Brook Cheng

Brook Cheng, PhD Founder of Neural Modulation Medicine (NMM)™ Transforming status quo clinicians into a sharpshooter doctor, 3-seconds homeostatic healer || Author of the NMM™ Protocols.

September 3, 2022

Low back pain (LBP) is the world’s leading cause of disability and work absence, but conventional medicine offers no help except asking patients to do exercise (John Albright, et al, 2001). The best result of conventional intervention for LBP reported so far is a response rate of 27.4% after 6-months of treatment (10-15 sessions) by drugs, exercise plus physiotherapy (Haake, M. et al, 2007). A 27.4% response rate means that in each 10 LBP patients, there are more than 7 patients for whom conventional therapy is clinically useless. So are there any better ways to deal with LBP?

Quick Pain Relief Is Paramount to The Patients

John A. Amaro, DC, LAc, is an internationally known author, lecturer and practitioner beginning his practice of chiropractic and acupuncture in 1971. He has personally studied acupuncture in nine separate Asian nations. He has been always sharing his experience of acupuncture with his spinal cracker fellows and other practitioners all over the world.

Talking about LBP, Dr Amaro says “Most low back pain suffers will wholeheartedly agree that pain relief is paramount, and as quickly as possible” (Dynamic Chiropractic 2010).

I absolutely agree with Dr Amaro's opinion: Quick pain relief is paramount to the patients. Plus, as a healer, by magically helping them get rid of the misery, you become a true sage or a “Got-sent” in your patients' eyes.

As mentioned earlier, conventional medicine offers no help except asking patients to do exercise. Disappointed with conventional medicine, LBP patients have to seek alternatives such as body works, acupuncture or others for help. But how much the alternatives can really do in fast pain relief?

Spinal Manipulation Therapy (SMT)

One of alternative interventions for LBP is spinal manipulation therapy (SMT). Various practitioners have been trying this technique on their LBP patients. In the US and Canada, chiropractors perform the majority of this technique, followed by physical therapists, osteopathic physicians, and medical doctors. Chiropractors often call SMT “adjustment of the vertebral subluxation”.

How effective is SMT for quick relief of pain including LBP? In veteran DC and LAc John Amaro's view, SMT does not help very much in pain relief in the first place, let alone fast pain relief. He voiced as such to his spinal popping fellows (Dynamic Chiropractic, 1993):

• Chiropractors … are incredibly effective in assisting a multitude of problems through adjustment of the vertebral subluxation. But how many times has a patient...discontinued care in the early stages of treatment and sought medical attention due to the presence of pain or slow progress before chiropractic care could be of benefit?

• The patients who fail to return to chiropractic care, having "tried it and it didn't help," affect us professionally and financially. If we could only ease their pain and speed their progress in the early treatments.

• Perhaps the number one reason why John Q. Public seeks chiropractic care is because of the presence of pain...

• The average patient with pain has only one goal: to be rid of the misery. It is so easy for us to tell the patient to "be patient" while the condition heals. However, this is difficult for the suffering patient when they have visited our offices four or five times, and even though they are improving clinically, have not seen a positive response in their pain relief.

• It is very frustrating for both the patient and the doctor when we fail to see improvement in pain despite our efforts ...

• This scenario happens far too often throughout the chiropractic profession...

As an experienced needle healer and spinal cracker, Dr Amaro ardently advocated acupuncture to his spinal popping fellows throughout his professional life.

So how much acupuncture can help?

Acupuncture: Dr Amaro's Meridian-Based Formula

Dr Amaro started to learn acupuncture in 1972. That was 10 years before TCM acupuncture was introduced into North American in early 1980s. His style of acupuncture is primarily from the tutelage of Asian physicians from Japan, Taiwan, and Hong Kong (John Amaro, 2001, Dynamic Chiropractic), which was meridian-based in contrast to its herb-based TCM counterpart.

How fast is pain relief from Dr Amaro's meridian-based acupuncture for LBP? In his article The Ultimate Acupuncture Point Formula for Relieving Low Back Pain (2010), Dr Amaro described his acu-formula for LBP, which is composed of the following meridian points: "SI 3, BL 62, BL 40 (54), GB 30, BL 30, ST 30, CV 3, KI 12, CV 4, and KI 13, in addition to the huo tuo jia ji points in the area of involvement and local GV points".

With this formula, he says: “In the vast majority of cases, regardless of the specific cause, the patient has experienced significant pain relief in a very short period of time [emphasis added] with the administration of a specialized acupuncture point formula.” “A very short period of time” is a ballpark estimate. It can be a few seconds, a few minutes, a few hours, a few days, or a few weeks, or even a few months.

Dr Amaro also says “The most important treatment goals are to achieve a successful level of pain reduction followed by correction and stabilization of the condition. .. In many cases, pain relief was considerable before chiropractic and/or physiotherapy procedures were even implemented.”

How many treatments are needed to “achieve a successful level of pain reduction”? Dr Amaro “always recommends 12 treatments in cases of lumbar pain as a trial of therapy” (Dynamic Chiropractic, 2010). For simple acute LBP, he expects “to discharge the patient to stabilization care [i.e., vertebra adjustment] within the first four visits".

