Acupuncture research points to importance of therapeutic relationship in treating back pain | Healthy Seminars

Acupuncture research points to importance of therapeutic relationship in treating back pain

This 2013 UK acupuncture study (funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and in part by a NIHR Career Scientist Award), “The Acceptability of Acupuncture for Low Back Pain: A Qualitative Study of Patient’s Experiences Nested within a Randomised Controlled Trial” found that the therapeutic relationship between the practitioner and patient is a strong driver in the acceptability of acupuncture for treating back pain.

The study used patient interviews following acupuncture treatment for back pain to identify, understand and describe the elements that contribute or detract from acceptability of treatment. 

Back pain, as we all know, is an all to common painful and frequently chronic condition that can lead to depression and overuse of painkillers. It makes sense for patients to look to alternative solutions to help cure their aching backs.

Take this quote from one of the study participants:

Prior to the acupuncture I was taking pain killers for my back to get to sleep at night, and then as the acupuncture progressed I didn’t take any for my back… I don’t like taking pills because of their effects on the body.

While the National Institute for Health and Clinical Excellence guidelines recommends acupuncture as a clinically effective treatment for chronic back pain, there is insufficient knowledge of what factors contribute to patients’ positive and negative experiences of acupuncture, and how those factors interact in terms of the acceptability of treatment. 

This study used patient interviews following acupuncture treatment for back pain to identify, understand and describe the elements that contribute or detract from acceptability of treatment. The interviews were analyzed and divided into themes.

Themes

Three over-arching themes emerged. The first called facilitators of acceptability contained five subthemes: experience of pain relief, improvements in physical activity, relaxation, psychological benefit, reduced reliance on medication. 

While I was there having the treatment I felt relaxed…it was just nice to be peace and quiet and just lay there… It’s a relaxant, it just levels you, it levels you and talking relaxes you so that you’ve got time…you walk home floating. 

My energy level has increased. I can now cook a meal without having to lie down every couple of minutes in between doing something, which is better.

The second over-arching theme identified barriers to acceptability, which included needle-related discomfort and temporary worsening of symptoms, pressure to continue treatment and financial cost. 

I had gone at first where it ached for two or three sessions, and I thought, this is not going to work, and then on the fourth session it was a lot easier. It was either the fifth or the sixth session when it was severe, and after that great. Each time I went then I got better and better. It got to the last one and I thought well really I don’t need it. 

I used to feel very tired… It was just a progression maybe of just your body saying you know you needed time to heal…I intentionally used to make my appointments later on in the day so I could come home and relax.

The third over-arching theme comprised mediators of acceptability, which included pre-treatment mediators such as expectation and previous experience, and treatment-related mediators of time, therapeutic alliance, lifestyle advice and the patient’s active involvement in recovery. These themes inform our understanding of the acceptability of acupuncture to patients with low back pain.

It’s totally for you, not for anybody else, totally for you and its lovely to have the attention instead of being on this five minutes list at a doctors and they don’t listen. They’ve got to listen to you and she’s interested.

Conclusion
The acceptability of acupuncture treatment for low back pain is complex and multifaceted. The therapeutic relationship between the practitioner and patient emerged as a strong driver for acceptability, and as a useful vehicle to develop the patients’ self-efficacy in pain management in the longer term. Unpleasant treatment related effects do not necessarily detract from patients’ overall perception of acceptability.

SourceRead the full study with citations at PlosOne