When treating pain it is important not to give up to soon. This case reviews a 36 year old woman I treated for lumbar pain. The patient rated her pain level at 7 – 10/10 for the last five years. She felt stress and anxiety as she was unable to work. After six visits over 3 weeks the patient reported significant pain reduction, improved range of motion, and that she was looking into working for the first time in five years.
History
The patient reports that she injured her self when she fell off a stool onto her buttocks. However, MRI have shown no abnormalities to her lumbar or sacral region.
The patient reports that she constantly experienced lumbar pain which radiated down her legs. She described the feeling as a deep ache, with tingling, and numbness. The patient reports little improvement with the various therapies(physical therapy, chiropractic) she had tried thus far. The patient took Ibuprofen durning the day to get by and Gabapentin at night to get some sleep.
The injury left the patient unable to walk, sit, or stand for greater than 20 minutes at a time. She also was unable to lay flat without the support of pillows and even then not for long periods of time. This greatly affected her ability to sleep. Without Gabapentin she would not have been able to sleep those five years. However, the patient reported she still woke up at 3 A.M daily due to pain and tossing and turning the rest of the night.
At the initial examination, I did not note any abnormalities with visual examination. The patient was highly sensitive to touch around the sacrum particularly at the sacroiliac joints.
Treatment
Due to the patient’s inability to stay in one position without being in pain, we had to be very creative with the treatments. Typically for the first part of the treatment I used only distal points, meaning points away from the area of pain. These distal points were in the patient’s hands, ears, and scalp. I chose these points based on acupuncture channel correlations. I had the patient walk around the room for a few minutes with the needles in. Afterward, the patient would come up onto the table and lie on a triangular wedge, as the patient could not lie flat. Once on the table I would needle points in the low back and sacrum.
After the initial visit, I incorporated electro-acupuncture into both parts of the acupuncture treatment described above.
The patient reported no real lasting benefit after the first two treatments. However after the third treatment the patient reported pain reduction to 4 – 7/10 and that she had not awoken at 3 A.M. the last few day. By the sixth visit, the patient reported pain of only 3/10 and improved range of motion:
ROM
Lumbar Flexion – Visit One- 35 degrees stopped by pain Visit Six – 75 degrees, stopped by pain
Lumbar Extension –Visit One- 10 degrees stopped by pain; Visit Six- 15 degrees, stopped by pain
Lumbar Rotation – Visit One – 25 degrees bilaterally, stopped by pain; Visit Six – 35 degrees, stopped by pain
Discussion
One reason I chose this case is because the patient saw no benefit at first and then saw huge improvements. Most treatments, regimens, or programs aimed at improving the body in some way or another take time. I have treated numerous cases like this, where the patient did not show improvement until possibly the fourth visit and then begin to improve rapidly. Unfortunately, I have seen some people quit way too early even though I tell them upfront that it may take a few visits. It’s important to look at the big picture and think about what is at stake.
Another important and related point is that acupuncture was at least the third modality this patient tried. It’s important to never give up unless you have really exhausted all your options. Some people will benefit from multiple modalities, however for some reason it seems some people only get benefit from one specific form of treatment. Start wherever you are comfortable and after giving that modality a fair shot, move on to the next one. But don’t make the assumption that because the first or second thing that you tried did not help that nothing will. There is usually something out there that will help to some degree, it is just a matter of finding it.
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