Volume 2, Number 4 | Winter 2007

Foreword
Guideline for Diagnosing and Treating Lower Back Pain and the Role of Kampo
The Guideline for treating lower back pain was first documented in the U.S. in 1994 and has since been
prepared in other countries. The latest Guideline was released in 2004 by experts from 14 European countries(Austria, Belgium, Denmark, Finland, France, Germany, Israel, Italy, the Netherlands, Norway, Spain, Sweden,Switzerland, and England). Each country’s efforts are designed to present appropriate interventions for lower
back pain since a large population with lower back pain has a significant influence on productivity andincremental medical and social security costs. The 2004 Guideline is the first guideline that refers both to acutelower back pain and chronic lower back pain whereas previous versions refer only to acute lower back pain.
It is said that as long as humans walk on two legs, lower back pain is unavoidable. Recent studies,
however, reject this notion as groundless. Although the root causes of lower back pain remain to be explained,some people who experience organic changes do not complain of pain. However, many people who do notexhibit medical abnormalities are plagued by persistent pain. If the cause is identified as lumber spine
degeneration for example, patients will undergo treatment no matter how painful it may be, and accept thedisease by making necessary changes in their lifestyle. If the cause is not known, patients may try one form oftreatment and switch to another. The aforementioned European Guideline contains the additional viewpointthat lower back pain whose onset is associated with stress is pain that is ongoing, or caused by biological or
sociopsychological factors including economic insecurity, as well as the conventional viewpoint that regards
lower back pain as physiological, structural, or biological damage.
Do YOU recall the male mummy (Ötzi the Iceman), frozen in the ice for 5,000 years, that was accidentally
discovered in 1991 near the Austrian-Italian border? The discovery is important in terms of both archaeology
and the history of anthropology. From the X-ray analysis of the mummy which indicates lumbar vertebral
degeneration and wear and tear of the knee joints, it is easy to assume that he was suffering from lower backpain and knee joint pain. What is further surprising is that the locations of the tattooes on his body closely
correspond to the meridian points for treating lower back pain and knee joints.
Although the cause of Ötzi’s lower back pain was identified by radiography, today’s guidelines do notrecommend the use of diagnostic imaging unless there is a strong reason to suspect a certain specific cause.
These guidelines also reject all traditional treatments based on common sense, and sound a warning against
the trend that operative treatment is easily opted for. The Guideline prepared in the U.S. in 1992 for treating
acute lower back pain recommends only administration of acetaminophen and NSAIDs as well as vertebral
manipulation for symptom amelioration. Complete rest is rejected, and physical therapy, acupuncture andwearing a corset are not deemed worthy as recommendations. The 2001 Guideline prepared in Japan does not
reject diagnostic imaging due to the importance of differential diagnosis of major diseases and recommends astreatment a combination of pharmacotherapy, physical therapy, therapeutic exercise and an educational
approach depending on the stage of the disease.
In Japan, acupuncture, moxibustion, and Kampo medicines are frequently used either on their own orcombined with other treatments. These are used based on an understanding of general body condition
associated with functional improvements or chronicity, with the aim of relieving symptoms as well as
enhancing the emotionally and psychologically damaged QOL, as pointed out in the European Guideline.
Moreover, Kampo medicines are expected to prevent gastrointestinal disorders and liver function impairment,and to reduce the dosing frequency of NSAIDs.

Akihiro Soma
Editorial Staff
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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