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Sandy Williams

Sandy Williams

Tuesday, 25 November 2014 17:08

Can acupuncture help spondylolisthesis?

Q: ] I have been diagnosed with Spondylolisthesis (slipped disc).  I have spent  approximately £600 on chiropracty and podiatry and  would like to know if acupuncture would be effective. 

A:  We are always a little reluctant to make claims for the potential success of acupuncture treatment when there has been structural change in the body that is unlikely to reverse. In some cases, for example, the use of acupuncture treatment to strengthen muscles which then cause someone's posture to revert to its normal position is well-documented, and many practitioners work alongside osteopaths to off a two-pronged approach to treatment. If the spondylolisthesis you have involves a relatively short forward displacement, there may be some possibility that this may be of considerable benefit. In this case, however, we would usually be guided by the osteopath's view of what is happening; they are, after all, the experts in bone and structure.

Conventional treatment is generally about pain management through anti-inflammatories, steroids and some physiotherapy. Acupuncture treatment has a long history of being used for chronic pain; indeed, this is one of the more frequently researched areas, mainly because the markers of pain and pain relief in body chemistry are easily measured and mean that research can be quantified easily. Our factsheet on chronic pain

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

is generally pretty upbeat about what can be achieved. In clinical practice most of us do not find the reduction of pain difficult to achieve. What really matters is the extent to which the pain is relieved and how sustainable the relief is. In the end it may come down to a financial equation - if someone needs weekly treatment almost indefinitely but as a result can function nearly normally, that hay be the equation they have to deal with. We know that some practitioners are not happy to work indefinitely without making long-term improvements, but occasionally treatment can be about stability or ever getting worse slower, so if a patient is happy to be kept going in this way, so be it.

Since each case of a condition like this is likely to be unique, we think that the only realistic advice is to visit a BAcC practitioner near and ask for a brief face to face assessment of what they think they might be able to achieve. Most practitioners review progress after the first four or five sessions when dealing with chronic conditions, and if there is no improvement consider the benefit of continuing while the bill has only reached the £200 mark. If the practitioner can sense changes in some of the diagnostic signs which make them believe that change is on the way, then the patient can make an informed decision about whether to continue rather than simply run up a large treatment bill without tangible results.

Tuesday, 25 November 2014 17:02

Developing pain after acupuncture

Q: I went for accupunture treatment for vertigo and had  8 sessions. I developed pain in my lower abdomen and  pain while urinating.  Could it be a result of accupunture, or just a coincidence?

A:Our first reaction is that this is probably a coincidence, but it never pays to be over-assertive without a great deal of information to go on. Much would depend on where the needles were inserted and what kind of manipulation was applied to them. There are no standard treatments for vertigo, and the phrase we frequently use, that we treat the person not the condition, could mean that the needles were applied anywhere depending on your overall balance.

What we can say with certainty, however, is that adverse events after acupuncture are rare, and where these do happen, the vast majority are minor and transient, i.e. only lasting a day or two at most and generally speaking things like a mild headache or feeling slightly unwell. Longer term problems are extremely unusual, and would have to involve physical damage to body tissues. For this to happen it would probably mean being very conscious of the injury as it happened. UK practitioners all use pre-sterilised one-use disposable needles and are thoroughly trained in safe needling, so the chances of infection from the needling are very small.

Whatever the cause, however, it is important that you seek treatment with your GP promptly. Although these are not in themselves what we would call 'red flag' symptoms requiring urgent medical attention, the pain in the lower abdomen and painful urination suggest a possible infection or mild inflammation. This needs to be checked so that appropriate treatment can be arranged. If there is any suggestion that the treatment may have been responsible this can be followed up later.

Q:  Do you know of a dentist in London who practices acupuncture and offers NHS treatment?  I don't mind where in London as long as I find one.

A: If you are looking for someone who incorporates the use of acupuncture into their dental work, the best bet is to contact the British Dental Acupuncture Society. However, we have had a few problems trying to locate them of late, their web address not seeming to work. It may be worthwhile contacting the British Medical Acupuncture Society with whom many dentists undertake training. This group can be contacted at www.medical-acupuncture.co.uk.

