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Q:  My mother is 93 years old and has had neuropathy in both feet and lower leg area. She has no pain but numbness and walking is difficult. Very unsure and poor balance. She has had acupuncture for 9 weeks with no sign of any change and balance is worsening. What are the chances of improvement?

A:  That is very difficult to say. Your mother's age is not the primary factor here other than that it is sometimes difficult to determine whether the decline in balance and confidence is entirely related to the underlying pathology. As the son of a 96 year old mother this 'expert' has seen a gradual decline in both her confidence and her balance which is not atypical of the pattern in many of the co-residents at her home without there being any obvious pathology.

However, if it is related to her neuropathy, as a general treatment comment this can be a difficult problem to address. Most of the questions we have been asked about neuropathy have tended to be about the treatment of the problem as a product of Type-2 diabetes and involve a certain amount of pain rather than simply numbness and balance. Much of the research in this area is focused on pain reduction (chemotherapy-caused neuropathy is another common presentation), and the outcome measurements for this are much more easily documented than those for balance and numbness. Numb patches can move around, and some days balance can be better than others for all sorts of reasons.

That said, most of the research shows positive outcomes, and after nine sessions your mother should be showing some small improvements, or at least evidence of not getting worse ('getting worse slower' as one of our more witty patients remarked). When we are treating someone with neuropathy, though, we are treating them, not simply the condition, and we are looking at their symptoms in the context of their whole overall patterns of balance. This means, as we are sure you will have read, that twenty people with the same named condition might be treated twenty different ways by a Chinese medicine practitioner. This does mean that we would always be looking at all aspects of someone's health all the time, and in cases where there is a 'headline' problem we would always be looking at other outcome measures to see if there were evidence of progress. This can sometimes be in the form of better sleep or better digestion, or the improvement of a secondary problem. This sort of thing, together with encouraging changes in diagnostic signs, might be enough to make a practitioner confident that change will occur.

There does come a point, though, where it appears that nothing is happening, and it is far better to draw a halt at this point and look at other alternatives rather than plod on in what Doctor Samuel Johnson once called in another context 'the triumph of hope over experience'. This expert has sent patients on to cranial osteopaths or reflexologists when there seems to be little chance of progress, and we all work alongside other healthcare professionals whose work we know and trust and who may be a better alternative.

So, in summary, we're not sure we could even begin to quantify your mother's chances of improvement, but we think it may be time to have a serious discussion with the practitioner about the value of carrying on and whether there is anything in the clinical picture which encourages them to believe that change is nigh.

Q:  Would acupuncture ease pain caused by nerve pain following parotidechtomy. It's a type of trigeminal neuralgia.

A: This is quite a complex issue to address.

If you look on our website you will find a factsheet on neuropathic pain which deals largely with trigeminal neuralgia

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

and the evidence looks fairly encouraging. Our clinical experience, as we have written elsewhere in these answers, is that TN is one of the more difficult conditions to treat, and can be very intractable. Where it does respond to acupuncture treatment, the response can be quite rapid. We have also at various times suggested that cranial osteopathy might be a viable alternative if the problem has arisen where the trigeminal nerve passes the tempero-mandibular joint, which we often find to be out of alignment.

However, surgery brings with it a whole new range of possibilities, which from a patient's perspective is probably an advantage. Excision of tissue and the subsequent scarring can create residual pain through the nerve endings which have been cut and through the scar tissue which forms. In the case of the former there is a growing body of evidence for the treatment of phantom limb pain, where a severed nerve sends a signal from the missing part. We have answered questions on this a number of times, and a typical response has been:

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:

http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97

Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142

Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112

Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213

Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in 'conventional' Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

In principle there is no reason why the same principle should not apply. If there has been unilateral damage, treatment of the opposite equivalent points combined with systemic treatment may be beneficial.

There is also an issue with scar tissue. There have been numerous examples of scar tissue causing a disruption in the flow if energy, understood from a Chinese medicine perspective, and generated some quite unpleasant pains as a consequence. We have sometimes found that very simple treatment at the site of the scar tissue can make a profound difference.

The best advice that we can give, and invariably do give, is to visit a local BAcC member for a more detailed face to face assessment. This will give you a better idea of what may be possible before committing to treatment, and will also give you a chance to meet the practitioner and see where they work before deciding how best to proceed.

Q  :I have suffered from Cauda Equine since February last year.They fused my back in June,put gel in my disc's had my coxixs manipulated and injected with steroids.My bowel doesn't work properly My legs are numb and painful. Will acupuncture work for me?

A:  We have to be honest and say that we would find it very difficult to offer a definitive view until we knew more about the circumstances which led to the presentation of cauda equina syndrome.

