CLINICAL APPLICATIONS

* Chronic low back pain (lumbago)

* Weakness and soreness of the lower back and knees

* Dull achy back pain, stiffness, and limited range of motion

* Slow and incomplete recovery from back injuries

* Sciatica, osteoarthritis, lumbago, lower back pain resulting from osteoporosis 

 

WESTERN THERAPEUTIC ACTIONS

* Chondroprotective function to prevent joint destruction and cartilage erosion

* Osteogenic function to promote generation of new bones

* Anti-inflammatory effect to reduce pain, swelling, and redness

* Analgesic influence to relieve pain

* Antispasmodic effect to stop muscle spasm and cramping

 

CHINESE THERAPEUTIC ACTIONS

* Disperses painful obstruction

* Relieves pain

* Invigorates qi and blood circulation

* Tonifies Liver and Kidney deficiencies

 

DOSAGE

Take 3 to 4 capsules three times daily. Patients who have chronic back pain from repetitive movement from their job should take this formula at a maintenance dose of two capsules a day to strengthen the muscles and tendons in the back to prevent injury. For maximum effectiveness, take the herbs on an empty stomach with warm water. This formula should not be taken during the acute phase of injury, where there is still bleeding, inflammation, and bruising.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Chuan Niu Xi (Radix Cyathulae)

Di Huang (Radix Rehmanniae)

Du Huo (Radix Angelicae Pubescentis)

Du Zhong (Cortex Eucommiae)

Ji Xue Teng (Caulis Spatholobi)

Mu Gua (Fructus Chaenomelis)

Qian Nian Jian (Rhizoma Homalomenae)

Sang Ji Sheng (Herba Taxilli)

Wei Ling Xian (Radix et Rhizoma Clematidis)

Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle)

 

BACKGROUND

Musculoskeletal and connective tissue injuries lead to over 10 million clinic visits per year in the United States.[1] Causes of these injuries may be external (sports injuries, car accidents, trauma), internal (chronic wear and tear of muscles, ligaments and tendons; bones weakened by osteoporosis), or both. Acute injuries are characterized by severe pain, swelling and inflammation, and in some cases, internal bleeding. Treatment of acute injuries should focus on relieving pain, reducing swelling and inflammation, and stopping bleeding. Chronic injuries are characterized by dull pain, stiffness and numbness, and decreased muscle mass and strength. Treatment of chronic injuries includes relief of pain and restoration of physical and physiological functions.

 

FORMULA EXPLANATION

Back Support (CR) is formulated based on Du Huo Ji Sheng Tang (Angelica Pubescens and Taxillus Decoction), the historical herbal formula used to treat chronic low back pain, sciatica, rheumatoid arthritis, and osteoarthritis.[2] Back Support (CR) contains herbs that activate qi and blood circulation, remove qi and blood stagnation, relieve pain, and nourish the muscles and tendons.

        In this formula, a large dose of Du Huo (Radix Angelicae Pubescentis) is used to dispel wind, cold, and dampness in the back and lower parts of the body. Du Zhong (Cortex Eucommiae), Sang Ji Sheng (Herba Taxilli), Qian Nian Jian (Rhizoma Homalomenae), and Di Huang (Radix Rehmanniae) replenish the vital functions of the Liver and the Kidney, which are responsible for strengthening the bones, sinews, and muscles of the lower back and knees. Bai Shao (Radix Paeoniae Alba) has analgesic, antispasmodic and anti-inflammatory effects. Together with the harmonizing effect of Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle), they nourish and relax the tendons and muscles in the back. Mu Gua (Fructus Chaenomelis), Wei Ling Xian (Radix et Rhizoma Clematidis), and Ji Xue Teng (Caulis Spatholobi) increase qi and blood circulation in order to relax the muscles and tendons in the back. Chuan Niu Xi (Radix Cyathulae) invigorates the blood and acts as a channel-guiding herb to direct the effects of the formula to the lumbar region. Together, these herbs treat chronic pain affecting the lower back.

 

CAUTIONS & CONTRAINDICATIONS

* Because of the blood-invigorating nature of this formula, Back Support (CR) is not recommended during pregnancy and nursing.

* Back Support (CR) is a warm formula, and use of this warm formula may be associated with a slight increase in blood pressure. Therefore, blood pressure should be monitored while taking this formula.