Here I noticed that, suppose treatment is conducted twice per week, it follows that Dr Amaro's acu-formula may, as “a trial of therapy”, be possibly able “to achieve a successful level of pain reduction” for chronic LBP in 6 weeks, and for acute LBP in 2 weeks (4 visits); but even after 12 acupuncture treatments, his health care for the patients is far from finished yet as these acupuncture treatments will be "followed by correction and stabilization of the condition", as he advocated (Dynamic Chiropractic, 2010).

Then how many visits are needed for "correction and stabilization" by using his vertebra adjustment? 12, 24, 36 or even more ? Dr Amaro did not say. Anyway, one thing for sure is that Dr Amaro also expects even after 12 treatments with his acu-formula, the pain will come back, or the ailment causing the pain are still there (possibly at a lower intensity), so "correction and stabilization" by vertebra adjustment is still needed.

Also, how predicable of the success rate of Dr Amaro's acu-formula is? The word “a trial of therapy” Dr Amaro used is an indication that the result of his formula may not be highly predictable, in other words, may not have a very high success rate, but at least 70%? A 70% of success rate is indeed amazing in contrast to the 27.4% from conventional therapies.

TCM Acupuncture in Blue-Chip Hospitals

The renowned Mayo Clinic in the US has adopted TCM acupuncture practice nationwide. They advised that in their clinic, not every LBP patient responds to acupuncture; some may see improvement after the first treatment (Note: this will usually take at least half hour or 60 x 30 = 1800 seconds), but others may not until after several treatments. “... if your back pain doesn't begin to improve within 6 to 8 weeks, acupuncture may not be the right treatment for you, ” says a Mayo Clinic post “Acupuncture for back pain?” (Brent A. Bauer, 2021).

TCM Acupuncture in Scientific Trials

In evidence-based scientific arena, the best result for LBP by TCM acupuncture has a patient-response rate of 47.4% (with 95% confidence) after 6 months of treatment (10-15 sessions) as reported in a large-scale Germany trial (Haake, M. et al, 2007). In this trial, a pain reduction of > 33% at 6 months was considered as “responded”. This means for 47.4% of patients, it takes 6 months for TCM acupuncture to reduce the pain intensity by 1/3; for the rest 52.6% of patients, even after 6 months of treatment, their misery does not change very much at least to a clinically significant level.

Acupuncture in Individual Clinics Nationwide in America

On Mar. 27, 2012, a question “How fast is pain relief from acupuncture? ” was posted on zeel.com, a New York-based on-line platform to connect patients to doctors. Eight practitioners from across the country (the US) responded.

One from Glendale, CA and another from Solana Beach, CA replied that pain relief would be almost always immediate. Great. It is supposed to be so in Neijing acupuncture. The remaining six responses, however, might be disappointing to the questioner patient.

The one from Winnetka, IL did not answer the question but only said “... every situation is unique”. The one from Orangeburg, NY responded: Acute conditions can usually be resolved in four to six treatments... chronic ones even longer. An answer not precisely hitting the point about “Pain Relief”.

The most explicit answer came from Castle Rock, CO: “Usually about 40% of patients experience pain relief after the first treatment, another 40% experience pain relief after 8 treatments. The final 20% have mixed results.”

The responder from Atlanta, GA with the name showing a Chinese origin wrote: “Unlike Western medicine, Eastern alternative medicine is not a 'quick fix'... We usually suggest starting with a course of 10 treatments to see how the body responds and go from there”. This is exactly a concept prevailing in TCM community in China: “No quick fix, at least 10 sessions to start with”.

The most impressive response was from Rosemead, CA. It was impressive because the response was entirely irrelevant to the question but was an answer to the inquiry “May I get a detailed resume of yours?”

The detailed resume provided in that response presented a 36 years of experience with “the highest postgraduate medical degree in China and postdoctoral training at Medical University...a physician & professor at medical schools in both China & USA...use acupuncture, herbal medicine and Chinese massage to treat medical problems...” Apparently, this acupuncturist is a highly educated and experienced scholar doctor trained in the genuine and authentic TCM.

However, “How fast is pain relief from acupuncture? ” is a question just too naive in view of many highly experienced TCM doctors in China, who do not consider the needling can be an independent therapy to treat anything without combination with herbs, tuina (Chinese style of massage), cupping, or guasha, etc. The TCM doctor from Rosemead, CA seemed to have just gently laughed the silly question off, never bothered to answer it.

Based on all 54 questions asked / answered by patients / acupuncturists across the country, a review by the Editorial Staff of Zeel.com concluded (May 18, 2020) :

“Acupuncture is not for people seeking a quick fix.

“ In some cases conditions worsen before they get better, or there may be no effect.”

This is what a “randomly sampled” group of acupuncturists across America could, to the best of their experience and knowledge, truthfully inform of their potential patients about how quick they can have the suffers get rid of the misery.