The majority of dental treatments are for calming the gag reflex rather than managing pain through the consultation. It is possible that anyone trained by the BMAS may have wider skills to hand, the only requirement for training being a registrant of a statutorily regulated healthcare profession, but whether they are entitled to treat conditions other than dental pain is something you would have to explore with them. The text on one of the dental insurers' sites is very useful in this respect:

Q. I am a dental hygienist with training in acupuncture. Am I allowed to use these techniques in the dental setting and do I need any additional indemnity?

There are some aspects of the provision of dental treatment that the General Dental Council's Scope of Practice simply does not cover. Acupuncture would be a good example. In the past the GDC has been a little cautious about its use in dentistry, presumably because they are not quite sure where it fits in. The use of holistic medicine and hypnosis would be other good examples. This lack of clarity from the GDC is not helpful, although they would probably argue that there does have to be a point where the scope of practice has to be at the registrant's discretion.

If a registrant is to consider using these techniques, they would need to demonstrate that they are competent to do so and have acquired the necessary training. A training course run for DCPs by a UK dental hospital would probably be regarded as appropriate training.

The difficulty would be how you might decide to use this additional skill in the dental surgery. As a hygienist, using acupuncture as some form of relaxation technique would not seem unreasonable. If you intended using acupuncture for the treatment of TMJ dysfunction this would be quite a different matter. For obvious reasons this type of treatment is a long way outside the scope of practice for a hygienist.

The use of acupuncture for a condition that was unrelated to dentistry would also be unacceptable. Indeed it would be necessary to ensure that a clear distinction was made between this alternative practice and the practice of dentistry. You could not, for example, advertise yourself as being a hygienist and in some way give additional credence to the treatment you provide from your GDC registration. On these occasions you would need to obtain additional indemnity from another provider.

There are overlaps which tend to complicate matters even further. It is, for example, the duty of all clinicians to provide advice on smoking cessation and to encourage patients to give up the habit. In the past, acupuncture (rather like hypnosis) has been shown to be quite successful in this respect. It is debatable whether the use of acupuncture in such a way is part of the practice of dentistry, or outside the dental field.

From Dental Protection's point of view, provided you are using acupuncture as part of dental treatment, there is no particular difficulty in relation to recieving an indemnity as a benefit of dental membership. This may change in the future if the GDC should decide that it falls outside the scope of practice for a hygienist.

Any DCP members finding themselves in a similar situation are invited to contact Dental Protection for advice.

We have done a brief web search for a dentist using acupuncture on the NHS in London and come up with nothing,so it may well be only through direct enquiry that you manage to locate someone. In this context it may well be worth contacting Guy's dental school http://www.guysandstthomas.nhs.uk/our-services/dental/overview.aspx. They offer emergency cover at all times and often seem to be in the forefront of new dental services. It may well be that someone there could advise you.

Q: I had a session of acupuncture to relieve some pain and inflammation. The acupuncturist I saw used points on my left hand and arm (close to the wrist).  During the treatment I felt a heavy pain moving up and down my arm which was quite uncomfortable.  When I got back home my wrist and hand swelled up and was painful. Today the symptoms remain the same . Should I worry or contact a doctor?

A: The short answer is, 'no, you shouldn't worry' but 'yes, you should see your doctor.'

Without knowing exactly what kind of acupuncture you had (traditional acupuncture according to Chinese Medicine principles or acupuncture from a doctor or physio) it's a little difficult to say with certainty what the heavy sensation was. There is a specific sensation elicited by the use of needles in traditional Chinese acupuncture which is called 'deqi', and which feels like a dull aching sensation which can travel along one of the channels in which the energy, or 'qi', flows. In China this is a sensation which the practitioner works hard to elicit, and many Chinese patients will not regard themselves as having been treated unless they feel this. In the West there is less insistence on making this happen, and often a greater use of Japanese needling techniques which cause little tangible sensation. If deqi occurs it is usually a good sign that the practitioner has managed to get things moving.

However, the wrist and hand swelling up is a little more of concern. The chances that there is an infection are remote. Most practitioners use pre-sterilised one-use disposable needles, and unless by a rare chance something was transferred from the skin surface to deeper tissue, there is unlikely to be an infection,. If there were the hand would be hot as well as swollen and quite clearly inflamed. The more likely possibility is that there has been some local bruising, possibly below the skin surface and not necessarily visible, which has caused some form of obstruction in the flow of blood and lymph tissue. The condition called carpal tunnel syndrome, which involved impingement of the nerves in the wrist near where your needles were inserted, can sometimes generate this as a symptom. In all probability the swelling will go down shortly.

