Gavin Erickson

Gavin Erickson

Wednesday, 29 February 2012 16:51

Post operation nerve damage healing

Q.  Hi. I have never had acupuncture before. I have a very rare bone conditon. I had surgery in April last year which involved breaking my tibia in two places and my fibula once, stretching my leg and puting a nail down the shaft of my tibia.

My foot and toes are still a bit swollen and sensitive but also numb.I can't stretch my little toes apart. My surgeon thinks it will return to normal in time. I wondered if acupuncture would be useful in aiding the healing of the nerves? Thanks.

 

A. One has to be very careful in giving advice in cases like this. From a Traditional Chinese medicine perspective the body is understood in terms of the flow of energy, called 'qi', and anything which breaks the flow of qi, for whatever reason, will be viewed as a potential cause of a weakness of energy 'downstream' from where the injury has been. It is not unusual, for example, for acupuncturists to treat scar tissue in this way, as a material blockage through which a good flow of qi must be restored.

 

From within the paradign of Chinese medicine the problems which you experience would make sense, and treatment would probably address both the over-arching constitutional balance as well as addressing the local issues where the problem lies. However, from a western perspective there is little or no research evidence (apart from a few studies of acupuncture on rats) that nerve healing can be increased or improved by the use of acupuncture. To put this in its proper context, though, the current gold standard of research against which acupuncture is measured is the randomised double blind control trial, and it is difficult to imagine how one could begin to design a trial which met the criteria for assessing this problem.

 

We would recommend, if you do decide to have acupuncture treatment, to talk to your consultant and ensure that they are happy for you to take this route. Acupuncture is a very safe therapy with very clear guidelines for safe and hygienic practice. Some western medical professionals still believe that the risks of infection are high, and the BAcC is happy to provide details for the benefit of patients to help them to convince their healthcare teams that treatment is not a risk.

Morton's neuroma is often caused by running and jogging, and treatment usually appears to be aimed at correcting the gait by the use of orthotics to relieve some of the pressures which are thought to cause the problem and then reducing the inflammation and pain by the use of medication. Although there is very little specific evidence for the use of acupuncture for this specific condition, acupuncture treatment is often used to reduce pain and inflammation in a number of conditions for which there is ample evidence, so it is within the bounds of what one might go to an acupuncturist for.

 

 

Traditional Chinese medicine has a different take on why and how such conditions are caused in the body, and a practitioner might well look at the overall balance to understand why this has arisen. In the majority of cases the cause is straightforward - over-exercise or poor alignment - and if acupuncture is successful in reducing the inflammation and pain there may well be some longer term management issues about how to balance continued running with treatment aimed at ensuring that the condition is kept under control. It may bne useful to involve a podiatrist or osteopath in the overall strategy.

 

If you do decide to go ahead with treatment we advise you to agree very specific outcomes with your practitioner and review progress on a regular basis. Conditions like these can be quite obstinate, and there is no point in having a long course of treatment if there is no change. For cases such as this there are surgical options which have a reasonably good success rate.

Gastroparesis has been the subject of some limited research, and there are encouraging reports that acupuncture may be a useful as part of the treatment strategy. One 2010 case study is reported:

 

 

http://aim.bmj.com/content/28/2/101.1.extract

 

and in 2004, a slightly more complex study

http://www.ncbi.nlm.nih.gov/pubmed/15510787

 

suggested that acupuncture might be helpful. However, the whole body of evidence is a long way short of what health commissioners in the West would regard as sufficiently conclusive to make any definite claims.

 

Chinese medicine, however, uses an entirely different conceptual structure to understand the body and mind in good health and in disease, and the diagnostic systems are often able to make sense of symptoms in terms of functional weakness in a way that is alien to western medicine. Since each person has a unique pattern of energy it is impossible to say for under-researched areas of illness that acupuncture would be of definite benefit. However some of the symptoms which are regularly associated with the condition fall very neatly into diagnostic patterns and syndromes in Chinese medicine for which an estbablished range of treatments do exist. It would be worthwhile talking to a BAcC member local to you to establish whether, in their view, acupuncture may be able to help.

