Clinical Research On Low Back Pain Treatment By Auricular Acupressure With Magnetic Pellet

Back ground:Low Back Pain(LBP)is one of the most common complaints and musculoskeletal condition that individual seek treatment.Low back pain occurs at any age but most prevalent is during the third decade of life and among the middle aged population in which the proportion of females is higher than that of males.LBP refers to discomfort and pain in lumbosacral region.The pain is localized below the 12th rib and above the inferior gluteal folds.It can be a dull pain or sharp pain or even burning or piercing sensation or numbness or weakness.The pain may radiate to the legs or feet even to upper back and hips.Fluctuations of pain intensity for low back pain are common and likely to occur during treatment.The pain would restrict patients’ mobility and affect their sleep,and their strenuous activity.Prolonged sitting,standing and walking would worsen the pain.Low back pain is usually self-limited and resolves within a few weeks,but some of the subjects develop chronic pain.LBP not only affects daily activities and the quality of life but also increases health care expenditure.LBP is divided to acute low back pain(ALBP)and chronic low back pain(CLBP)that ALBP last less than 4 weeks and CLBP last more than 12 weeks(3 months).LBP classified as specific if its etiology is known(e.g.,radiculopathy,discogenic disease)and non-specific that etiology of low back pain is unknown(in the majority of cases).The prevalence of low back pain and the number of patients seeking care with complementary and alternative medicine(CAM)therapies in the world has increased over the last two decades.Objective:To evaluate the efficacy of Auricular Point Acupressure(APA)by magnetic pellet for low back pain.Material and methods:A pilot randomized clinical trial(RCT)performed at the school of Acupuncture,Moxibustion and Tuina in Beijing University of Chinese Medicine,China,with cooperation of a special acupuncture clinic,Iran,from June 2017 to March 2018.The people who took part in this study suffered from LBP,and have recalled by a specialist in orthopedic.After participants complete a baseline evaluation,all of 90 participants were randomly divided into one of the three groups of this study(two main groups that the first group was study group and second group(control group)had two subgroups(control group 1 and control group 2):The study group was recei-ved Auricular Point Acupressure by magnetic pellet(APAbMP)and control group 1 was received Auricular Point Acupressure by Vaccaria Seed(wangbuliuxing),(APAbVS),and control group 2 was received only plaster without stimulation that was called APA sham group.Schedule for study was as follow:· First step:Screening consist of standard interview,take history,physical examination,imaging(X-ray and MRI and CT-scan)and laboratory tests whenever necessary,filling MPQ and VAS questionnaires(before beginning of treatment).· Second step:Treatment initiation,in study group(APAbMP group),patients was received magnetic pellets for 4 weeks(one time per week)and in control group 1(APAbVS),patients was received Vaccaria Seed for 4 weeks(one time per week)and in control group 2,patients was received only plaster without pressing for 4 weeks(one time per week).Third step:Two weeks after beginning of treatment filling MPQ and VAS questionnaires for second time.· Forth step:At the end of 4th week of intervention(end of treatment),filling MPQ and VAS questionnaires for third time.Fifth step:Follow up(4 weeks after last session of treatment),filling MPQ and VAS questionnaires for forth time.In the Study group and control group 1,the participants received treatment that followed an Auriculotherapy(AT)program(APAbMP and APAbVS)using according to TCM technique.In the control group 2 participants received only Plaster per week without stimulation.The intervention in all of groups lasted 4 weeks.In Study group and control group 1,Auricular points were selected consist of three main points:Shenmen[TF2],Subcortex(Thalamus)[CW2/IC4],Prostaglandin(PGE1)[LO1/PL1],and local points on ear were:Lumbago(Coxalgia or Lumbodynia)[AH11&AH12]and the corresponding lower back(lumbar vertebrae)point on the back of ear(in front of AH11 on the posterior aspect of ear).And in control group 2 auricular points were selected consist of:Mouth[IC5],Stomach[IC6],Duodenum[SCI,PC3],Eye[LO4]and tonsil[LO3]Result:Final data were imported and analyzed by an expert medical statistician who was blinded to