Gavin Erickson

Gavin Erickson

Monday, 20 February 2012 11:43

Bulging disc in neck causing arm pain

Q. My Father has a bulging disc in his neck which is pushing against his nerve, which in turn causes him pain down his shoulder and arm when the weather is cold. It's caused his arm to be extremely weak.

 

 

Tests have proven nothing wrong with his nerves but its a few discs which are pushing against the nerve causing the problem. Doctors have suggested surgery to replace the discs.

 

I was wondering if Acupunture is a feasible alternative to surgery? Can you please advise?

 

A. This is a very difficult question to answer. Generally speaking, when there is a physical change in the structure of the body, it would be foolish to suggest without qualification that acupuncture can correct it. The neck, in particular, is an area where structural changes through wear and tear as someone gets older are very difficult to treat. That said, acupuncture may be able to reduce to an extent any inflammation which is associated with the bulging disc.

In the case of sciatica, for example, which is sometimes caused by a similar problem in the lower spine, there is some evidence that acupuncture may reduce inflammation, as we point out in our fact sheet here

 

However, it is quite likely, if the doctors are proposing surgery, that things have gone a bit further, and the structural changes may well continue to cause inflammation, even if acupuncture treatment provided some relief in the short term. It would probably not be wise, therefore, to consider acupuncture as an alternative to surgery.

Chinese medicine treats the person, not the disease, however, and regards each person's patterns of energy as unique and different. There may be some merit in seeking advice from one of our members tocal to you who can perhaps see your father and assess whether in his case there is greater reason to feel that acupuncture may provide positive help.

Monday, 20 February 2012 11:33

Energy

Q. Energy has been a problem for most of my 69 years. I read that acupuncture may help. My GP only uses acupuncture on muscles, & cannot help. My Question is: Does an acupuncturist attend extra training to learn about energy? Are you aware of those who qualify in this acupuncture speciality? Many thanks.

 

A. We have to be a little careful with our terms here. Traditional Chinese Medicine has a clear understanding of the body, mind and spirit as different forms of 'qi', a word which is very difficult to translate, but which if often described as 'energy', or 'vital life force'. This is seen as the base material of everything, and through its different forms and their inter-relationships, described by using terms such as yin and yang, a complex understanding of the person on all levels is derived. Similar terms such as 'prana' and 'ki' are found in Inidan and Japanese thought. Acupuncture treatment is aimed at improving the flow of qi, removing blockages and sorting out relatuve excesses and deficiencies.

 

 

However, this is not quite the same as the 'energy' which people talk about when they say that they 'have no energy'. It's very true that feeling an utter lack of energy can be understood as a a problem with the qi, but that doesn't necessarily mean that it is something which a Chinese medicine practitioner can automatically sort out. What it does often mean, however, is that the paradigm of Chinese medicine is sometimes able to make sense of someone's symptoms and lifestyle in a way which is wholly unlike the way that western medicine views the person. The sense of feeling depleted and lacking the energy to do things is described in several of the syndromes and patterns recognised in Chinese medicine. Your best course of action is to seek out a BAcC member local to you and ask their advice on whether your specific and particular patterns are amenable to treatment.

Monday, 20 February 2012 11:26

Ear specialisms

Q. I have inner ear canal paresis of around 29% in my right ear and a preponderence ti the left of 27%. I have had some accupuncture treatment but was not sure my condition is treatable by accupuncture and the accupuncturist was rather young. Do you have an accuopuncturist in specializes in treating inner ear canal paresis? on your books?

 

A. The BAcC does not as yet recognise specialisms, although it is looking closely at how best to describe with groups practitioners who focus the majority of their work on one group, like children or pregnant women. Even where this is the case, the skills in Chinese medicine remain largely the same; it is often the additional conventional medical knowledge which defines expert practice. In theory any member of the BAcC is competent to treat people equally competently according to traditional chinese medicine principles. Clearly someone with many years of experience may have seen similar cases which could guide their thinking, but there are no practitioners of whom we are aware who focus on problems in the inner ear.

 

 

There is very little research evidence for the treatment of canal paresis with acupuncture. However, Chinese medicine operates in a way which it is difficult to put to the test in trials. Each patient is treated according to their unique and specific patterns, and the underlying premise, that if the energies of the body are in balance symptoms will resolve, means that in individual cases there can occasionally be profound changes to symptoms which have not responded to conventional treatment.

 

It would be fair to say, though, that even with the prevalence of people blogging their stories on the internet there are very few accounts of acupuncture having a great deal of effect on this problem, and we would hope that anyone offering treatment for this as a primary presentation is reviewing progress on a regular basis and not creating expectations which cannot be realised.

