| Objective: By comparing the clinical efficacy of the three intervention methods of needling local pain points,needling distal pain points and needling both local pain points and distal pain points in the management of non-specific low back pain,we optimized the needling intervention plan for the use of pain points in the treatment of non-specific low back pain,so as to increase the clinical efficacy of acupuncture in the treatment of non-specific low back pain.Methods: With patients with non-specific low back pain as the target population,those who met the inclusion criteria for this study were randomly divided into three groups using a randomized,one-blind trial design method: the local pain point acupuncture group(referred to as the local pain point group),the distal pain point acupuncture group(referred to as the distal pain point group)and the local distal pain point acupuncture group(referred to as the local distal pain point group).Each group consisted of 30 patients.The specific treatment methods are as follows:(1)the method of determining the pain point:(1)the area where the patient complains of the most pain can be used as the pain point(2)the same doctor presses the corresponding area with the same strength with the thumb,and when the patient complains that a certain pressure produces "pressure pain","soreness" When the patient complains that a certain pressure produces "pressure pain","soreness","swelling pain" and other sensations,the site is identified as the pain point and marked with a marker.The patient’s most painful point was used as the pinpoint.(3)Division of local pain points and distal pain points: taking the first lumbar vertebra and the hip line and the mid-axillary line on both sides as the boundary,the pain points in this area of the back of the body are local pain points;the pain points in the area below the hip line are distal pain points.(4)If the location of the pain point overlaps with the selected acupuncture point,this location is treated as a pain point.(2)Acupuncture operation method:(1)Local pain point group: Let the patient adopt a prone position and sterilize at Kidney Yu(double),Large Intestine Yu(double),Wei Zhong(double),Diaphragm Yu(double)and pain points.After acupuncture,a twisting diarrhea method was applied,and the needles were retained for 30 minutes,with acupuncture needles performed at 15-minute intervals.(2)Distant pain points group: the distant pain points are firstly needled and then the Kidney Yu(double),Large Intestine Yu(double),Wei Zhong(double)and Diaphragm Yu(double)are needled,and the operation method is the same as that of the local pain points needling group.(3)Local distal pain point group:first needling the distal pain point,then needling the local pain point,followed by needling Kidney Yu(double),Large Intestine Yu(double),Wei Zhong(double)and Diaphragm Yu(double),and the operation method is the same as the local pain point needling group.The above three groups were treated once a day for 10 days for a total of 1 course of therapy.The patients’ visual analogue scale(VAS)scores,current pain intensities scale(PPI)scores and Oswestry dysfunction index questionnaire(ODI)scores before and after therapy were recorded as observation indexes.The efficacy assessments were in accordance with the standards of clinical outcomes in the Guidelines for Clinical Research on New Chinese Medicines of the Ministry of Health of China.The changes in the scores of the study subjects before and after treatment were statistically analyzed by the data processing system SPSS25.0,and the pain point selection scheme for using pain points to treat non-specific low back pain was preferentially selected,so as to optimize the acupuncture prescription for the treatment of non-specific low back pain by acupuncture.Result:1.By a statistical comparison analysis,there were no statistically meaningful significant differences in age,disease length,gender,pretreatment VAS scores,PPI scores and ODI scores of the three groups(P>0.05),indicating that the three study groups were comparable.2.Intra-group comparing of VAS scores,PPI scores and ODI scores before and after therapy in the three groups: the within-group differences in VAS scores,PPI scores and ODI scores before and after therapy in the local pain point group,distal pain point group and focal distal pain point group were found to be statistically significant(P < 0.05),indicating that the pain degree and waist function improved in all three groups before and after therapy.3.The comparison of VAS score,PPI score and ODI score differential between the three groups before and after treatment: the VAS score,PPI score and ODI score differential before and after therapy in the focal and distal pain point group were statistically meaningful compared with the distal pain point group and local pain point group(P < 0.05,P < 0.05);the VAS score,PPI score and ODI score differential before and after therapy in the local pain point group were statistically meaningful compared with the distal pain point group(P < 0.05);the VAS score,PPI score and ODI score differential before and after therapy in the local pain point group were statistically significant compared with the distal pain point group(P < 0.05).The difference of VAS score,PPI score and ODI score before and after treatment in the local pain point group was statistically meaningful compared with that in the distal pain point group(P < 0.05),indicating that there were differences in the efficacy of analgesia in the three groups,among which the local distal pain point group was the strongest,the local pain point was the second,and the distal pain point was the weakest;there were differences in the improvement of lumbar functional activities in the three groups,among which the local distal pain point group was the best,the local pain point group was the second,and the distal pain point group was the weakest.4.In comparing the clinical treatment efficacy of the three groups,the total working efficiency of the local pain point group was 73.3%,the total functioning efficiency of the distal pain point group was60.0%,and the total acting efficiency of the local distal pain point group was 93.3%.The clinical results of the local distal pain point group were statistically significant compared with those of the local pain point group and the distal pain point group(P < 0.05,P < 0.05),indicating that the clinical efficacy of acupuncture at the local distal pain point was higher than that of acupuncture at the local pain point or the distal pain point alone.The clinical efficacy of the local pain point group compared with the distal pain point group was statistically significant(P < 0.05),indicating that the clinical efficacy of acupuncture at local pain points was higher than that of acupuncture at distal pain points.Conclusion : The results of this study showed that all three modalities were effective in providing analgesia and improving lumbar mobility in patients with non-specific low back pain,but the clinical efficacy of acupuncture at local and distal pain points was better than that of acupuncture at local and distal pain points alone,and the clinical efficacy of acupuncture at local pain points was better than that of acupuncture at distal pain points,and this study provides a clinical reference for optimizing the prescription of acupuncture points for the treatment of non-specific low back pain using pain points. |
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