However, with problems like this it is always safer to err on the side of caution, and we would advise you to make an appointment with your doctor as soon as possible for both reassurance and for immediate treatment should it turn out to be more significant. Doctors do not mind being consulted where something is unclear, and nobody benefits from a symptom being allowed to run unchecked for any longer than is necessary.

It may be useful to ask the practitioner exactly what points were used and where. This will certainly help the doctor to be able to diagnose what is happening

Tuesday, 25 November 2014 16:52

Can acupucture help facial pain

Q:  I have had problems with TMJ for approx 4 months.  My dentist has now fitted me with a splint which I am building up to wearing day and night .Would accupuncture help with this problem?

A:  We have produced a factsheet on facial pain which focuses heavily on tempero-mandibular pain

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/facial-pain.html

and the evidence for the effectiveness of acupuncture treatment is reasonable.

A great deal depends on the initial cause of the TMJ disorder. In many cases this may be a result of dental work itself, not least because some of the more difficult operations like root canal work and wisdom tooth extraction involve some considerable force being applied to what is a relatively unstable joint. This is not to blame dentists, though - it's just a possible risk of treatment like any other.

In Chinese medicine proper function determines structure, that is, if everything is working the way it should be, then the body will assume its proper shape. There are ways of analysing the flow of energies on the face and head which reveal whether they have been disrupted and whether treatment might reinstate them to good effect. This expert has certainly managed to deal with number of cases by using local treatment and on occasion used a much more systemic treatment when it is clear that the problem has been able to happen because of a generic weakness which has given rise to a local symptom because the musculature of the body was not as resilient as it should be.

However, that said, the people who may be able to offer the most direct help are cranial osteopaths. In this specialised sub-system of osteopathy, the TMJ is a central part of the focus of attention. The average osteopath's knowledge of treating it on a regular basis will far exceed the average acupuncturist's. That is not to say that acupuncture treatment may not be able to offer you some help. In fact, we would still recommend that you visit a BAcC member local to you for advice and an honest assessment of what they can do, and if they believe that referral to a local osteopath is a better bet, you will no doubt get a named referral, which is always better than picking a name at random out of a book.

Don't, though, under-estimate the value of advice from your dentist himself or herself. Many now offer much more comprehensive advice about the management of these issues, and often work closely with other professionals around them to provide joined-up care for their patients.

Tuesday, 25 November 2014 16:09

Can acupunctue help nerve damage?

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

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html

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.

Tuesday, 25 November 2014 16:05

Acupuncture and chronic pain

Q:  My son has a diagnosis of CPRS due to presumed ( imaging shows no other damage) nerve damage around the left ankle area following a football tackle. 10 months on the pain has not responded to NSAIDs, gabapentin or amitriptyline and a nerve block seems to have resolved little. Mobility remains impaired despite daily physio which is limited by the pain. Any thoughts or suggestions as to potential from accupuncture. His pain team say there is little positive experience in this area and given his localised neuropathic type pain, the chances of getting near him with needles makes it probably a non starter. I wondered whether local anaesthetic prior to needle insertion is possible?

A: If we can unpick your question accurately, against a backdrop of severe chronic pain for which no visible damage can be found and which does not respond to conventional treatment, the questions are first, whether acupuncture is worth trying, i.e. what level of evidence, if any, is there that it might work, and second, would the fact that your son is now hyper-sensitised, whether anyone could actually get needles in or near the affected area.

As far as the first question is concerned, there has been a long history into the use of acupuncture for chronic pain. Our website is down at the moment, or we would have posted an up to date reference to a fact sheet which can be found on the home page by following buttons to research and beyond. This identifies many studies which have been conducted over the years. The measures both for pain and natural pain relievers in the form of neurotransmitters are easily measured, and there have been dozens of studies which show that acupuncture can have an effect on pain. The usual question is not whether but how much and how sustainable the effect.

However, this takes us down a very western-medical route. Chinese medicine understood pain as the consequence of changes in the flows of energy through an area, either through injury or blockage or through systemic weakness. Often there is an overlay, where a systemic weakness predisposes to injury, but in the case of injury it is not uncommon for us to find a weakness in the flow which has no specific correlate in conventional medicine. This is why, often as the treatment of last resort, we have successes where the problem has not even been properly identified. However, each person is unique and different, and your best option would be to take your son to a BAcC member local to you for an informal assessment of what may be possible. Most of our colleagues are happy to give up a little time without charge to establish whether treatment would be advisable or beneficial.