 

Even if there is not a direct equivalence, it is worth bearing in mind that some of the systems of Chinese medicine work in a very different way, aiming to re-balance the body's energies, without specific regard to symptoms, in the belief that a system in balance will not create the alarm bells which symptoms represent. This can be as powerful as direct treatment of the symptom.

There is a growing body of evidence now being accepted in the West that acupuncture may well be an effective treatment for neck pain. Two studies which reviewed all of the trials they could find were cautiously optimistic about the short term benefits of acupuncture treatment and proposed that further long term studies were needed.

 

 

http://www.ncbi.nlm.nih.gov/pubmed/19216662

 

http://summaries.cochrane.org/CD004870/acupuncture-for-neck-pain

 

That said, you GP is not probably not wrong - by the time that someone is in their 70s or 80s there is often quite a lot of degeneration in the vertebrae in the neck, and if this is causing impingement of some of the nerves emerging at the neck, or tightening of the ligaments and tendons which is itself causing pain, there may be a limit to what acupuncture treatment might be able to achieve. If the restriction of movement is mainly caused by muscles which are guarding to prevent further pain there is a possibility that the treatment may relax them sufficiently to improve the range of movement.

 

If you do choose to have acupuncture treatment it will be important to establish whether the treatment is providing the same kind of relief for a period but no more on each occasion. Although a practitioner will aim to bring about overall improvement there are times when even a guaranteed period of less pain and easier movement is an acceptable outcome for a patient. This has to be an agreed outcome, though, not simply assumed by either party.

This is quite a difficult one to answer for two reasons:

 

  1. although the BAcC does not yet recognise standards of specialist qualification, there is a growing number of members who spend their time working with particular groups of patients, such as children or pregnant women, and who undertake further training directly related to these groups. While the acupuncture used to treat most 'special' groups is identical to any other kind of treatment, a strong case is currently being made that there are variations in standard patterns of treatment when dealing with the under 5's in particular. However, as a profession we are committed to generalist practise, and are still debating whether to allow people to claim expertise in any one field, so we would not normally be able to cherrypick a number of members in an area based on informal knowledge of their focus.
  2. although chinese herbal medicine is often used very successfully alongside, or sometimes instead of, acupuncture in the treatment of chronic skin problems, we are not in a position to comment on how suitable herbal medicine might be for a two-year old.

 

So, our best recommendation is that you contact some of the BAcC members local to you and ask if any have had further training in paediatric acupuncture and have dealt with this problem before, or perhaps google 'treating children with acupuncture north surrey' to generate a list of people who have undertaken further training. There are also a small number of well-known course providers whose websites often list members who have undertaken further postgraduate trainiing in paediatrics.

 

It may also be worth contacting the Register of Chinese Herbal Medicine (http://www.rchm.co.uk/) to ask its view of whether herbal treatment is suitable for infants. There is no doubt that the regularity and frequency of treatment may be beneficial in maintaining a momentum which weekly or bi-weekly acupuncture treatments may not match.

Wednesday, 29 February 2012 15:39

How does acupuncture work?

A great deal depends on one's perspective. From a western scientific point of view, the mechanisms of acupuncture are largely understood to be neurophysiological but mainly not yet understood. Most of the varieties of western medical acupuncture are based on an understanding that the insertion of needles has an effect on nerves which can release muscles, over-ride brain signals, and so on. There are very often chemical changes in body fluids associated with treatment, and there is a great deal of experimentation on animals to see how various hormones and neurotransmitters are affected by inserting needles in specific areas or points.

