Between 65 percent and 80 percent of humans experience back or neck pain at some point in their lives. The elderly complain of back pain more often than any other musculoskeletal ailment.1 Whether small animals experience spinal pain with similar frequency is unknown. Perhaps the majority of animals afflicted with back or neck pain recovers spontaneously within six weeks, as do humans.2 For animals that do not recover, the pain frequently remains untreated, undertreated or treated inappropriately.3 Clients may misinterpret alterations in their animals' behavior as "slowing down," "getting old and grouchy" or "being stubborn." Mapping the Course Determining the proper course of action for spinal pain requires in-depth knowledge of veterinary anatomy and pathology. Some clients are tempted to pursue treatment from non-veterinarian chiropractors or physical therapists in lieu of proper diagnostics. Doing so may cause irreparable harm to the animal because of delayed diagnosis and improper treatment, especially when back pain arises from neoplastic or infectious causes.4 Nevertheless, clients may prefer a nonpharmacologic approach for their animal's condition, given the potential adverse effects of conventional approaches. Nonsteroidal anti-inflammatory drugs increase the risk of gastrointestinal bleeding and renal damage, especially in older animals. Narcotic analgesics cause constipation and straining to eliminate worsens the pain. Sustained inactivity from cage rest leads to deconditioning and may worsen spinal instability. A commonly overlooked source of musculoskeletal pain is the musculature itself and its enveloping fascia. Myofascial pain syndrome can sometimes mimic radicular pain or internal organ disease.5 The key to identifying this type of pain involves palpating for taut bands and trigger points encased within the myofascial fabric. Once identified, myofascial pain can readily respond to physical medicine approaches, such as acupuncture, even after medication has failed.6 7 Human Research Parallels Controlled trials and systematic reviews in human research provide increasingly stronger evidence that acupuncture effectively treats chronic spinal pain.8 9 10 Several uncontrolled studies have reported that acupuncture improves spinal pain of various causes in dogs and horses. According to Adrian R. White, MD, the author of several systematic reviews on acupuncture, "Acupuncture treatment should be considered for anyone who has nonspecific mechanical back pain that has persisted for six weeks or more despite standard treatment."11 12 In humans, 10 sessions of needle-body acupuncture produced stable, long-term effects lasting at least six months, according to a recently published prospective cohort study.13 A 2005 paper systematically reviewing acupuncture for chronic low-back pain echoed the findings of earlier work, concluding that adding acupuncture plus conventional treatment produced better analgesia and functional improvement than conventional treatments alone.14 Acupuncture Modalities However, not all acupuncture treatments are equal. Deeper acupuncture stimulation in humans with lumbar myofascial pain provides greater pain reduction than does superficial needling, although it causes more post-treatment soreness.15 Neuroanatomically focused acupuncture addresses spine-related pain by treating the nerves mediating pain from spinal structures.16 Stimulation of paravertebral somatic afferent fibers at acupuncture points along the spine suppresses activity in spinal nociceptive neurons.17 Benefits Acupuncture also works by affecting various aspects of the central nervous system. Acupuncture attenuates inflammation in part by activating the hypothalamic-pituitary-adrenal axis.18 Opioid peptides in the spinal cord and brain participate in endogenous pain control pathways.19 The reduction in central nervous system excitation helps dampen pain transmission and sympathetic tone. Acupuncture improves muscle blood flow, which benefits patients with chronic pain.20 Sustained stimulation from manual acupuncture reduces muscle tension by reducing alpha motoneuron excitability.21 --- Dr. Robinson, DVM, DO, Dipl. ABMA, FAAMA, oversees complementary veterinary education at Colorado State University.