Adverse events arising from acupuncture treatment are quite rare. Safety surveys published in the BMJ a few years ago showed a likelihood of less than 1 in 10,000 of an adverse reaction to treatment. However, that does not mean they never happen.

 

 

In the first instance you should go back to the practitioner whom you are seeing to let them take a look at the problem. If the practitioner is a BAcC member he or she will be sufficiently trained in western medicine to recognise whether this is a temporary transient reaction or one which requires referral to a doctor. It will be useful to establish whether the part of the body where the inflamed spots are was in contact with any soaps, creams or lotions which might have penetrated the skin barrier. Since all the needles used by BAcC members are pre-sterilised, used once and then disposed of, the only way that a puncture point could become infected or inflamed would be from the needle carrying something from the skin surface into the dermis, or the puncture points not 'sealing' immediately after the treatment and something on the skin surface passing the outer payer of defence.

 

As a general point inflammation does not necessarily mean infection, and there are a small percentage of patients whose skin can react to needles in this way. This reaction is more often than not transient.

Tuesday, 14 February 2012 19:35

Normal response to needling?

Q. I have had an on going hip and leg problem since the summer. I am now seeing a local physiotherapist who on my last visit suggested acupuncture, as the needle first went in to my buttock my leg went numb for a second or so, I just wondered if this is a normal response or should I avoid acupuncture with him in the future?

 

A. People can experience a range of sensations when they are needled. People frequently describe a dull, aching numbness where the needle has been inserted, and in China this is seen as a necessary component of successful treatment. Other patients report a mild tingling sensation.

 

 

The sensation is most often local to where the needle was inserted. In some cases people can report that the sensation 'travels', and the pathway usually follows the channels or meridians which are described in Chinese medicine for the flow of energy. Some Chinese practitioners use a quite vigorous form of needling to create this effect in what they term 'propagated needle sensation', often used to treat a problem from a distance and often where someone wants to help an affected limb.

 

It is possible, therefore, that your physiotherapist has, consciously or not, achieved this sensation in using needles which, if they are being inserted in the buttock, are likely to be longer and more substantial than the needles that practitioners customarily use. The other possibility is that the needles have been used at a depth which has got close to the sciatic nerve, and the sensation arises from the proximity to the nerve. It won't have been a direct hit on the nerve, which you would have experienced as an electric shock.

 

The important point is that the reaction lasted only a second or two. Unusual as it is, this may still be worth putting up with if the improvements you get from the acupuncture outweigh this slight disbenefit. If, however, you find this disconcerting, you can simply ask the physio not to use needles again.

Tuesday, 14 February 2012 19:32

Adhesions

Q. My 28year old daughter has been off work for 1 year with debilitating abdominal pain, after the usual investigations it has been found that she has adhesionsin in her abdoman (although the doctors have not confirmed that this is the cause of her pain). With the exasperating out-look of trial & error pain killers for the next indefinate period whould acupucture be of help?

 

A. The doctor's caution in not concluding that the adhesions are causing the pain is justified; although adhesions can cause considerable pain in the lower abdomen they are by no means the only cause of chronic pain. Many people, for example, suffer from forms of irritable bowel syndrome with similar symptoms but without any obvious physical evidence like adhesions to identify as a possible cause.

 

 

The strength of Chinese medicine is that many of its diagnostic systems draw directly on the patient's description of the exact type, nature and location of the pain which they are experiencing, and can make sense of this in relation to the various functions in the lower abdomen and the patterns of flow of energy in the area. This can often provide treatment strategies which aim to relieve the pain by moving energy where it is blocked or in excess.

 

The best course of action would be for your daughter to visit a BAcC member local to where she lives to see whether they think that her problem is one which they consider might be helped by treatment. Chinese medicine treats the person, not the illness or disease, which is why it is always difficult to say 'acupuncture treats x' with absolute certainty; in some cases a practitioner might conclude that there are other more appropriate therapies to deal with a person's specific problem. However, people with ill-defined chronic abdominal pains often turn to acupuncture, and anecdotally there are frequent reports of a lessening of the frequency and severity of the condition. At this point, however, the research evidence is a little thin on the ground, but that is as much to do with the fact that running trials for conditions without precise definition is very difficult.


 

Tuesday, 14 February 2012 20:40

Crohn's disease

Q. I have had Crohn's disease for 23 years. I have managed this without drugs for the last 14 years (diet, exercise, healthy lifestyle) however the Doctors convinced me to start an immunosupressant drug about 6 months ago as they said the disease activity was very severe (even though I experience few, and only mild, symptoms). The drug does not seem to have worked and the doctors are suggesting I add another immunosupressant drug to this. I am really keen to prevent this so am looking for alternative treatments. I am aware that there is a body of research supporting the effectiveness of acupuncture in the treatment of Crohn's and was hoping you would be able to recommend somebody who has a knowledge/experience of this?