 

 

From an eastern point of view, the patholology and physiology of the body is understood very differently. This is not just in China, but in Japan, India and other East Asian cultures where acupuncture is practised. The energies of all matter, both organic and inorganic, are thought to be manifestations of a single universal energy or force called 'qi', the movement and balance of which in the human being is seen as directly linked to the health of the individual. Inserting acupuncture needles in specific points is believed to harmonise and improve the flow of qi, and this understanding can be used both locally if the qi of a specific limb is affected, or systemically if the symptoms are an expression of a deeper underlying disorder. Qi in balance allows all physiological functions to return to normal.

 

The technical terms used to describe systems of medicine viewed in this way is paradigms, and following the work of Thomas Kuhn in the philosophy of science are thought to be qualitatively different to the extent that one cannot be mapped onto another. While this is true on some levels, the one bridging factor between all systems of medicine are the symptoms which the person feels and describes, and the observations and signs which the practitioner makes or sees. There are some rather abstruse arguments and theories being generated on the fringes of orthodox science which are trying to equate the East asian understandings of qi, prana or ki with some of the energies found in sub-atomic and quantum physics, but this is still highly speculative work, however telling some of the similarities may be.

 

The major difficulty which this paradigm difference presents to traditional acupuncture is that to gain acceptance in the West a great deal depends on claims for efficacy for particular named conditions based on trials which are based on the randomised double blind control trials used for drugs. These try to reduce the variables to a minimum to assess whether a single change has an effect, whereas acupuncture is a world of variables, a form of treatment which evolves and changes in response to feedback, not simply a mechanistic repetition of formula treatment.

 

In short, though, from an eastern perspective it is simply a way of moving qi, whereas from a western perspective it's mechanism is not fully understood but thought to be neurophysiological.

The BAcC's factsheet on nausea and vomiting makes the point that the research studies on the effectiveness of using acupuncture to deal with morning sickness are equivocal and need to be of better quality in order for it to be able to say without qualification that acupuncture can benefit in the case of morning sickness. Anecdotally we hear many, many stories and testimonials of how well acupuncture has been able to bring morning sickness under control, but there are a number of problems associated with setting up proper trials which mean that evidence of sufficient quality does not yet exist.

 

That said, one of the early papers produced by Dundee et al well over a decade ago

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1291716/pdf/jrsocmed00159-0026.pdf

 

seemed to show that acupressure on a point very commonly used in acupuncture treatment seemed to relieve symptoms for over eight hours. Many women purchase and use the anti-sea sickness bands from their chemists as a way of self-treating, and as long as the care team is aware that there is a problem and that you are using something like this to help control it then all is well.

 

The only concern which we have is that occasionally patients have such faith that treatment will work that they stick with it long after they should have sought further medical help - it is very easy to become severely dehydrated and require to be on a drip, especially in severe cases where it is difficult to keep anything down.

 

As far as safety is concerned, the points commonly used to treat morning sickness do not represent any risk to the mother or baby. There are one or two points which are contra-indicated for this stage of the pregnancy, but aside from the fact that very few British practitioners will be using techniques vigorous enough to be a risk, all BAcC members are carefully trained in the knowledge of which points are to be avoided in pregnancy and other conditions.

 

There are a small number of studies, two examples of which are:

 

 

http://www.ncbi.nlm.nih.gov/pubmed/9828874

 

http://www.ispub.com/journal/the-internet-journal-of-dermatology/volume-3-number-2/acupuncture-in-the-treatment-of-chronic-urticaria-a-double-blind-study.html

 

which make encouraging comments about the value of using acupuncture to treat urticaria. Of the common skin problems a great deal more research has been done on eczema and psoriasis, mainly because it is easy to put together a sufficiently large group for trial purposes, and the conditions are more clearly defined. Much of this research in undertaken in China, and doubt is often cast on the methodological soundness, which is why it is rarely accepted without great qualification in the West.

 

As you may have read in other answers on this website one of the strengths of Chinese medicine is that the patient's symptoms often make sense directly within the diagnostic categories which are unique to Chinese medicine. How a symptom feels, where it is, what times of day or night it feels better, what helps it to be more bearable often lead a practitioner, together with diagnostic signs like taking the pulse and looking at the tongue, to some fairly straightforward treatment strategies.