As far as the needles are concerned, they are minimally painful, but we have come across situations where even the gentlest insertion was too much to bear. The beauty of the Chinese medicine system is that the complex interconnections mean that we have strategies for dealing with situations just like this. Received wisdom, for example, is that you never treat a limb where lymph nodes have been stripped, and it is not uncommon to treat the opposite limb or in some cases, the opposite lower limb. This can be very handy where someone is in a cast. The different points have resonance with each other, and even in mainstream treatment there are times when one uses points far away from the actual site of the problem. Any well trained practitioner should be versatile enough to deal with this kind of problem and provide direct treatment from a

Tuesday, 25 November 2014 16:02

How many session of acupuncture required?

Q: I have pcos and persistent rhinitis. I have had acupuncture by two practitioners. One hurt me, I  lost sensation in my head and collapsed when i got off the couch. The other was much kinder, helpful and caring but I felt that i wasn't getting any benefit after 4 months of weekly treatments. How many treatments should I require to notice some difference? I know it depends on the condition and severity but 16 sessions and no difference?

A:As you say, this is getting to be a substantial investment in time and money, and you need to know whether this is actually heading somewhere or has just become a kind of 'treatment habit.'

As you say, these can both be very stubborn conditions. With long term chronic problems it is often quite difficult to establish an analogue scale of improvement. With acutes it is far easier: 'how many out of 10 is your pain now?' With chronic conditions this is often trickier. One of our Japanese colleagues once remarked that if someone tells you they are 10% better, they're just telling you that you are a nice person and keep trying.

The best that one can do is to maintain a regular review, usually every four or five sessions, and to share with a patient the findings from a Chinese medicine perspective. There are a number of occasions where changes in the tongue and pulse can be quite radical without having yet filtered through into changes in the main conditions. If a practitioner is sure that there is progress they need to share this with the patient. It is also important to try to set measurable outcomes, difficult as this can sometimes be. It is very easy to be unable to say what happened last week, and with both problems there are usually some symptoms whose appearance can be charted. This can help to establish just how many episodes there have been and whether there has been a change.

If nothing happens, then there are a number of options. One is for the practitioner to seek a consultation with a colleague present or refer to someone else just to have a fresh pair of eyes looking at the case. Occasionally, though, it just has to be agreed that treatment isn't working, and the practitioner is usually in a good position to suggest alternative treatments which may help. Chinese Herbal medicine is often used alongside acupuncture to good effect, and although homeopathy has had a run of really bad press in recent years, this expert has several patients who have used homeopathy to treat both acute and chronic rhinitis when acupuncture hasn't done the trick (and stayed with acupuncture for other conditions).

The best person to address your concerns is your practitioner, however. None of us minds being asked about the benefits of treatment when results are slow in coming, and sometimes it marks a good time to call it a day. Good communication sidesteps many of the problems which can otherwise emerge.

Tuesday, 25 November 2014 15:58

Acupuncture related injury

Q:  This question is not strictly related to acupuncture, but i couldn't find answers anywhere else so I'm hoping an expert here could help me. Last week I accidentally punctured the palm of my hand with a large thumb tack by putting my weight on the desk when standing,  not realising the was an upturned pin under where I put my hand. It was a shock to say the least but the pain subsided quickly after I pulled the pin out. There was very little blood but my ring finger did twitch and my forearm felt tingly. Now a week on I am still feeling uncomfortable sensations in my ring finger, like a tightness and slight pain. The pin went in about two inches below the base of my ring finger. I should mention also that about a year ago I accidentally sliced open my hand about 1 inch below my ring finger and pinky. At the time I had it glued with butterfly stitches. There was no remaining pain once the slight swelling etc had gone down.

A: We're sorry to hear what has happened to you.

As you say, it isn't an acupuncture-related injury, but if we did have a patient report of similar response to an acupuncture needle, we would probably say that the reason for the continuing pain is most likely to be from deep bruising which has caused a clot to form and which is pressing on the nerve, replicating the pains you felt when the accident first happened. If this is the case, then it will clear within a fortnight or so with a gradual reduction in the unpleasant sensations.

