Journal of Pain Management & Medicine

How to Treat Low Back Pain in Pregnancy without Using any Antiinflammatory Medications

Huang Wei Ling^* General Practitioner, Acupuncturist and Pain Specialist, Medical Acupuncture and Pain Management Clinic, Franca, Sao Paulo, Brazil
^*Correspondence: Huang Wei Ling, General Practitioner, Acupuncturist and Pain Specialist, Medical Acupuncture and Pain Management Clinic, Franca, Sao Paulo, Brazil, Tel: (55 16) 3721-2437, Fax: (55 16) 3702-85, Email:

Received: 27-May-2020 Published: 01-Aug-2020, DOI: 10.35248/2684-1320.20.6.137

Introduction

Low back pain is a common musculoskeletal disorder affecting 80% of the population. In the USA it is the most common cause of job-related disability and absenteeism. In pregnancy, low back is also very common [1-3].

It is very common in pregnancy, affecting around 50% of pregnant women. In the first trimester, back pain is commonly linked to an increase in hormones and stress. During pregnancy, the ligament naturally become softer and stretch to prepare the body for labor. This can put a strain on the joints of the lower back, causing back pain [1-3].

The symptoms of back pain may range from muscle ache to shooting or stabbing pain, limited flexibility or movement, or an inability to stand straight. This back pain is considered chronic when it persists for more than three months [1-3].

In TCM, the causes of back pain are as follows: internal damage, trauma and external contraction. The main TCM patterns include Kidney deficiency lumbago, blood stasis lumbago, cold-dampness lumbago and damp-heat lumbago [4].

For the compilation of this article, the author based her perspective and pathways of treatment in a specific case of a patient the author had in 2006. For better comprehension on how the reasoning of the treatment of the patient was based, it is important to explain this first case [5-12].

This patient was a 70-year-old patient, who reported pain in the legs and was diagnosed with Kidney-Yang deficiency, according to TCM. He received treatment with Chinese dietary counselling, acupuncture and auricular acupuncture associated with apex ear bloodletting [9-12].

With the treatment done, the pain in the legs diminished and the patient was submitted to an interview after the treatment. In this interview, 30 days after the treatment, the patient revealed that his eye pressure had also lowered with the treatment, as his ophthalmologist confirmed. During the treatment, he had not reported to be treating glaucoma in the last 40 years with no improvement of his condition. With the treatment performed, his pressure lowers from 40 mmHg to 17 mm Hg [9-12].

This interesting case became the cornerstone of the author studies in the field, trying to comprehend how the treatment based on the root of the problem could treat different diseases and symptoms simultaneously and using the same methods [9-12].

Purpose

The purpose of this study is to demonstrate that it is possible to treat low back pain in pregnancy without using any anti-inflammatory medication.

It is also a goal to emphasize the importance of considering other relevant ancient medical traditions, such as Traditional Chinese Medicine, on the treatment of the most varied pathologies, and to address how a treatment done in the root-level, considering the energy imbalance of each patient as a priority can be safe and effective on the treatment of low back pain in pregnancy.

Methods

The methodology of this study consisted in review of medical literature regarding back pain in pregnancy in Western and in Traditional Chinese Medicine, as well as one case report of a patient with low back pain on her 8° month of pregnancy.

Case Report

M.T.F., female, 40, primiparous, 8-month pregnant. On January 30, 2013, her left leg began to hurt at the thigh near her buttocks, which made it difficult for her to walk. As it was the end of the afternoon, she assumed it was because she had not rested enough. She laid down, and when she tried to get up, she could not walk and the pain was very strong. The patient decided not to take any anti-inflammatory or pain medication, due to the pregnancy. She started a treatment with ancient medical tools, including acupuncture on January 31, 2013. In her first consultation, she entered the office with significant mobility difficulty, especially for walking.

She was diagnosed with Kidney Yin and Yang deficiency and Blood deficiency. According to TCM. She then received the first session of auricular and scalp acupuncture. Due to her pain, she received scalp acupuncture seated, on the left and right side of the schools, using the motor are related to the lower limbs on TCM literature. On the very first session, there was significant improvement of the pain. The patient also received auricular acupuncture with apex ear bloodletting.

The specific case of this patient in question is better described in another article of the author, entitled How do you Treat Back Pain in Your Practice? Part 2, published by the Medical Acupuncture Journal in 2018.

In Figure 1, it is possible to see that the points correspondent to the posterior furrow of the spinal cord, showing the five areas corresponding to the vertebral column in Figure 1.

Figure 1: Posterior ear divided into the five spinal cord areas.

