Acupuncture for Chronic Low Back Pain.

A 45-year-old construction worker with a 7-year history of intermittent low back pain is seen by his family physician. The pain has gradually increased over the past 4 months, despite pain medications, physical therapy, and two epidural corticosteroid injections. The pain is described as a dull ache in the lumbosacral area with episodic aching in the posterior aspect of both thighs; it worsens with prolonged standing and sitting. He is concerned about losing his job, while at the same time worried that continuing to work could cause further pain. The results of a neurologic examination and a straight-leg-raising test are normal. Magnetic resonance imaging (MRI) shows evidence of moderate degenerative disk disease at the L4-L5 and L5-S1 levels and a small midline disk herniation at L5-S1 without frank nerve impingement. The patient wonders whether acupuncture would be beneficial and asks for a referral to a licensed acupuncturist. Copyright © 2010 Massachusetts Medical Society. All rights reserved.