It is possible that there has been some damage to the nerve itself, or any one of several nerves which traverse the area, and the outcome here may be a little more difficult to predict. We have certainly come across one case where a direct hit on a nerve generated unpleasant sensations for a number of months. However, this would be very rare, and if the symptoms continue with the same level of intensity thrughout the next fortnight, or even become a bit worse, then you will need to see your GP to get a referral to a neurologist. There may be no harm in seeing your GP early anyway; waiting list medicine sometimes demands that people try to get themselves on the treadmill sooner rather than later. If your GP has on inspection any reason to suspect nerve damage, then an early referral is a good idea.

On the balance of probabilities, though, the symptoms should begin to subside during this week.

As an aside, there are a number of powerful acupuncture points on the palm of the hand, and you may have given yourself an unwitting treatment. Two of the major channels travel where you report symptoms, but the chances that they would resonate for this long are very small. Not the nicest way to have acupuncture treatment either!

Q:  I have been diagnosed with Menieres disease which affects my right ear. I also get regular migraines which solmatriptan doesn't relieve. Since I believe both to be associated with restricted blood flow to the head, I'm wondering if acupuncture could help?

A: We have published a factsheet on migraines

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/migraines.html

which possibly does not so justice to the fact that these form one of the more common reasons why people turn to acupuncture treatment for relief. The research is not as good as it could be, and there are a number of reasons for this to do with trial design and identifying control groups. Suffice it to say that with the NICE guidelines now recommending acupuncture for the closely related problem of cluster headaches, there is increasing evidence that acupuncture treatment may well be of benefit.

Certainly this 'expert' believes that this is one of the conditions for which it is possible from the outset to be confident of some positive change. The challenge is making sure that people continue treatment after the migraines have become less frequent to ensure that they stay away. Again, this expert's experience is that it often takes regular maintenance treatment for a while longer than simply getting rid of the symptoms. Ideally people will keep on having maintenance treatment anyway, whatever the initial problem, but in this particular it does seem to be more advantageous.

We have again covered Meniere's disease in our factsheet on vertigo

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/vertigo.html

and generally speaking the evidence is encouraging. In a response to a query about the condition some time ago we said

However, as the systematic review cited says

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136456/

the majority of studies were generally comparing standard treatments with treatments plus acupuncture, and the model most respected and accepted in the West usually compares treatment with something which appears to be treatment, so called 'sham acupuncture' to assess whether the acupuncture really does work. As such, there is always some reluctance to accept results which are from more pragmatic trials. There is also often an unwarranted suspicion about the objectivity of trials and studies from China. The assumption is often made that because acupuncture is already an accepted part of the healthcare system there may be bias towards finding that acupuncture works, and there is no doubt that earlier trials were less interested in 'does it work?' than 'which treatment works better?'. However, times have changed, and the Chinese are as determined as anyone else to assess efficacy, and furthermore have the numbers of patients available to run meaningful trials very efficiently.

That said, we must always come back to the fact that this is Chinese medicine we are discussing, not the treatment of western diseases with Chinese techniques. There are ways of differentiating the symptoms which we call Meniere's disease into several different patterns or syndromes within Chinese medicine, and the treatment which someone would receive would take this into account as well as taking into account the underlying constitutional balance of the person as well. This itself will have a significant bearing on how well treatment may work. The skill of the practitioner lies in making sense of specific symptoms using an entirely different conceptual framework which takes into account how this symptom squares with other aspects of someone's health, and also checks whether the problem is systemic and to do with the internal functions of the body or, as is sometimes the case, a case of local blockage and stagnation, two concepts which reflect that fact that good health is premised on a proper flow of energies throughout the system.

Our best advice is to contact a BAcC member local to you and seek their advice on whether acupuncture treatment may benefit your particular presentation. We are confident that they will give you an honest assessment and if they believe acupuncture is not the best option they will direct you to other forms of treatment.

and we think that this remains good advice on all levels, especially the need to contact someone to discuss directly with them whether acupuncture might be beneficial.

We don't have specialists for conditions such as this. We suppose you could say that from our perspective all of our members are specialists in traditional acupuncture. The skill lies not in treating the condition but in treating the person who has the condition, i.e. establishing why this particular patient has this particular problem. You can be reassured that all practitioners will have treatment many similar cases of headache and balance problem, and be familiar with making sense of the way that these conditions are frequently generated within the system.

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