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Ask an expert - muscles and bones - neck

16 questions

Q:  My  mum (aged 72) has spondylosis and suffers greatly with pain in her neck and now has quite a pronounced curvature on her spine. Would acupuncture help with the pain anddiscomfort she is experiencing?

A:We actually gave a very comprehensive response to a question about pain relief and spondylosis some months ago. It said:

There are very few research papers for the treatment of spondylitis with acupuncture, and those which have become available are generally Chinese studies which are both small and often methodologically flawed. A good example is this one:

This does not mean that it has no significance. The problem is that in the West there is more focus on the 'does it work?' question rather than, until recently in China, a focus on 'what works better?'. When you are using a two-thousand year old tradition which is embedded in the culture the use of the western drug testing model, the randomised double blind control trial, is not likely to be
your model of choice. This latter test is not entirely appropriate for testing acupuncture, because reducing the variables to one is inconsistent with how good acupuncture is practised, so unsurprisingly the number of meaningful trials is limited.

That said, pain relief was one of the most heavily tested aspects of acupuncture treatment when it became more popular in the West, which is generally taken to be after Nixon's visit to China in the 1970s. The outcome measures for research purposes, the various neurotransmitters, and the patient reports of pain are easily measured, and many studies were done which showed that acupuncture does have an effect on the experience of pain. Our fact sheet on chronic pain cites a number of the better known ones. The main issue with using acupuncture for pain relief is weighing up the extent and sustainability of te relief against the cost of treatment, to put it bluntly. If, for example, treatment offers 48 hours of pain free life followed by a couple of days of bearable pain, then someone with deep pockets might find
acupuncture treatment a reasonable investment. The vast majority of us, though, are not in this position, and also the greater majority of practitioners tend not to like to continue treatment indefinitely if there is no sign of a permanent reduction in the levels of pain.

The key aim with a condition like spondylitis is not a reversal of the fusing of vertebrae ultimately caused by the condition but a breaking of the cycle of inflammation which tends to sustain itself, i.e. inflamed areas press against surrounding tissue and further aggravate the inflammation. If treatment, whether by medication or acupuncture, can break this cycle there is a chance of
maintaining a level of manageable pain. The disease label covers a wide range of presentations, and you would need to see a
BAcC member local to you for a brief face to face assessment of whether treatment would be worthwhile for you. From a Chinese medicine perspective there are also a number of systemic problems which can underpin what is in effect a local problem, and a practitioner will be able to assess quite rapidly what else may be going on in the system to inform the diagnosis in Chinese
medicine terms and to give a clearer sense of the prognosis. He or she, if you do decide to have treatment, will be very clear about setting clear outcome measures to see whether the treatment is working, and regular review periods to assess whether treatment continues to be of benefit. We think that remains good advice. The fact that your mother is 72 is not in itself an issue. The problem is more to do with the level of deterioration. In the parlance of modern supermarket advertising 'when it's gone it's gone', which means that in most cases a physical deterioration of bony structures limits the extent to which change can be effected. However, the
fact that someone has spondylosis and also has pain does not mean that there is an absolute correlation between the two. We have treated patients with severe deterioration and seen changes which were thought to have been impossible. It may well be that the pain was not a direct response to the physical issue. However, this is the exception, not the rule, and since each person's condition
is going to be unique to them in Chinese medicine terms, the best advice that we can give is to visit a local BAcC member for a brief face to face assessment of what may be possible.

Q: My boyfriend had acne when he was younger and took acutane for that. While the acne went away, it left him with considerable nerve damage where he had a constant  burning sensation on his face and scalp. The western medicine doctors say that it is because the medicine has made the nerve endings extra sensitive. The only relief that they recommend is painkillers, which is not working effectively either. Can acupuncture help with this? He used the acne medication 12 years ago and has been in chronic pain since.

A: This is a difficult question to answer. A great deal depends on the physical damage to the nerve endings caused by the drug, if this is indeed the cause of the problem. Chinese medicine has its limitations, as does any system of medicine, and if something has been damaged beyond repair, the best that one can hope for is a reduction in the severity of the symptoms.

On this score there may be some cause for hope. As our factsheets on chronic pain and neuropathic pain show

there is a fairly extensive body of evidence suggesting that acupuncture treatment may be helpful in reducing the severity of pain . While this is not conclusive, i.e. we can't say with certainty that treatment will help, pain management with acupuncture has been one of the most heavily researched areas since President Nixon's visit to China in the mid 70s and the remarkable photos of people having operations with needles alone. The markers for pain and pain control are easily measured, making it a very easy area to test. The main question is how much pain relief and how sustainable. If the relief is temporary and only ever reaches the same levels, then it becomes as much a financial problem as anything else - is the level of relief for the time it happens worth the expense?

However, from a Chinese medicine perspective there are other ways of understanding what is happening which may offer some hope. The theory of acupuncture is based on an understanding of the body mind and emotions as a flow of energy called 'qi', pronounced 'chee'. In very simplistic terms when the flow is deficient, excessive or blocked, pain results, and the skill of the practitioner lies in determining where best to treat to restore flow. This is particularly interesting when people present with scar tissue after operations or accidents where there is a literal break in the flow which is not always restored as the body recovers. It is just possible that the scarring which acne can cause has left some local disruption of flow as a legacy, and this might offer another avenue to explore.