1. Cervical area

2. Thoracic areas

3. Thoracic areas

4. Lumbar area

5. Sacrum area.

Figure 2 shows the five spinal cord areas on the front of the ear. The procedure of apex ear bloodletting was also done on the patient described. For this procedure, described in Figure 3, the ear is massaged from the bottle to the top. Subsequently the ear is bent to bleed the top, pricked quickly with an insulin syringe needle, usually squeezing around five to ten drops of blood, while cleaning constantly with a dry cotton ball. See Figure 3.

Figure 2: Anterior ear and five spinal cord areas.

Figure 3: Apex ear bloodletting procedure.

Small square pieces of adhesive tape with two mustard seeds each are fixed to the ear on the chosen points. The points are applied on the area corresponding to the symptomatic low back area, further points are treated to help the energy imbalance: Shen-Men, Kidney, Liver, Lung, Spleen, Large Intestine, Hunger, and Anxiety, as showed on Figure 4.

Figure 4: Points placed on the ear.

Several more applications are made on the back of the ear, on the part correspondent to the back, along the vertebral area on the posterior furrow of the spinal column, corresponding to the lumbar and sacrum. Also, one application is on the sciatica posterior furrow (1) and the leg posterior furrow (2) as it is possible to see in Figure 5.

Figure 5: Back of the ear.

Results

After the sixth session, twice a week, she practically did not feel anymore low back pain. The patient was very happy with the treatment result, as she did not had to intake any medication and she was able to go back to work normally.

Discussion

Western medicine and low back pain in pregnancy

Low back pain is a common symptom of pregnancy affecting the majority of pregnant women on the second a third trimester. The causes are associated with the weight gain, posture changes due to the belly, hormonal changes and muscular separation, as the organs and the whole body stretches to receive the baby [1-3].

Western Medicine recommended treatment depends on the level of the back pain. For example, in small and mild cases, the recommendation is exercise and posture changes, as well as antiinflammatory medications safe for pregnancy [1-3].

In cases where there is severe pain, increasingly severe pain or pain that begins abruptly, rhythmic cramping pains and difficulty urinating or “pins and needles” in your extremities, it is recommended to search for urgent medical attention, as, in rare cases, severe back pain may be related to problems such as pregnancy-associated osteoporosis, vertebral osteoarthritis, or septic arthritis. Rhythmic pains may be a sign of preterm labor [1-3]

Sciatica, also known as lumbosacral radicular syndrome, is caused by irritation of your sciatic nerve which starts in the lumbar or lower spine and ends in the thigh. It can be a deep, dull pain or a shooting, sharp pain. Sciatic pain can range from mild to severe. It often goes away with treatment [1-3].

Sciatica due to a herniated disc during pregnancy isn’t common. But, sciatic-like symptoms are common with low back pain in pregnancy. In fact, between 50 and 80 percent of women have back pain during their pregnancies. The treatment for this specific type of back pain is done with anti-inflammatory medications and stretches. Acupuncture is also recommended, even in Western Medicine. On the article of the author How do you Treat Back Pain in Your Practice? Part 2, published by the Medical Acupuncture Journal in 2018, the author performed a survey with several patients with low back pain, treated only with auricular acupuncture and apex ear bloodletting techniques, and it was discovered that 100% of these patients improved only with this technique, and even patients who had surgical indication for disc herniation, improved only with auricular acupuncture associated with apex ear bloodletting [4].

Acupuncture is recognized as a medical specialty in Brazil since 1995 by the Federal Medical Council.

The metaphor of the tree

In this session, it is important for the author to establish the metaphor of tree. The metaphor has been widely used by the author on all her other studies, because it places an allegory on the differences between the approach of Western and Traditional Chinese Medicine [4-12].

The tree has a trunk with several branches. Each branch represents one medical specialty and each leaf coming out of each branch represent the symptoms and diseases of each specialty. The leaves and the branches are the visible part and the object of study and practice in the western medical profession. The focus is to treat each leaf in each specialty. The treatment proposed by the author aims to treat all the tree, through the root to reach a “health leaf” [4-12].

There, in this root, there is energy that when balanced can generate health to the whole tree. The reason of this study is to address which are the energy alterations present in the root level, responsible for low back pain in pregnancy symptoms [4-12].

On Figure 6, it is possible to see how the roots of the tree are represented by the Yin and Yang theory and the Five Elements Theory. On the case report described, and on the case that originated the reasoning of this study, the main goal of the author is always to correct energy imbalances, rebalancing Yin, Yang, Qi and Blood energies. As this theory was presented on the Acupuncture Research Conference, in the Harvard Medical School in Boston, in 2015, attesting that treating energy imbalances can treat all diseases at the same time [4-12].