* Patients who have pain radiating to the extremities accompanied by a sudden loss of bladder or bowel control may have a pinched nerve or spinal injury, and must be referred out to emergency care if they have not already been evaluated by a specialist. This condition, known as cauda equina syndrome, can lead to permanent disability and must be evaluated and treated immediately.

* If the patient presents with fever and one-sided back pain, consider a possible kidney infection and do not use this herbal formula. Patients with acute nephritis should be referred to their medical doctor immediately.

 

CLINICAL NOTES

* Back Support (AC) is for acute cases with inflammation and pain. It is the best formula for recent injury or acute exacerbation with excruciating pain.

* Back Support (CR) is usually used for chronic pain or dull pain. In addition to having herbs that relieve pain, this formula also has herbs to nourish and strengthen the underlying structures and tissues so the back becomes less fragile.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Soft tissue damage: turtle pulse, a convex-shaped pulse on the left chi; the more forceful the pulse, the more recent the injury, with more inflammation and pain

* Bone spurs or disk problems: guitar string / steel wire pulse on the left chi

* Low back pain due to blood stasis from old injuries: dispersing pulse, a pulse in which its border is difficult to perceive, soft, weak, and deep, on the left chi

 

SUPPLEMENTARY FORMULAS

* For chronic low back pain with weakness and soreness of the knees, add Knee & Ankle (CR).

* For chronic low back pain with weakened soft tissues (muscles, tendons, and ligaments), add Flex (MLT).

* To enhance the analgesic effect, add Herbal ANG.

* For osteoporosis or weakness of the bones, add Osteo 8.

* For chronic low back pain due to herniated disk, use with Back Support (HD).

* For soreness and weakness of the lower back and knees and/or low sex drive because of Kidney yang deficiency, add Kidney Tonic (Yang).

* For soreness and weakness of the lower back and knees due to yin deficiency, add Kidney Tonic (Yin).

* For bone fractures and internal bruises, add Flex (TMX).

* For arthritis that worsens during cold or rainy seasons, add Flex (CD).

* For arthritis with redness, inflammation, swelling, and burning pain, add Flex (Heat).

* For muscle spasms and cramps, add Flex (SC).

* For pain related to bone spurs, add Flex (SPR).

* For back pain due to kidney stones, use Dissolve (KS).

* For back pain or soreness because of nephritis, use Kidney DTX.

* For dull back pain during menstruation, add Mense-Ease.

* For back pain resulting from obesity, use Herbalite to help with weight loss.

* For chronic, stubborn back pain with blood stagnation, add Circulation (SJ).

* With inflammation, add Astringent Complex.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Huatuojiaji points (Extra 15) in the back from L3 to L5 for lower back pain. Huatuojiaji points (Extra 15) from T1 to T12 for upper back pain.

* Hegu (LI 4), Yaotongxue (Extra 29), Huantiao (GB 30), Yaoyen (Extra 21), Shenshu (BL 23), Weizhong (BL 40)

 

Classic Master Tung's Points:

* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.

* Linggu (T 22.05), Chongzi (T 22.01), Chongxian (T 22.02), Wanshunyi (T 22.08), Wanshuner (T 22.09), Zhongbai (T 22.06), Zhengjin (T 77.01), Zhengzong (T 77.02), Zhongjiuli (T 88.25), Tongshen (T 88.09), Tongwei (T 88.10), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Shuijin (T 1010.20), Shuitong (T 1010.19), Chengshan (BL 57), Biyi (T 1010.22), Zhitong (T 44.13)

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* For acute pain, bleed first then needle.

* For chronic pain, needle first then bleed.

* Mid back pain: Needle contralaterally Chongzi (T 22.01), Chongxian (T 22.02), Zhengjin (T 77.01), Zhengzong (T 77.02). Bleed ipsilaterally popliteal fossa or local tender spot.

* Low back pain: Bleed ipsilaterally popliteal fossa or local tender spot.

§ L1-L3 pain: Needle contralaterally Zhongbai (T 22.06), Xiabai (T 22.07).

§ L4-L5 pain: Needle contralaterally Dabai (T 22.04), Linggu (T 22.05).

§ S1-S2 pain: Needle contralaterally Wanshunyi (T 22.08), Wanshuner (T 22.09).

* Hip pain: Needle contralaterally Jianzhong (T 44.06), Xiaqu (T 44.15), Shangqu (T 44.16), Yunbai (T 44.11), Libai (T 44.12). Bleed ipsilaterally popliteal fossa or local tender spot.