study grouping.Statistical analysis was performed by using the SPSS version 18.0 for Windows.One hundred-eight subjects were evaluated regarding the study eligibility criteria.Of these,18(16,66%)were excluded and 90(83,33%)participated in the study.Only 83 participants(76,85%)completed the treatment(Test group = 28;Control group 1= 29;control group 2 = 26).Of the 29 participants in Control group 1(APAbVS),16(55,17%)were male and 13(44,82%)were female,with an average age of 60.10 ± 11.45 years.And of the 26 participants in control group 2(Sham APA),14(53,84%)were male and 12(46,15%)were female,with an average age of 58.88 ± 10.61 years,28 participants were allocated to Study group(APAbMP),14(50%)were male and 14(50%)were female,with an average age of 55.46 ± 9.83 years.According to ANOVA test between 3 groups:VAS-1(P-Value = 0.985)was not significant meaningful,VAS-2was not statistically meaningful(P-Value =0.243).VAS-3(P-value =0.0001)and VAS-4(P-value =0.048)were meaningful.And MPQ-1(P-Value =0.987)was not significant meaningful,MPQ-2 was not statistically meaningful(P-Value=0.055).MPQ-3 was meaningful(P-value =0.0001)and MPQ-4 were meaningful(P-value =0.025).And According to Bonferroni test for comparing of pair wise groups:VAS-1 between APAbMP and APAbVS,between APAbMP and Sham APA,between APAbVS and Sham APA was not meaningful significant(P-value = 1.000,P-value = 1.000,P-value =1.000).VAS-2 between APAbMP and APAbVS.between APAbMP and Sham APA.between APAbVS and Sham APA was not meaningful significant(P-value = 1.000,P-value=0.412,P-value = 0.443).VAS-3 between APAbMP and APAbVS was not meaningful(P-value =0.054),and between APAbMP and Sham APA was meaningful(P-value = 0.0001),and between APAbVS and Sham APA was meaningful(P-value = 0.0001).VAS-4 between APAbMP and APAbVS was not meaningful(P-value =0.672),and between APAbMP and Sham APA was meaningful(P-value = 0.042),and between APAbVS and Sham APA was not meaningful(P-value = 0.558).And MPQ-1 between APAbMP and APAbVS,between APAbMP and Sham APA.between APAbVS and Sham APA was not meaningful significant(P-value = 1.000,P-value＝1.000,P-value = 1.000).MPQ-2 between APAbMP and APAbVS,between APAbMP and Sham APA,between APAbVS and Sham APA was not meaningful significant(P-value =1.000,P-value = 0.100,P-value = 0.114).MPQ-3 between APAbMP and APAbVS was not meaningful(P-value =0.218),and between APAbMP and Sham APA was meaningful(P-value = 0.0001),and between APAbVS and Sham APA was meaningful(P-value =0.0001),MPQ-4 between APAbMP and APAbVS was not meaningful(P-value =1.000),and between APAbMP and Sham APA was meaningful(P-value = 0.036),and between APAbVS and Sham APA was not meaningful(P-value = 0.083).Mean of weight between groups in this study was meaningful and efficacy of weight in this study was interacting.But in repeated major management,we adjusted weight variation.In this study we assessed efficacy of time on mean score pain of patients in whole groups that showed variation of mean score of pain in duration of time was not meaningful(P-Value =0.129).Assessment of interaction of time and groups was meaningful(P-value =0.0001).Because of intervention weight in this study,we survey efficacy of weight and time that was not significant.The main table in this study showed mean score of pain in 3 groups,in different time that this was meaningful(P－Valuee=0.044).Therefore pain in all of times between all of groups had significant variation.The results presented in the text and tables were means plus and minus standard deviation of the mean(mean± standard deviation);P-Value<0.05 was considered to be statistically significant.Conclusion:Finally this study revealed more efficacy for Auricular Point Acupressure by magnetic pellet(APAbMP)and Auricular Point Acupressure by Vaccaria Seed(APAbVS)on relieving low back pain compared to Sham Auricular Point Acupressure(Sham APA)by only plaster without stimulation,and there was not significant different between efficacy of APAbMP and APAbVS at the end of treatment(4 weeks after beginning of treatment).But in follow up(4 weeks after the end of treatment),efficacy of APAbVS was not stable and significant,but efficacy of APAbMP was stable up to 4 weeks after treatment sessions have finished.APAbMP and APAbVS are effective,noninvasive treatments that offer a simple way to pain relief,and they can be used as an adjunct therapy to other forms of pain management and can promote a reduced use of analgesics,which can minimize potential adverse effects and tolerance.