 

That said, from the first study you will see that there is a point prescription which is widely used to treat urticaria. This is often the case in Chinese medicine - for all the subtleties of diagnosis there are often some fairly routine agreed solutions. The skill of the practitioner often rests on determining whether treating at this level will make the problem get better and stay away, or whether there are underlying constitutional issues which might need to be corrected to ensure that someone stays well.

 

As always, we recommend that you find a BAcC member local to you and ask their advice on your unique presentation.

Q. I have a question on the possible side effects of accupuncture.

 

I have been lower back pain for 6 months. This may have originated from a slipped disc but the pain is now less severe but shifting. It is primarily in my hips and buttocks, with some down the back of my legs. The pain is sometimes a stinging sensation, sometimes a burning. My NHS physio has given me one session of accupuncture. However, the stinging has been worse since (almost a week ago). Is this of any concern? I am due to go back for more in 2 days. Many thanks.

 

A.  Acupuncture is a very safe intervention - adverse events are very rare. In cases like this, where a pain seems to increase after treatment there are three possibilities:

  1. that the increase in the pain has coincided with, but not been caused by, the treatment. It is not unknown for an acupuncture treatment to be held responsible for anything which happens after a treatment.
  2. this is a healing reaction - it is also not uncommon when treating musculo-skeletal problems to find that some of the symptoms are exacerbated over the next 24-48 hours, after which they usually subside and there is then a gradual improvement in the presenting condition
  3. this is an adverse event associated with the treatment itself. Most adverse events are temporary and transient, such as minor bruising or slight discomfort. Only a very few involve cause damage or persisting pain to the patient.

In this particular case, the best course of action is to discuss the matter thoroughly with the physiotherapist to see what their take on the problem is. He or she will have the techniques available to assess whether the discomfort which you are experiencing is associated with any changes in the structural alignments in the lower back brought about by the overall package of treatment. In general terms, however, it would be more likely that the stinging has increased as a consequence of an overall shift in the structure of the lower back, rather than being a direct consequence of the physical insertion of a needle. In the rare cases where a needle touches a nerve the sensation is immediate and unmistakeable. Your physio will be able to assess whether the points they have used could have caused such a reaction.

 

It is important to remember that treatment of any kind involves the informed consent of the patient. If you have reservations about the use of acupuncture as a part of your treatment you are free to request that it not be done.

Weight loss was the subject of some critical scrutiny a decade ago, and the conclusion drawn at the time was that acupuncture did not have any significant effect on weight loss. However, trying to test whether acupuncture can help someone to reduce their weight is likely to be a difficult matter; there are dozens of reasons in Chinese medicine why someone's weight may be increasing. Trying to group together a sufficiently large number of patients whose western problem and eastern diagnosis are the same is extremely difficult.

 

 

In one or two cases there is a very direct correlation between someone's weight and their underlying imbalances from a Chinese medicine perspective. Correcting these may have an immediate impact on, say, the amount of fluid someone is carrying, and that could create a 3-5kg loss very quickly.

 

However, all of the best dietary programmes say that after the initial and often quite dramatic week or two most good weight loss programmes at best will see someone lose only a pound or two every month, and in fact, there is discouragement from trying to do more in order for the body's system to keep pace with the change. Acupuncture may well have been used successfully alongside some fairly strict dietary rules, and from a patient's perspective it would be very difficult to say whether the acupuncture treatment added value to what someone was doing already.

 

The bottom line is that there are are no 'magic' points which reduce someone's weight without effort, and the effect of acupuncture may be no more than to give someone the support and commitment to keep trying with diet and exercise programmes. However, if someone remains motivated as a consequence of acupuncturre treatment that itself would be a very positive outcome.

 

There are a number of experience practitioners in Lincoln, and you can find them all by clicking on the search button. Any of then will be able to advise you whether acupuncture might be worth pursuing in your individual case.