* Sciatic pain: Needle contralaterally Dabai (T 22.04), Linggu (T 22.05), Wanshunyi (T 22.08). Needle ipsilaterally Weizhong (BL 40), Kunlun (BL 60), Zuqianjin (T 77.24), Zuwujin (T 77.25).

 

Balance Method by Dr. Richard Tan:

* Needle the following points on the side opposite the pain: Hegu (LI 4), Houxi (SI 3), Wangu (SI 4), Linggu (T 22.05), Dabai (T 22.04), Zhongbai (T 22.06), Dazhong (KI 4) or ah shi points nearby, and Fuliu (KI 7), Ququan (LR 8) or ah shi points nearby.

* Needle the following points on the same side as the pain: All ah shi points nearby Chize (LU 5), Kongzui (LU 6), Shaohai (HT 3) to Lingdao (HT 4), Shugu (BL 65).

* Needle ah shi points around Fengfu (GV 16) to Houding (GV 19).

 

Ear Acupuncture:

* Back, Lumbago, Small Intestine, Adrenal Gland, Pituitary Gland

* Embed ear needles or use ear seeds.

* Ten treatments equal one course.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Low back pain due to Kidney qi deficiency: Corresponding points (to the area of pain in the Lumbar and Lumbar Muscle Area), Kidney, Liver, Spleen, Endocrine, Coronary Vascular Subcortex, Large Auricular Nerve, Lumbar Area

 

NUTRITION

* Eat a diet with a wide variety of raw vegetables and fruits, and whole grain cereals to ensure a complete supply of nutrients for the bones, nerves, and muscles.

* Adequate intake of calcium is essential for the repair and rebuilding of bones, tendons, cartilage, and connective tissues.

* Fresh pineapples are recommended as they contain bromelain, an enzyme that is excellent in reducing inflammation.

* To relieve cramps and spasms, eat plenty of fruits and vegetables, especially those high in potassium such as bananas and oranges. Also drink an adequate amount of water, as back pain may be due in part to dehydration.

* Adequate intake of minerals, such as calcium and potassium, are essential for pain management. Deficiency of these minerals will lead to spasms, cramps, and tense muscles.

* Avoid red meat and seafood in the diet as they contain high levels of uric acid, which adds strain on the kidneys.

* Avoid cold beverages, ice cream, caffeine, sugar, tomatoes, milk, and dairy products.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* To help tonify the Kidney

§ Make soup with green beans, black beans, azuki beans, and a pinch of cinnamon.

§ Slowly cook (2 to 3 hours) ½ cup black beans, ½ cup water, and ¾ cup rice wine.

§ Eat a handful of curry cashews daily. Make curry cashews by dry roasting cashews in a pan and sprinkle with curry powder for a couple of minutes on high flame. Remove promptly and avoid burning the cashews.

§ Eat a small handful daily of pecans that have been soaked in sherry or port for one week or more.

 

LIFESTYLE INSTRUCTIONS

* Patients are advised to use their legs (instead of bending their back) when lifting heavy objects.

* Exercises for stretching and strengthening the back muscles are essential for long-term recovery. Strengthening the stomach muscles is also beneficial as it reduces the strain on the lower back.

* Mild exercise such as swimming, yoga, or tai chi chuan [tai ji quan] is recommended.

* Weight loss is suggested to decrease the pressure on the joints and relieve pain.

* Proper balance of work and rest is very important. While sitting, make sure the back is straight and the elbows and knees are bent at a 90° angle. Take a break at least once every hour to alleviate the pressure on the vertebrae and disks.

* Mild back pain can be relieved with application of heat to stimulate the blood circulation. Massage, hot packs, saunas and whirlpools are recommended.

* Hot baths with Ai Ye (Folium Artemisiae Argyi) or Epsom salts help to relax tense muscles, invigorate blood flow and draw toxins from tissues. Rest and relax in the bath for about 15 to 30 minutes, but avoid becoming over-tired from the heat and soaking. Mix about 2 to 3 tablespoons of Ai Ye (Folium Artemisiae Argyi) extract powder in the hot water each time.

* Patients are encouraged to wear clothing that cover their back completely, and tuck their shirts into their pants or skirts to avoid any wind exposure to their back, which can further aggravate the condition.

* Firm beds are recommended over soft ones for patients with back pain.

* Finally, adequate rest is essential to recovery.

