Low Back Pain

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Foundational Concepts

1.  Needling of Tendons & Ligaments is NOT a Placebo: Puncture of Cell membrane With Inflammatory Lipid Release

In the treatment of low back pain there are four treatment comparison studies. The control group in all back studies involved needle contact with attachments of ligaments and tendons. By injecting ligaments and tendons, there is needle contact with cell membranes of connective tissue cells. Disrupting cell membranes releases lipids, which in turn cause signaling of fibroblasts.
Examples of Needling Effects

  • 19% improvement (sustained 6 mo) in chronic low back pain (LBP) with saline injections with bone contact.  (Ongley MJ, Klein RG, Dorman TA, et al. A New Approach to the Treatment of Chronic Low Back Pain. Lancet 1987; 2: 143-146.)
  • 27% improvement (sustained 6 mo) in chronic LBP with anesthetic injection with bone contact.   (Klein RG, Bjorn CE, DeLong B, et al. A randomized double-blind trial of dextrose-glycerine-phenol injections for chronic low back pain. J Spinal Disord 1993; 6: 23-33.)
  • 36% improvement (sustained 1 yr) in chronic LBP with saline injection with bone contact.  (Yelland MJ, Glasziou PP, Bogduk N, et al. Prolotherapy Injections, Saline Injections, and Exercises for Chronic Low-Back Pain: A Randomized Trial. Spine 2004; 29(1): 9-16.)

2.  Needling of Tendons is NOT a Placebo: Microbleeding with Platelet Effects

In addition, microbleeding from needle contact is expected, and Edwards and colleagues have demonstrated the potential healing effect of whole blood injection in patients with recalcitrant tennis elbow.   (Edwards SG, Calandruccio JH: Autologous blood injections for refractory lateral epicondylitis J Hand Surg [Am] 28(2):272, 2003.)

The hope is that future studies on low back pain will include a near-placebo arm that avoids connective tissue contact or blood effects and that standard injection methods will be used. In the treatment of low back pain, standard treatment methods are now taught in cadaver courses offered by the American Academy of Orthopedic Medicine. An example of such a near-placebo would be needle insertion through skin without contacting bone or ligament.

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