Neijing Acupuncture: A Millennia-Old Healing Art in China

The acupuncture widely practiced millennia ago in China as described in Huangdi Neijing is a miracle. The relief of pains including LBP happens instantly upon the needle insertion. More importantly, such instant efficacy was highly reliable, reproducible and predictable. When you read Neijing, you can always feel intensely the ancient Chinese doctors' strong confidence in the efficacy of their needling: if the pain relief is not instant, you just have not done the job correctly.

Why Neijing acupuncture works like a magic? It is because it treats the pain at specific location by needling or bleeding the specific corresponding spots or areas, case by case. There are no “accurately” defined fixed points to prick or bleed. For any specifically localized disorder, the specific point or area for healing can only be determined by palpation and/or observation of abnormalities of the skin case by case.

Note here I use “spots or areas” instead of “points”. The reason is that there is no acu-points on the body, and any specific spots or areas on the body can be needled for a specific cure with more or less effect.

Pain Can Happen at Any Spot in Low Back Area

The Global Burden of Disease (GBD) study defines LBP as pain on the posterior aspect of the body from the 12th ribs to the lower gluteal crease. That is, LBP can happen anywhere on almost half of the posterior body trunk. The exact location of the pain can be at any spot along the T12 – L5 spine bone or related muscles such as multifidus, spinalis, longissimus, iliocostalis, or obliques, just to name a few, or at L5/S1, or at sacrum at level of S2 – S5, or at SI joints (sacral sulcus), or at piriformis (origin or insertion) on either side or bilateral ..., the possibilities of the location of pain is endless.

For spinal crackers treating LBP, they would use their hands to apply a force exclusively and exactly on the lumbar or thoracic spinal facet joints, as they do not consider any physical stimulation applied to non-spinal body parts as “vertebra subluxition adjustment”.

For needle healers treating LBP, where do we place the needles? Ask a newly graduated TCM acupuncture student to select acupoints for LBP, I am 99% for sure he or she will choose acupoint BL 40 (a spot at popliteal fossa) and BL 23 or BL 25 (a spot 6 cm lateral to L2 or L5 vertebra joint) plus a few local Jia-ji points (located on spinal transverse processes), without asking back “can you first tell me where the pain is exactly located?”

Dr Amaro's acu-formula for LBP is not based on the herb-based TCM theory. But his formula has one thing in common with TCM: Both are using meridian points which are “accurately” and precisely defined to fixed locations.

Why All Fail?

Will a manual force precisely applied to spinal facet joints, or pricking the “accurately” defined points on the 0.1 mm-wide meridians, be able to relieve quickly and reliably all types of LBP regardless of the exact location of the pain in the lower posterior body trunk?

No, the answer is definitely NO. This is because the possible locations of pain in the lower posterior body trunk is countless while specific location requires stimulation to the specific spots or areas on the body for maximum efficacy, a rule clearly described in the millennia old Chinese medicine classic Huangdi Neijing. But all the tricks (SMT, meridian needling and TCM acupuncture) work in a way of “stab in the dark then pray”.

How to Relieve LBP in 5 Seconds with 95% Certainty

How to become a sharpshooter in instant relief of LBP (or neck pain, or shoulder pain, or knee pain …) in 5 seconds upon needle insertion saying good-bye to “stab in the dark then pray”? Stay tuned, I will discuss it in detail in the on-coming posts.

Epilogue

My writing of this Newsletter – Truth of Acupuncture Science: How A Jewel Ended up A Quackish Stone in Acupuncture History- would not have been possible without the constant inspiration from tons of great works by numerous scientifically-minded people. Among these people, there is Dr. John Amaro, an American chiropractic doctor (DC) and a non-TCM acupuncturist beginning his multiple practice in early 1970s. He has been a columnist for the international publication "Dynamic Chiropractic" since 1988 as well as a columnist for "Acupuncture Today". He was awarded the prestigious Fellow of the American College of Chiropractic (FACC) in 1997.

References

Brent A. Bauer, M.D., Acupuncture for Back Pain? May 28, 2021, https://www.mayoclinic.org/diseases-conditions/back-pain/expert-answers/acupuncture-for-back-pain/faq-20058329

Haake, M. et al, German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups, Arch Intern Med, 2007 Sep 24;167(17):1892-8

Huangdi Neijing: Suwen 6 阴阳离合论; Suwen 41 刺腰痛；Suwen 56 皮部论; Suwen 62 调经论；Suwen 63 缪刺论.

John Amaro, Meridian Therapy -- Pain Management, Dynamic Chiropractic – January 15, 1993, Vol. 11, Issue 02

John Amaro, DCs Who Perform Acupuncture -Turf War, or Question of Training? Dynamic Chiropractic – May 21, 2001

John Amaro, Lumbar Spine When All Else Fails, Dynamic Chiropractic 2001

John Amaro, Acupuncture Orthopedics: The Lumbar Spine and Lower Extremity, Dynamic Chiropractic 2002

John Amaro, The Ultimate Acupuncture Point Formula for Relieving Low Back Pain, Dynamic Chiropractic 2010

Phillips FM. Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine (Phila Pa 1976). 2013;38(7):E409

WHO, 2013, Low back pain, https://www.who.int › areas › Ch6_24LBP PDF