 

CASE STUDIES

* G.P., a 57-year-old female patient, presented with low back pain she had been experiencing for ten years. Her blood pressure was 116/62 mmHg. Objective findings included tenderness upon palpation of L4/L5 area, as well as limited range of motion while performing lateral flexion on both the left and right side. The practitioner diagnosed this condition as Kidney deficiency. After taking Back Support (CR), the patient felt improvement in her mobility and was able to move around in confidence. She also reported that she was able to walk and stand for longer periods of time. The patient stopped taking Vicodin (hydrocodone/acetaminophen) she was prescribed by her medical doctor and continued to take two more bottles of Back Support (CR). Submitted by G.S., Pasadena, California.

* B.F., a 35-year-old male, presented with mid-back pain, especially during exhaustion and stress. Patient has no desire to take pain killer and was looking for alternative medicine to help. No recent injuries were mentioned; however, he had a history of a sports injury 15 years ago. The practitioner diagnosed his condition as Kidney yang deficiency, blocked channels, and Spleen qi deficiency. After taking Back Support (CR) for six weeks, the patient reported his pain decreasing from 6 to 0, based on a scale from 0 to 10 (with 10 being the most painful). He now only takes the herbs and receives acupuncture as needed. Additional lifestyle changes recommended were applying heat, and core strengthening exercises. Submitted by L.M., Las Vegas, Nevada.

* J.J., a 55-year-old female, presented with pain in the back, neck and shoulder areas. The practitioner diagnosed this condition as qi and blood stagnation located in the Urinary Bladder and Small Intestine channels. Upon diagnosis, Back Support (CR) was prescribed for treatment. As a result of taking Back Support (CR) and also receiving acupuncture, cupping, and electrical stimulation, the patient’s posture improved and was able to stand up straighter, and experienced an overall decrease in pain. Submitted by B.S., Niceville, Florida.

* A 58-year-old female presented with back pain she’d had for 15 years, that was worse upon waking and better with activity. Most recently, she had hip pain for five months that felt deep in the acetabulum region. Tendon pain located antero-medially near the groin was also noted. No structural abnormalities were found upon further investigation. The practitioner diagnosed the condition as qi and blood stagnation in the Urinary Bladder and Gallbladder channels. After taking Back Support (CR), her back pain decreased and since then, she experienced less muscle stiffness, especially in the morning. Her previous radiating hip pain is now less severe and infrequent. She has also noticed that walking, which was painful for her in the past, has become almost pain-free. In addition to Back Support (CR), she also took Wobenzyme and has improved her diet. Submitted by J.M., Baltimore, Maryland.

* A 56-year-old female presented with severe back pain, joint pain, morning stiffness, and difficulty walking, which were all attributed to degenerative joint disease. Standing and bending aggravated her pain. She found relief with rest. Severe irritation and discomfort were evoked during lumbar range of motion. The practitioner diagnosed the condition as cold-damp stagnation in the Urinary Bladder channel with underlying Kidney deficiency. The patient was treated with Back Support (CR) along with acupuncture. Soon after, the patient reported that she was able to walk without difficulty and stand without pain for longer periods of time (30 to 60 minutes). Eventually she was able to return to a painless level of activity and function. Submitted by M.I., San Pedro, California.

* A 45-year-old male presented with pain in the low back and buttocks. On a pain scale from 0-10 (with 10 being the most painful), the patient rated his pain as a 7. There were decreased range of motion in the lumbar spine, and radicular pain on the right side. He was diagnosed with a herniated disc in the lumbar spine. After taking Back Support (CR), the patient stated that the severity of the pain decreased on a daily basis from 7 to 4. Submitted by G.P., Lawndale, California.

* A female patient suffering from lower back (L4 area) pain radiating down the left hip was unable to lie on her back. On examination, her left leg was shorter than the right. The patient reported that the pain was caused by a twisted pelvis from a tailbone injury years before: her tailbone projected outwards, and her knees were swollen and painful. She also suffered from gout. X-ray showed bone spurs in the lower spine. After taking Back Support (CR), she was able to lie on her back for almost an hour without pain, sit for a longer period of time with less pain, and sleep restfully. She also experienced more flexibility in the lower spine while doing yoga. Submitted by S.M., Midline, Michigan.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Back Support (CR) is an excellent formula for rehabilitation from chronic back injuries, such as repetitive injuries or long-term wear and tear of the muscles and joints. As a result, the chronic nature of this condition may eventually contribute to atrophy and degeneration, accompanied by decreased mobility of the joints, and generalized weakness and pain of the muscles. Back Support (CR) contains herbs with chondroprotective, osteogenic, anti-inflammatory, analgesic, and muscle-relaxant functions.