 

A. The use of acupuncture and moxibustion for the treatment of Crohn's Disease and related conditions such as ulcerative colitis has a long history in China. There are many studies which seek to establish what treatments are more effective, but most presume that acupuncture already works and are not accepted in the west because of methodological weakness. You will find individual studies which show some positive outcomes, such as

 

 

http://www.ncbi.nlm.nih.gov/pubmed/15114043

 

and a much quoted systematic review which is highly encouraging

 

http://www.ncbi.nlm.nih.gov/pubmed/17659687

 

but it would be a bit of a stretch to call this a 'body of evidence.'

 

There is always an element of concern in our advice when someone has a potentially serious condition which is being treated with conventional medication. If the markers for your illness are quite serious, in spite of the relative absence of symptoms, and serious enough for your doctors and consultants to want to try a second immunosuppressive drug, it would be irresponsible of us to recommend that you try to use acupuncture instead of this. Our advice would always be to use acupuncture treatment alongside conventional medicine for cases such as yours, and if and only if the markers reduce, then discuss with your consultant the possibility for reducing the prescribed medicines.

 

As far as our members are concerned, all are equally equipped to use Chinese medicine for the most frequent presentations in clinic; indeed, the generalist physician was honoured in ancient China above the specialist physician who was seen to be limited. There are one or two areas where members focus their work on specific groups of patients, like children or pregnant women, and they often take on board some additional conventional medical material to help them to work better with their patients. The entry level acupuncture skills are the same for all members, however, and experience usually means learning how to use the basic knowledge better, not learning more new knowledge. Any BAcC member located near you should be able to provide you with safe and competent treatment.

 

The majority of acupuncture provision in the NHS is through GPs and physios, both of whom offer acupuncture treatment within their existing scope of practice, i.e. it can be used as another tool in the toolbox for what they normally do. However, they are both limited by the evidence accepted in the west and by NICE guidelines in what they can offer, so treatment for many of the conditions for which people seek treatment from a traditional acupuncturist would not be available from a GP even if they did regularly offer acupuncture treatment.

 

 

There is very limited traditional acupuncture provision within the NHS. A small number of BAcC members are funded by PCTs and GP consortia to provide free treatment, but unless you are fortunate enough to live within the catchment area of one of these groups or individuals there is not much we can offer.

 

It is worth pointing out, though, that the majority of BAcC members are prepared to discuss their fees if someone really needs treatment but is unwaged or on benefits. There are also a number of multibed clinics set up by BAcC members which offer treatments in group settings for slightly lower fees. There are no rules set for these arrangements, and while few practitioners offer free treatments, many are willing to consider substantial reductions if someone's health is at stake.

A great deal depends on how the problem is being generated. It usually manifests in a pinching of one of the nerve roots in the neck, and if the cause is physical and of this nature, then acupuncture will have little long term effect, although it may be of value in bringing some form of temporary relief. If the pain is not arising as a result of pressure at the nerve root, there may be more hope

 

 

One of the strengths of acupuncture and Chinese medicine is the different understanding of the physiology and pathology of the body. This often allows it to make sense of a symptom or a group of symptoms in ways which are different from western medicine, because whatever system of medicine one employs, the patient's account of what they feel and the visible signs are the same. Chinese medicine has developed over 2000 years with a system of its own for classifying pain and discomfort by location, strength, heat or cold nature, how it feels - sharp, dull, etc, and has a number of ways of making sense of symptoms like yours which may help to reduce the level fo discomfort you are feeling.

 

The best course of action is to see if one of our members local to you is happy to spare you a little time without charge to assess briefly whether your specific problem is one which they feel they may be able to help.

A great deal depends on the relationship between the various symptoms you have and the Arnold-Chiari Malformation Type I which you have. If the symptoms are arising directly from the malformation it is highly likely that acupuncture might have minimal effect other than perhaps to reduce their severity. As you will see from the factsheets of evidence here for vertigo and headaches, there is a gathering body of evidence that acupuncture may be of value.

 

 

Tinnitus is a different matter. Although the factsheet here offers a small hope the reality is that tinnitus can be one of the most intractable problems to address, with many people investing huge amounts of time and money to no avail and then experiencing a total loss of symptom for no apparent reason.

Given the specific nature of the malformation you have, however, if you did decide to have acupuncture treatment your practitioner would benefit greatly from talking to your consultant(s) to detemine how much of your symptom pattern derived directly from the physical fault, and how much might simply be contingent. This would enable them to give a much clearer answer to how much they think they might be able to help you.