AURICULAR ACUPUNCTURE IN LUMBAR STENOSIS A CASE STUDY REPORT

Transcription

1 AURICULAR ACUPUNCTURE IN LUMBAR STENOSIS A CASE STUDY REPORT Panagiotis Spyropoulos, Ph.D., P.T. March 2013

2 Introduction Low Back Pain (LBP) is one of the most prevalent dysfunctions affecting the majority of the population amongst all developed countries. Indeed, LBP may appear to almost 80% of the people at least once in their lifetime (MacKenzie, 2006). LBP can affect people of all ages, in all social classes who perform all types of work. People may develop LBP although they exercise regularly despite their general health condition. A person may injure his/her back while performing a heavy activity in his/her job or he/she may experience severe pain in his/her low back after a usual night of sleep (Jull-Kristensen and Jensen 2005; Manchikanti, 2000; Burdorf et al., 1993). Conservative treatment of LBP usually includes administration of anti-inflammatory medication, injections and physical therapy (Lizier et al., 2012; Maas et al., 2012; Cosgrove et al., 2011). Of all these types of treatment physical therapy seems to be the most preferable amongst patients because it is effective and has no contraindications like the different types of medication, although patients need to spend a considerable amount of time and money for physical therapy treatments. However, physical therapy procedures have no great success in some types of LBP as in lumbar stenosis because it is frequently accompanied by intense sciatica (Issack, et al., 2012). Thus, patients may need to have surgery which is not always successful. Therefore, the purpose of this study is to examine the effectiveness of auricular acupuncture in managing LBP accompanied by sciatica. 2

3 MATERIALS AND METHODS The following is the presentation of a case study of a patient with LBP due to lumbar stenosis who was treated with auricular acupuncture according to protocols instructed by Br. Bazonni. History Patient was a 72 year old female who had been suffering intermittently from LBP with sciatica for about 6 years, due to O4-O5 and O5-I1 disc protrusions compressing on the dural sac. Because of the double disc pathology spinal stenosis was developed at the same spinal segments. During the last 6 years, patient had had several intense episodes (greater than 10) of LBP with sciatica and was treated with medication, injections and conventional physical therapy. Thus, the patient was referred again for physical therapy and because of the great intensity of symptoms she was informed to consider surgery. Physical Examination The following physical findings were recorded: 1. VAS 9/10 on the right side particularly at right sacroiliac area and right lateral leg region. 2. No weakness recorded on toe and heel walking. 3. Restricted lumbar range of motion by 80% due to pain. 4. Right Laseque positive at 30 o 5. Moderate kyphotic posture with intense paraspinal muscle tightness bilaterally, and upon palpation there were tender points into right gluteus maximus muscle. 6. Patient was unable to ambulate continuously for more than 20 meters due to pain. Treatment plan 1. TENS paraspinally at 5 Hz and intensity as tolerated for 15 minutes on prone position 2. Mc Kenzie extension exercises. 3. Lumbar manipulation (High Velocity Thrust Motion) on left side lying. 4. Intermittent manual lumbar traction on supine position. 5. Spinal decompression by holding through hands on horizontal bar 40% of body weight. 6. Lumbar decompression by supporting body weight onto office desk. 3

4 7. Ergonomic instruction for correct sitting posture, bending and correct standing posture. Assessment Treatment was considered successful initially and after 7 visits in 3 weeks patient reported pain on VAS as 3/10 She had also regained her spinal mobility by 90% as well as her ability to ambulate free of pain for more than 300 meters. In addition, she had corrected her posture and returned to her normal activities. However, in the third day after the completion of her physical therapy treatment, patient had had a ride as a passenger in a car for about one hour on an anomalous road. Hence, she immediately experienced intense pain (8/10) and presented with the previously described symptoms. Two subsequent physical therapy sessions resulted in no considerable improvement and patient was suffering greatly. Patient was advised to try auricular acupuncture before scheduling for spinal surgery. Therefore, she was treated according to the following protocol: AURICULOTHERAPY PROTOCOL Since patient was right-handed and her pain was felt in the right lumbopelvic region and right lower extremity in the posterior aspect, the right ear was examined electrically and by palpation. In the event that active zones related to her lumbar pain were not detected on the right ear, the left ear would be examined. Inspection: The entire lower branch of the anthelix was hypertrophied. There were a few venules in the corresponding pelvic area of the anthelix on the right ear. Diagonal Ear Lobe Creases were present bilaterally. Both ears were swept lightly with a piece of cotton. Electrical Detection: While using a PointoSelect digital machine (Schwa-medica) set at sensitivity 10 in manual gold mode, the following points were active and marked on the right ear in their corresponding zones. 1. Point Zero 2. Shen Men 3. Three neuroreflexive points related to lumbar pain were detected in the root of the lower branch and middle part of the anthelix as well as in the middle wall of the lower branch of anthelix (radicular point). 4. Thalamus point in the base of antitragus in the lower concha. 5. Antidepressant point in the lower part of antitragus externally. 4

