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J. Acupunct. Tuina. Sci. 2010, 8 (1): 47-49 DOI: 10.

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

Author: LIU Jing (1983- ), female, attending physician

Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 47

J. Acupunct. Tuina. Sci. 2010, 8 (1): 47-49

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.

Duration (days) 2.842.15 3.651.57 2.501.18

NRS 6.660.97 6.251.07 5.980.87

RMDQ 12.722.37 10.852.92 11.872.80

2 Treatment Methods 2.1 Acupuncture group


Major acupopints: Yaotongdian (Ex-UE 7), Weizhong (BL 40), and Ashi point. Adjunct acupoints: Houxi (SI 3) and Shenmai (BL 62) were added for pain in the Governor Vessel, Yanglao (SI 6) and Kunlun (BL 60) for pain in the Bladder Meridian, and Waiguan (TE 5), Zulinqi (GB 41) and Yanglingquan (GB 34) for pain in the Gallbladder Meridian or Belt Vessel. Operation: The patient stood, and was asked to bend, extend and rotate the waist within tolerance. Meanwhile Yaotongdian (Ex-UE 7) and Weizhong (BL 40) were punctured with needles of 0.3 mm in diameter and 40 mm in length. Then the patient sat or lay prone while other acupoints were punctured until needling sensation arrived. The needles were retained for 30 min, and manipulated every 10 min. The treatment was done once daily for 5 d. 2.2 Drug group Diclofenac Sodium was administered orally, 50 mg per time, twice one day for 5 d. 2.3 Combination group Patients in the combination group were treated with methods in both the acupuncture and the drug groups. Patients in different groups were treated at

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

Note: Compared with the acupuncture and drug groups, 1) P0.01

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

Related Link

Location of Yaotong Point and the Optimal Time of Its Needling


Objective: To determine the location of Yaotong point and the optimal time of its needling in the treatment of acute lumbar sprain. Method: Thirty-five cases of acute lumbar sprain were retrospectively analyzed for the location of Yaotong point and the method of its needling according to their disease courses and effects. Results: The optimal time of needling is 1-3 days after lumbar sprain, and the location of Yaotong points on both hands correspond to the location of sprain. Conclusion: This correspondence is useful in practice.
Selected from CHEN Ri-lan, YUE Xiao-yan, MAO Shu-zhang. Location of Yaotong Point and the Optimal Time of Its Needling. J Tradit Chin Med, 2006, 26(2): 100-101.

Shanghai Research Institute of Acupuncture and Meridian and Springer-Verlag Berlin Heidelberg 2010 49