Figure 6: Schematic drawing of the views of western and traditional chinese medicine.

Acupuncture and pregnancy

Acupuncture is becoming an increasingly popular treatment for pregnancy-related conditions. No reported evidence or clinical studies justify any concerns regarding acupuncture in the treatment of pregnancy-related conditions [13,14].

Specific care when treating pregnant women includes avoiding the use of contraindicated points and specific point combinations as well as taking care with certain needle techniques and the use of moxa and having sufficient knowledge of anatomy so that appropriate techniques are used when needing points that lie over the growing uterus [13,14].

On the case report described, the use of auricular and scalp acupuncture was chosen to be used with this patient because during the last three months of her pregnancy her abdominal volume was very large making it difficult for her to lie down properly so points were used at a distance from the pain's location, making the treatment more pleasant and comfortable.

Traditional Chinese medicine and low back pain

Traditional Chinese Medicine (TCM) theory states, “The lumbus is the house of the Kidney” which means that Kidney essence provides nutrition and warmth to the lumbar region. If Kidney essence becomes insufficient or consumed, “the house of the Kidney” will lose nutrition and warmth, resulting in low back pain [4].

In TCM therapies patients with acute low back pain mostly involve excess syndromes, mainly caused by static Blood or Wind, Cold or Dampness obstructing the channels. For “obstruction following pain”, obstructed channels can lead to low back pain. The treatment principle for this pattern is to activate Blood and resolve stasis, dredge the collaterals, and relieve pain. Reducing needle techniques or pricking to bleed are both appropriate treatment methods for this pattern [4].

Patients with chronic low back pain mainly have deficiency syndromes caused by deficiencies of the Liver and Kidney or deficiencies of Blood and Qi. Treatment involves enriching the liver and kidney while fortifying sinews and bone. Reinforcing needle techniques are appropriate. In Yang deficiency patients, moxibustion and acupuncture should be combined in order to warm the kidney and assist Yang; while these methods should not be used for Yin deficiency patients to avoid excessive consumption of Yin. These needling methods are based on the principles of enriching Yin and nourishing Blood, supplementing essence, and replenishing marrow [4].

Moxibustion

Moxibustion is very positive in pregnancy, previous studies shown that moxibustion is very effective on the treatment of pregnancyrelated conditions, such as nausea during pregnancy, miscarriage, anemia, edema and small-for-babies, provided the presenting patterns of disharmony do not reflect Yin deficiency or pathological internal Heat [15].

Arndt-Schultz’s Law

The Arndt-Schultz law, was the reason why the author avoided the use of anti-inflammatory medications on the case report described, besides the orientation of avoiding the use of any medication during pregnancy [4-12].

The Arndt-Schulz's law, originally formulated in 1888, states the effects of different drug concentrations on an individual basis, Figure 7. The rule states that for all substances, small doses stimulate, moderate doses inhibit and overdoses kill [4-12].

Figure 7: Arndt-Schultz Law.

According to this law, highly diluted drugs improve organic processes, while high concentrations harm health. In the case of prescription drugs with high concentrations, in any case, they will be reducing the vital energy, and the in the case report, the author is describing the patient already had a Kidney Yin and Yang deficiency that was causing the low back pain symptoms, according to Traditional Chinese Medicine, and would worsen the lack of energy condition [4-12].

In the case of pregnant women, there is close relationship between the energy state of the mother and the energy state of the baby, and that is why using acupuncture could be a good choice, treating the energy imbalances causing the symptoms of low back pain [4-12].

Yin and Yang metaphor of Western and traditional Chinese medicine

In order to treat patients with low back pain in pregnancy in a deeper way, the physician has to comprehend the importance of the different medicine perspectives. The body, is not only physical and constituted by organs and tissues, it is formed by energy. In Figure 8, a metaphor of Yin and Yang as the different kinds of medicine was created by the author. Nowadays, these two perspectives are separated, but they can be complementary [4-12].

Figure 8: Traditional chinese medicine and western medicine-Yin and Yang Metaphor.

Traditional Chinese medicine can be considered as Yang energy, and Western medicine is considered Yin energy, already materialized. In the same way of the relationship of Yin and Yang, Traditional Chinese Medicine starts where Western Medicine ends [4-12].

Conclusion

The conclusion of this study is that it is possible to treat low back pain in pregnancy without using any anti-inflammatory medication. To achieve this goal it is important to correct the energy imbalances at the root level, treating the cause and not only the symptom. This kind of treatment could prevent further energy imbalances caused by the ingestion of high-concentrated medications, harming the health of the pregnant mother and also of the baby.

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