5 6. Liver in the middle part of concha close to the wall of the anthelix leveled to the root of the helix. 7. Ear apex externally and internally. 8. Two active points were detected on the mastoid surface of the ear corresponding to the lumbopelvic pain. No Neuropathic points were detected at the rim of middle upper helix. Through a 250 gr palpeur (blue), one neuroreflexive point was selected which was the mostly painful and elicited a grade 4 grimace. This point was located at the root of the lower branch of the anthelix. Based on the above described electrical detection and palpation and after a light cleaning of the marking ink, yellow New Pyonex (Seirin America, Inc.) semipermanent needles were placed at points 2, 5, 6, 7, green New Pyonex were placed at the two points (they count as one point) of the mastoid surface of the ear and blue green New Pyonex were inserted at the one mostly painful neuroreflexive point and point 4 (thalamus). The order of New Pyonex needle placement is shown in the following pictures. 5

6 6

7 7

8 8

9 Below there is a photograph of patient s ear (mastoid surface) with green New Pyonex needles (2) Below there is a photograph of patient s ear (external surface) with yellow and blue New Pyonex needles 9

10 Results and Discussion of Therapeutic Protocol Patient reported great relief from pain in twelve hours of needle application after the first visit (VAS 2/10). She was instructed to take the needles off 48 hours before the next visits. The second visit was in 15 days (VAS 1/10), the third in 21 days (VAS 1/10), and the fourth visit took place in one month (VAS 0/10). Patient has returned to her normal activities as a sculptor and engraver artist. These activities are very stressful because they frequently require the body to be in a flexed position which increases lumbar loading (Nachenson, 1976). Patient is currently very happy because she has no pain and has avoided surgery. She has been instructed to follow correct body mechanics in all postures especially at work(saunders, 2004). She was also advised to call immediately should the pain reappear. In the above case study considering the patient s history, it was impressive that the pain had almost completely disappeared in twelve hours after the application of semipermanent needles. As a pathological entity, lumbar stenosis is certainly very difficult to deal exclusively with physical therapy procedures and therapeutic exercises since the damage is permanent (Issack et al., 2012; Cadogan, 2011). Due to the severity of this pathology, nerve roots like L4, L5 and S1 are frequently in a state of inflammation and dysfunction due to compression. As a result, patient usually experiences severe pain especially with activities. In this case study it seems that auriculotherapy was very effective in the management of pain probably because of activating body mechanisms which balanced the pain dysfunction in this patient. Of course, no statistical significance can be established by this case study but based on many years of personal professional experience it could be stated that other patients with lumbar stenosis may also respond favorably to auricular treatment. At least this treatment should be tried to this category of patients before lumbar surgery is performed. 10

11 REFERENCES Burdorf A, Naakgeboren B, de Groot HC: Occupational risk factors for low back pain among sedentary workers. J Occup Med, 35(12) , Cadogan MP: Lumbar spinal stenosis. Clinical considerations for older adults. J Gerontol Nurs, 37(6):8-12, Cosgrove JL, Bertolet M, Chase SL, et al.: Epidural steroid injections in the treatment of lumbar spinal stenosis. Efficacy and predictability of successful response. Am J Phys Med Rehabil, 90(12):1050-5, Issack PS, Cunningham ME, Pumberger M, et al.: Degenerative lumbar spinal stenosis: evaluation and management. J Am Acad Orthop Surg, 20(8):527-35, Jull-Kristensen B, Jensen C: Self-reported workplace related ergonomic conditions as prognostic factors for musculoskeletal symptoms: The BIT follow up study on office workers. Occup Environ Med, 62(3):188-94, Lizier DT, Perez MV, Sakata RK. Exercises for treatment of non specific low back pain. Rev Bras Anestesiol, 62(6):838-46, Maas ET, Juch JN, Groeneweg JG et al.: Cost-effectiveness of minimal interventional procedures for chronic mechanical low back pain: design of four randomised controlled trials with an economic evaluation. BMC Musculoskelet Disord, 28;13:260, Manchikanti L: Epidemiology of low back pain. Pain Physician, 3(2):167-92, McKenzie R and May S: The Lumbar Spine Mechanical Diagnosis and Therapy, Waikanae New Zealand, Spinal Publications, Nachemson A: The lumbar spine. An Orthopaedic Challenge. Spine 1:50-71, Saunders DH and Saunders RR: Evaluation treatment and prevention of musculoskeletal disorders, Chaska MN, The Saunders Group, Inc.,