Diagnosis/Condition:
Discipline:
ICD-9 Codes:
ICD-10 Codes:
Origination Date:
Review/Revised Date:
Next Review Date:
Low Back Pain
Low back pain
Lumbago
Backache, unspecified
Sprains and strains of the lumbar spine
LAc
724.2; 724.85; 847.2
04/2012
04/2014
Back pain is one of the most common reasons for a visit to an acupuncturist. The goal of low back
pain (LBP) therapy is to mitigate symptoms, increase patient function and decrease chronic
health care visits. Several systematic reviews have concluded that acupuncture is a viable
treatment option for the treatment of LBP and sciatica. This accumulated evidence is further
supported by the findings of several more recent RCTs and outcomes research not covered in
these reviews. Acupuncture appears to be a cost-effective means of treating LBP.
Subjective Findings and History
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Macro trauma: Onset of pain and paraspinal muscle spasm begins either immediately after
the injury or gradually over the next 24 hours.
Micro trauma: Repetitive traumatic events not singularly capable of producing
injury
Local pain, sometimes at standardized acupuncture point locations, sometimes
accompanied by pain along acupuncture channels traversing the involved area, diffuse
(scleratogenous pain distribution)
Loss of flexibility
Pain is usually relieved by rest and aggravated by motion
History of prior similar episodes
Objective Findings
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Postural evaluation may reveal decrease/loss of normal spinal curvature, may present with
lateral list
Decrease/loss of normal spinal ROM
Palpation: Tenderness with pressure over involved tissues, muscle spasm or tautness of
paravertebral muscles, MFTPs, tenderness of acupuncture points
Pulse and tongue diagnosis findings will vary
Assessment
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Assess for “red flags” of serious disease and factors that may promote prolonged disability.
The clinical impression should indicate the specific anatomical structures and
acupuncture channels involved, and clinically correlate them with the mechanism of
injury, history, subjective complaints, and objective findings
The CHP Group
Lower Back Pain/Lumbago Clinical Pathway
1
Plan
Passive Care:
• Acupuncture, electroacupuncture, other physical modalities
• Chinese herbs and herbal formulas
• Psychological/emotional counseling
Active Care:
• Rest from inciting activity
• Activity/work restriction if appropriate may include: No repetitive motion, lifting,
grasping, pinching
• Appropriate stretching and strengthening exercises, tai ji, qigong
• Appropriate dietary modification
Length of Treatment
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Estimated duration of care: initially 2-3 times per week for 2-3 weeks
Patient should be improved after 2-3 weeks
Treatments can continue if symptoms are acute (<6 months) for 2-3 months, if chronic
(>6months) for 3-6 months
Referral Criteria
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If patient is not improved or worsens with the initial course of treatment (over first 2-3
weeks) then the patient should be referred for co-management with primary care and/or
manipulative therapy.
Practitioner Resources
Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for
low back pain: a systematic review. Spine. 2008 Nov 1;33(23):E887-900
Patient Resources
SUMMARIES FOR PATIENTS: Diagnosis and Treatment of Low Back Pain: Recommendations
from the American College of Physicians/American Pain Society. Ann Intern Med, Oct 2007; 147:
I-45. http://www.annals.org/cgi/reprint/147/7/I-45.pdf
Simple steps can put an end to unnecessary suffering. TimesOnline. Sept 19, 2005.
http://www.timesonline.co.uk/tol/life_and_style/health/expert_advice/article567626.ece
Gypson W. Traditional Chinese Medicine (TCM) and Back Pain. Spine Unitverse.
http://www.spineuniverse.com/displayarticle.php/article829.html
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Cherkin DC, Sherman KJ, Avins AL, et al. A randomized trial comparing acupuncture, simulated
acupuncture and usual care for chronic low back pain. Arch Intern Med. 2009;169(9):858-866.
The CHP Group
Lower Back Pain/Lumbago Clinical Pathway
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The CHP Group
Lower Back Pain/Lumbago Clinical Pathway
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Cochrane Database Syst Rev 2000;CD001351The CHP Group
Lower Back Pain/Lumbago Clinical Pathway
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Clinical Pathway Feedback
CHP desires to keep our clinical pathways customarily updated. If you wish to provide additional
input, please use the e-mail address listed below and identify which clinical pathway you are
referencing. Thank you for taking the time to give us your comments.
Chuck Simpson, DC, CHP Medical Director: [email protected]
The CHP Group
Lower Back Pain/Lumbago Clinical Pathway
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