        Back Support (CR) contains many herbs to strengthen and rebuild soft tissues, including muscles, tendons, and ligaments. Chuan Niu Xi (Radix Cyathulae) shows a great chondroprotective effect against cartilage-degrading disorders, and is an excellent herb to protect the cartilage from repetitive and stress-induced injuries. According to one study, the extract of this herb has a potent effect to inhibit the induction of MMP-13, an important enzyme for the degradation of the cartilage collagen matrix, especially under arthritic conditions by down-regulating the MMP-13 activity.[3] Wei Ling Xian (Radix et Rhizoma Clematidis) also has an excellent chondroprotective effect. According to one study, the saponin fraction from Wei Ling Xian (Radix et Rhizoma Clematidis) is effective in ameliorating joint destruction and cartilage erosion in subjects with osteoarthritis. The mechanisms of action for protecting articular cartilage are through preventing extracellular matrix degradation and chondrocyte injury.[4] Another study demonstrates that the acetone extract of Wei Ling Xian (Radix et Rhizoma Clematidis) has significant and dose-dependent inhibitory effects on the pro-inflammatory and degradative mediators associated with inflammatory arthritis. Wei Ling Xian (Radix et Rhizoma Clematidis) inhibits prostaglandin E(2), metalloproteinase (MMP-3 and -13), and cyclo-oxygenase-2 production by primary human chondrocytes stimulated by lipopolysaccharide.[5] Lastly, Wei Ling Xian (Radix et Rhizoma Clematidis) also shows a beneficial effect for the treatment of osteoarthritis by preventing apoptosis in primary cultured articular chondrocytes induced by adenoviral TNF-related apoptosis-inducing ligand.[6]

        Back Support (CR) also has many herbs to strengthen and rebuild bones. Du Zhong (Cortex Eucommiae) has significant osteogenic and antiosteoporotic effects to promote generation of new bones and prevent osteoporosis. According to a bone cells culture experiment, administration of Du Zhong (Cortex Eucommiae) shows a potential effect to increase the proliferation and differentiation of the osteoblasts without affecting osteoclast activity. The researchers conclude that these herbs can effectively increase the rate of tissue regeneration of damaged bones.[7] According to another study, use of Du Zhong (Cortex Eucommiae) for 16 weeks shows a marked effect to protect subjects from estrogen deficiency-induced osteoporosis. In a dose-dependent manner, the herb improves bone biomechanical quality through modifications of bone mineral density and trabecular microarchitecture without hyperplastic effects on the uterus. The researchers suggest that Du Zhong (Cortex Eucommiae) might be a potential alternative medicine for treatment of postmenopausal osteoporosis.[8] Sang Ji Sheng (Herba Taxilli) has significant osteogenic and antiosteoporotic actions to promote generation of new bones and prevent osteoporosis. According to a bone cells culture experiment, administration of Sang Ji Sheng (Herba Taxilli) shows a potential effect to increase the proliferation and differentiation of the osteoblasts without affecting osteoclast activity. The researchers conclude that these herbs can effectively increase the rate of tissue regeneration of damaged bones.[9]

        Back Support (CR) utilizes many herbs with anti-inflammatory effects to treat pain and inflammation in the lower back. Ji Xue Teng (Caulis Spatholobi) exhibits an anti-inflammatory effect through its inhibitory activities against a panel of key enzymes relating to inflammation, including cyclo-oxygenase, phospholipase A(2), and lipoxygenase (5-LO).[10] Mu Gua (Fructus Chaenomelis) reduces inflammation and relieves arthritis via prevention of ultrastructural changes of synoviocytes and inhibition of secretion of pro-inflammatory cytokines, such as interleukin-1 (IL-1), tumor necrosis factor-alpha (TNF-α), and prostaglandin E2.[11] Wei Ling Xian (Radix et Rhizoma Clematidis) exerts its significant anti-inflammatory effect by blocking the production of the pro-inflammatory mediators, nitric oxide and prostaglandin E(2).[12] Furthermore, Du Zhong (Cortex Eucommiae) demonstrates marked anti-inflammatory effects through its stimulating effect on the endocrine system and consequent secretion of steroids from the adrenal cortex.[13] Di Huang (Radix Rehmanniae) exerts an anti-inflammatory effect to reduce swelling and inflammation via its influence on the endocrine system.[14] Lastly, Du Huo (Radix Angelicae Pubescentis) has a mild sedative effect and marked analgesic and anti-inflammatory effects.[15] Clinically, Du Zhong (Cortex Eucommiae) has been used successfully in an herbal formula to treat six patients with sciatica,[16] Di Huang (Radix Rehmanniae) has been used in an herbal formula to successfully treat 12 patients with rheumatoid arthritis,[17] and Wei Ling Xian (Radix et Rhizoma Clematidis) has significant effect to inhibit pro-inflammatory compounds and prevent rheumatoid arthritis.[18]