The best solution, as we say on nearly every occasion, is to visit a BAcC member local to you for advice on the basis of a brief face to face assessment. Most members are more than happy to give up a little time without charge to cast an eye over a problem before committing to treatment.

Q: Good to have this blog to post questions.  My question is we have consulted a physio for neck pain and the physio instructed that it's due to trapezius muscle knot and he has given me acupuncture treatment. The neck pain has reduced but have the  trapezius muscle pain. I am worrying if its due to acupuncture treatment? What are the side effects for trapezius muscle acupuncture?

A:If we understand you correctly, the treatment for the neck involved releasing the trapezius muscle and now that the neck pain has reduced the trapezius is painful instead.

A great deal depends on how long it is since the treatment was given. Many physiotherapists use forms of what is known as 'trigger point' acupuncture. This is a western acupuncture approach which involves locating and treating tight spots in the muscle fibres which cause pain where they are and also cause muscle contraction which can then cause pain further down the line. Trigger point treatment often involves using longer and thicker needles than we would use in traditional acupuncture, and the treatment itself can sometimes leave a painful area for a few days. There is sometimes a little internal bruising after this technique, and this can also take a short while to go. You could normally expect this kind of pain to go after 48-72 hours, although if the treatment has been epecially vigorous this may be as long as a week.

If the pain persists after this the first person you should speak to is the physion himself; he will be in the best position to assess what is happening because he will know exactly what he has done, and may be able to apply further treatment and exercises to help to resolve the problem. If this does not do the trick then the next port of call is your GP. However, we strongly suspect that the problem will have gone long before you reach this stage.

The other possibility to consider is that sometimes a severe pain can overshadow another pain in the same area, and when the primary pain goes, the second one becomes more noticeable. This is very common in feedback when people have multiple problems. Here again the physio is the best person to speak to. If he has managed to reduce the neck pain, then he can probably release the trapezius pain too.

There shouldn't be any especially noticeable side effects from this treatment. Clearly if the treatment is vigorous you may feel a little bruised in the area for up to 48 hours, but if the physio recognises from your first session that you are quite sensitive to the needling he may well reduce the intensity of the treatment to make the after-effects a little less noticeable.

We hope that this reassures you.

Q:  I am suffering from severe neck pain.  Also how do I go into studying acupuncture and go into this field of work?

As far as the neck pain is concerned, there is considerable evidence for the use of acupuncture for a number of problems which can manifest as neck pain. Our factsheets on pain relief, osteoarthritis and so on, which can be found at this location

all point to encouraging studies which, although far from conclusive, would indicate that you may well get some relief from treatment.

We are a little concerned about the use of the word 'severe', however. The first thing we would ask if your were a patient would be not just a description of all aspects of the pain, but more importantly how it has developed. In modern life there are many reasons why people develop neck pain, in the use of computers for hour after hour, for example, and if their work depends on this they sometimes have to keep soldiering on to the point where a niggling pain may become something far more severe. There are also a number of accidents or near misses which can leave people in this state, and which may or may not have been thoroughly checked out.

We would probably want to be reassured that you had had some conventional medical tests like Xrays or scans to establish where there is a physical cause. Our concern would be that acupuncture treatment might offer pain relief and reduction of some of the inflammation but leave an underlying problem untreated which might deteriorate further. This may sound alarmist but is simply common sense; we believe that patients should get the best of all possible worlds, and if there is structural damage no amount of treatmentis going to change that. Unlikely, it is true, but we would need to check.

The best advice we can give is that you visit a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture treatment may be of benefit. This will enable them to ask the kinds of question that we might, and to advise you accordingly.

As far as studying acupuncture is concerned, we offer automatic elegibility to graduates of courses accredited by the British Acupuncture Accreditation Board, a list of which can be found here:

There are other courses, but we believe that these have the highest standards of training and enable us to maintain the standards of professionalism which we espouse.

We hope that if you do decide to have acupuncture treatment it works well for you. Nothing could be a greater encouragement to start training!

Q:  I have a badly knotted neck down into my shoulder due, I think, to a lactic acid build up. Can acupuncture help or is massage a better route?

A:  This need not necessarily be an either/or; many of our members are also trained in tui na, which is a form of Chinese massage using the same energetic principles as the acupuncture treatment itself. A large number of members are also trained in forms of conventional massage, and it may well be possible by using a careful google search to find a BAcC member near you who does acupuncture and massage. He or she will be able to use their professional his/her professional judgement about what is the most appropriate way to go forward.
As a general principle, though, we would say that the most important thing to establish is whether the problem is a local one involving a specific set of muscles or whether it is the local manifestation of a deeper problem which requires a different treatment strategy. This is the sort of judgement on which we would find it difficult to speculate at a distance. We would want to see where and how the problem manifests, and ask a great many questions about its onset (gradual or sudden), how it manifests, what makes it feel better or worse, and so on, to get an idea of what may be happening.
Our best advice is for you to visit a BAcC member local to you to ask their opinion of whether acupuncture treatment may be benefical. If they are dual qualified, as we mentioned, then they will be ideally placed to assess what may be the best option for you. Even if they are not, most will know very quickly whether it lies within their limits of competence and advise you accordingly. 

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