As you are probably already aware, recovery from the syndrome, even with first rate treatment, can be very slow. If the problem which caused the syndrome to develop has been addressed, like a compression injury or a narrowing of the spinal canal, then it may be possible over time for some of the problems which it causes to be reversed. However, if the syndrome has developed after an accident which has caused traumatic injury the outlook may not be so positive. The only way that you could get a more informed view of what may be possible would be to visit one of our colleagues who practises local to where you live and could ask you in more detail about what has happened. Most members are more than happy to give up a little time without charge to assess whether acupuncture treatment would be worthwhile.

However, we must always stress when we give these opinions that we practise an entirely different form of medicine based on a theory of energy, called 'qi', and its patterns of flow and balance in the system. Chinese medicine has been practised for over 2500 years, and even without the kind of detailed knowledge that we now have from X-rays and MRI scans the Chinese would have tried to make sense of the symptoms of problems like yours within their own frame of reference. This can sometimes mean that a problem which has been written off as untreatable in the West can respond to treatment, but only because a blockage has developed in the energy flow which in turn generates a symptom which is thought of as unlikely to recover. We have to be careful how we say this, though, because people can sometimes run away with the idea that Chinese medicine can offer a result where a problem has been written off as untreatable. Whatever system of medicine one practises, if there has been permanent damage it won't reverse.

We think it might well be worth popping along to a local BAcC member for guidance. Our experience is that when recovery is possible acupuncture treatment appears to encourage a speeding up of the healing process. Certainly our practical experience of treating post-surgery patients is that their consultants are often surprised by how well and how quickly they recover, although it would be difficult to generate research to validate this. It would certainly do no harm, though, and may well be able to help you deal with the emotional and mental consequences of what must have been a very distressing change in your life.

Can acupuncture make PTSD symptoms worse? I had acupuncture done on my ears and I had my first PTSD episode in 3 months.

A: The short answer would be 'probably not' unless there was something about the treatment itself which re-awakened some of the trauma which initiated the problem. We have encountered this on a couple of occasions with patients who have been stabbed, but it is rare.

What is more likely is that the treatment has released something which the body has held on to. We often find that shock and stress can be held almost like memories in the system, and from our perspective as Chinese medicine practitioners this them interferes with the normal flow of energy, and can manifest in the sorts of symptoms which are classified as PTSD and to which the system ultimately adjusts to get on with life. Once a practitioner starts to balance things up again these patterns can often be released, and this can sometimes result in a resurgence of the original problems and even the initial shock.

The homoeopaths actually acknowledge this formally within their systems as the 'law of cure' where symptoms can re-appear in the reverse chronological order, and although we would not go this far we are aware that when we treat people with a history of migraine or other problems from the past which it is assumed they have 'grown out of' there is a strong chance that they might have another bout.

One small concern is that you talk about using ear acupuncture. We think this can be a valuable modality for addressing many issues, and there are indeed practitioners in the UK who train exclusively in this based on the work of people like Nogier, a French man who really developed this as a working method in the 1950s and 1960s. We would hope that the person who is offering the treatment is doing so within a framework which provides proper support to you as a patient. If you have had the treatment for one problem and it brings back another one we would expect that there is some safety net in place which means that you haven't had this very unpleasant problem dropped back on you without some chance to address it.

We suspect that it will be a one-off episode, but even so we know just how difficult it can be and how frightened that people can become that it returns for a longer time. If this episode continues we would probably advise you not to continue having ear acupuncture unless it is within a setting which affords you proper and appropriate support.

A:There are surprisingly few studies into the effects of acupuncture treatment on polymyalgia, and this does limit what we can say from a conventional medical perspective about the treatment of the condition.

However, we suspect that this is a great deal to do with the diffuse ways in which the condition presents. In our experience the definition is imprecise, and we have seen patients with identical presentations diagnosed very differently. From a Chinese medicine perspective, though, this doesn't really matter. For us the description of the patient's symptoms is seen against an entirely different theoretical framework. This involves an understanding of the body as a flow of energy whose rhythms, flow and balance can affect someone's health. When pain arises it is usually a sign of blockage in the system, or excesses and deficiencies which we can correct with the use of needles.

The real skill and art of the practitioner lies in identifying the true source of the problem. Such is the complex web of inter-relationships within the body a symptom will often not be the same as the cause of the problem. Finding out where the root cause is and addressing it is what differentiates a traditional practitioner from someone using simple all-purpose formula points. If the root is not addressed then the problem will come back. This also explains why a dozen people with the same symptom can be treated in a dozen different ways, with treating being individualised to each case.

The best advice that we can give is that you visit a BAcC member local to you so they can give you a brief face to face assessment of what could be possible. A skilled practitioner should be able to give you a rough idea quite quickly of how much change they think they might achieve and over what period of time. Most of our colleagues are happy to give up a few minutes without charge to enable the patient to make an informed choice, and will also be likely to offer good alternatives if they think these will address your problems better.

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