        Bai Shao (Radix Paeoniae Alba) and Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) are two of the most effective herbs to relieve pain, reduce inflammation, and alleviate spasms and cramps. Pharmacologically, these two herbs have shown marked analgesic, anti-inflammatory, and muscle-relaxant effects.[19]^,[20] Bai Shao (Radix Paeoniae Alba) exhibits an excellent anti-inflammatory effect to treat arthritis by modulating the pro-inflammatory mediators production from macrophage-like synoviocytes.[21] Zhi Gan Cao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) illustrates marked anti-inflammatory effects by enhancing the effect of glucocorticoids through increased production and secretion as well as decreased metabolism by the liver, along with increased plasma concentration caused by decreased protein binding.[22] Clinically, these two herbs have been used to treat a wide variety of musculoskeletal disorders. According to one study, use of these herbs via intramuscular injection was associated with an 84.67% rate of effectiveness (105 out of 124 subjects) to treat general complaints of pain.[23] More specifically, these two herbs have also been found to effectively treat pain in the lower back and legs among 33 elderly patients,[24] as well as severe pain of the back and legs in 27 patients.[25] Furthermore, the combination of these two herbs was effective in relieving nerve pain (neuralgia) in 30 out of 42 patients.[26] According to another study, the use of these two herbs was also effective for muscle spasms and cramps in various areas of the body, including muscle spasms and twitching in the facial region in 11 patients,[27] intestinal spasms in 254 patients,[28] and intestinal cramps and spasms in 85 patients.[29]

        In summary, Back Support (CR) is an excellent formula that contains herbs with analgesic and anti-inflammatory effects to relieve pain and inflammation associated with back pain. Furthermore, it also utilizes herbs with chondroprotective and osteogenic functions to repair cartilage erosion, protect joint destruction, and promote generation of new bones.

 

COMPARATIVE ANALYSIS

Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing, or aching). Pain may be of acute or chronic state, and may be of nociceptive, neuropathic, or psychogenic origin. For acute pain, use of non-steroidal anti-inflammatory agents (NSAID), and opioid analgesics offer immediate and reliable effects to relieve pain. Though these drugs have serious side effects, short-term use can be justified because the benefits often outweigh the risks. For chronic pain, on the other hand, use of NSAIDs and opioid analgesics are usually not the desired treatment options, as they symptomatically relieve pain, but do not change the underlying course of illness. Unfortunately, the convenience of these drugs contributes to the vicious cycle of pain, followed by continuous and repetitive use of drugs to symptomatically relieve pain. When the effect of the drugs dissipates, patients are often left with nothing but more pain and more complications from side effects. Therefore, it is important to understand that while these drugs may be beneficial for acute pain, they do not adequately address most cases of chronic pain. Additional treatment modalities must be incorporated to ensure effective and complete recovery from chronic pain conditions. [Note: Common side effects of NSAIDs include gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headache. Serious side effects of newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], include significantly higher risk of cardiovascular events, including heart attack and stroke. Side effects of opioid analgesics [such as Vicodin (APAP/Hydrocodone) and morphine] include dizziness, lightheadedness, drowsiness, upset stomach, vomiting, constipation, stomach pain, rash, difficult urination, and respiratory depression resulting in difficult breathing. Furthermore, long-term use of these drugs leads to tolerance and addiction.]

        Treatment of chronic pain is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnation), and locations (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture, and tui-na therapies. All these therapies work together to tonify the underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. TCM pain management targets both the symptom and the cause of pain, and as such, often achieves immediate and long-term success. Furthermore, TCM pain management is often associated with few or no side effects.

        In conclusion, for treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects as Western medicine with significantly fewer side effects. Though TCM therapies may not be as potent as the drugs for acute pain management, they are often superior [better effects with fewer side effects] for chronic pain management.