treatment of Low Back Pain: a Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society. Ann Intern Med, 2007, 147: 478-491. Translator: CUI Xue-jun () Received Date: November 10, 2009
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Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 49