Researchers find triple acupuncture combined with warm needle acupuncture safe and effective for the treatment of lower back pain. In a clinical investigation, Xianning Hospital researchers tested the efficacy of acupuncture for the treatment of dorsal ramus syndrome, which is characterized by lower back pain, spasms, and radiculopathy. The results of the investigation reveal that triple acupuncture combined with warm needle acupuncture has an 80% total effective rate for the alleviation of dorsal ramus syndrome. Another group receiving standard acupuncture protocols without triple needling or warm needle stimulation achieved a 66.7% total effective rate.
After spinal nerves pass through the intervertebral foramina, they split into several branches: dorsal rami, ventral rami, meningeal branches, rami communicantes. A dorsal ramus is a branch of a spinal nerve that innervates muscles and skin of the dorsal aspect of the back. Lower back, gluteal, and hamstring pain that is relieved by blocking signal conduction along dorsal rami is attributable to dorsal ramus syndrome.
The researchers achieved significant clinical success (80%) by applying acupuncture needles to Huatuojiaji acupoints and GB30 (Huantiao, Jumping Circle). The Huatuojiaji acupoints were applied bilaterally at sites where patients experienced pain. Huantiao was needled on the affected side.
The researchers used sterile, single-use, filiform needles (0.35 × 50–75 mm). Following skin disinfection, Huatuojiaji acupoints were needled perpendicularly until patients experienced deqi sensations (e.g., soreness, electricity) and to a maximum depth of 1.5 inches. GB30 was needled (maximum depth 2–3 inches) to elicit a deqi response; specifically, an electrical sensation radiating towards the lower limbs.
Triple Acupuncture Next, triple acupuncture was applied. To achieve this, an acupuncture needle was inserted 1 cun superior to GB30 and another was inserted 1 cun inferior to GB30. A maximum depth of 2–3 inches was applied with perpendicular insertion. The two additional points were manually stimulated to achieve a downward deqi sensation. This protocol is a standard triple acupuncture approach to GB30 that varies from another approach that was not implemented in this study. Another triple acupuncture approach is to needle GB30 to a shallower depth while the inferior and superior acupoints are needled deeply with strong manual elicitation of a deqi response. This alternate approach is used to avoid excessive stimulation of the sciatic nerve. Here, the researchers applied vigorous stimulation to all three acupoints and subsequently achieved excellent clinical results.
Moxa cigar cuttings (2 cm) were attached to the triple acupuncture points at the handle and were ignited. Total needle retention time was 30 minutes per acupuncture session. Acupuncture treatments were administered once per day for a total of 10 treatments, comprising one course of care. Three courses of care were administered with a three day break between courses for a grand total of 30 acupuncture treatments. The 80% total effective rate achieved by this protocol indicates that it is an effective approach to patient care.
A second arm of the study received a different acupuncture treatment protocol. Acupuncture needles were applied to the following points on the affected side:
Shenshu BL23 (Kidney Shu)
Dachangshu BL25 (Large Intestine Shu)
Zhibian BL54 (Order’s Limit)
Huantiao GB30 (Jumping Circle)
Chengfu BL36 (Hold and Support)
Yinmen BL37 (Gate of Abundance)
Weizhong BL40 (Middle of the Crook)
Yanglingquan GB34 (Yang Mound Spring)
Following skin disinfection, filiform needles were applied (0.35 × 40–75 mm). GB30 was needled identically to the method used in the other arm of the study. The remaining acupoints were needled to a depth of 0.8–1.5 inches and were manually stimulated with mild reinforcing and attenuating techniques, until the patients experienced a deqi response. The same frequency of treatments and total number of acupuncture visits was applied as in the other arm of the study. The 66.7% total effective rate indicates that the warm needle triple acupuncture protocol achieves superior patient outcome rates when compared with this standard protocol.
Triple Needling Variation #2 The researchers comment that triple acupuncture increases clinical efficacy for the treatment of dorsal ramus syndrome.