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Q:  I suffer from very  bad headaches, have done for years but since having my total hysterectomy at the end of 2012 they are worse  on HRT. I tried Amitrypline but it is horrrible, made me like a zombie, can only use paracetamol but it doesn't  help much. I have  been looking on the internet and found out about acupuncture - can it help me? #

A: We tend to be very upbeat about treating migraines, cluster headaches and persistent headaches, and with good reason. The evidence for successful treatment is very encouraging, as our factsheets show


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

and 

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

and when we conduct online surveys of the main reasons why people consult a BAcC member headaches in one form or another appear in the top ten reasons. The evidence has been good enough for NICE to recommend acupuncture for the treatment of cluster headaches.

However, we have to be a little cautious. The great strength of Chinese medicine is that it understands the symptom within its overall context, and that does mean that while the majority of people will experience some benefit there will always be those whose overall balance means that short term success is less likely. On the other hand, the majority of research trials tend to be undertaken with formula acupuncture in order to meet the criteria espouse in the West, where the outcome is the only variable, and we have long argued that this is not the best way to test a system which is geared to the individual and where treatment evolves as the patient progresses. In many cases this refinement of treatment generates much better results than the orthodox trials suggest are likely, but until we come up with ways of preserving the integrity of what we do in a research setting we are where we are.

The best advice we can give you, based on what you describe, is to visit a BAcC member local to you for a short face to face assessment. Most of us are happy to give up a few minutes without charge to assess whether acupuncture is the best treatment for what troubles you, and this will also give you a better idea of what we do, who you might see and the surroundings in which they work. We find that this means prospective patients feel more empowered in making their choices rather than simply being booked in sight unseen.

A: A great deal depends on the time that has lapsed since he has had the stroke.

We have produced a fairly hefty review paper on the use of acupuncture for the treatment of post-stroke problems

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which  is a bit of dense document, but basically concludes that there is growing evidence that acupuncture treatment speeds up recovery.

In China, acupuncture is amongst the first interventions after a stroke, and it is not uncommon for someone to have treatment within hours  of the episode. The underlying logic is that the stroke, often called a 'windstroke' in Chinese medicine, disrupts the flow of energy, called 'qi'. The sooner this can be restored to its normal flow, the better, and daily or even twice daily treatment is often used to try to restore function as quickly as possible.

This is not an unusual concept. There was some fascinating research some years ago suggesting that people with artificial limbs fared much better if they had them fitted within days of the amputation. Stumps healed quicker, and movement was better. It seems like the body has a kind of habit energy which if tapped into can recover quickly, whereas if someone develops a new 'habit' this can take a while to shift.

That is not to say that acupuncture treatment cannot have an impact when started a little later, simply that it can take a little longer to achieve the same results. We are always very cautious in offering a prognosis since we have found that the extent of the initial symptoms is not a reliable indicator or future progress, and mild strokes can sometimes cause permanent changes which defy the best efforts at treatment. However, each person is unique and different, and their underlying pre-stroke constitution will have an impact on recovery. This is why acupuncture treatment, which is aimed at treating the whole person and not simply the presenting problem, is such a valuable intervention. It may be able to improve basic functioning and hasten what recovery may be possible over and above getting better movement in a limb.

The advice we invariably give is to contact a BAcC member local to your father and arrange for a brief face to face assessment. This will give them a much clearer idea of what may be possible that we can do at a distance. 

A:  This is not as easy as you might think.

Very few of our members are now contracted to provide acupuncture services within the NHS. Although in theory the change to commissioning groups should have given GPs more flexibility in how they spend their budgets, at the same time these budgets were cut and a series of cuts equivalent to one doctor per practice are now in mid flow. Such contracts as do exist mainly develop from personal friendships between consultants or GPs, where there is a good understanding of the longer term benefits of acupuncture.

In theory you could look at the websites of the two largest medical acupuncture bodies, the British Medical Acupuncture Society and the Acupuncture Association of Chartered Physiotherapists. This gives you potential access to about 9000 practitioners but the reality is that you would need to get a referral to a physio who also does acupuncture or to a doctor within your practice or nearby practises. This may not be as easy as it sounds, since all are bound to a degree to work within scope and where there is an evidence base for the condition being treated. Given that the bar for this is set high at the entirely inappropriate randomised double blind trial, the chances of a match are poor.

We are assuming that your need for an NHS acupuncturist is driven by finances, and apologies if we have guessed wrong. Most of our members are willing to make concessions in case of genuine financial hardship and an increasing number are now operating out of community/multibed clinics, a list of the main ones of which can be found here http://acmac.net/acu/clinics. It may be worth checking out what can be obtained locally at low cost because once you look at the whole package, including travel time and costs, a modest fee may well still be within your range.

A:  A great deal depends on what is causing the severe knee pain. If this arises as a consequence of serious osteooarthritic degeneration of the joint, probably the best that one could do with acupuncture treatment is to reduce some of the inflammation as well as reducing the pain itself. When acupuncture first became more popular in the West after Nixon's visit to China, it was the pain relief and anaesthetic aspect of the work which was very heavily researched, especially when people saw operations conducted without anaesthetic. As our fact sheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1187-chronic-pain.html

there has been a focus on this area, and results are sufficiently encouraging to make acupuncture treatment a part of the standard offer in pain management clinics. 

With the underlying condition in severe deterioration unlikely to change, the only issue is how much relief the treatment can offer and how sustainable it may be. This may come down to a question of finances; if the cost of regular treatment is outweighed by the benefits it gives, then it may well be worth pursuing. The chances are, however, that only replacement surgery will make a great difference.

If the pain is acute on chronic, though, there is a slightly better chance that treatment may be of benefit. There was a huge trial in Germany some years ago, called the GERAC trial, which involved an assessment of hundreds of thousands of treatments.

https://en.wikipedia.org/wiki/German_acupuncture_trials

The outcomes for osteoarthritis of the knee were particularly impressive, and it was a source of deep annoyance to our medical colleagues that acupuncture was not included in the NICE guidelines because the placebo control scored nearly as well as the real acupuncture. In their view, both were so much better than the conventional treatment that it would still make sense to use acupuncture even as a placebo, but that is not the way of modern healthcare policy.

The best advice that we can give is that you visit a BAcC member local to you and see what they make of the specific presentation you have. It may, for example, that there are lifestyle issues like work which keeps you on your feet all day which might adversely impact on treatment outcomes, or it may be that there are specific reasons for the pain like injury or accident which would have to be factored in to their assessment. In any event there is no substitute for looking directly at the problem, and we could give no more specific an answer here than that it would be worthwhile seeing a BAcC member of face to face advice.

Q:  How long will it take for treatment of keloids with acupuncture? I have keloids on my chest. 

A:  There isn't a great deal of information about the time scales for trying to help keloid scar tissue on the body, and more to the point there isn't a great deal of formal research which would enable us to make a specific claim that acupuncture works. Most of us have treated people with keloid scarring, and there are many anecdotal reports of considerable help and improvement. There are equally as many reports of trying to help and having no effect at all, as this expert has found on a number of occasions. There are also cases where the scarring remains but the blockages which they can create in the flow of energy, or qi as we call it, are helped considerably by the use of acupuncture treatment. We find this particularly in the case of horizontal scarring after a C-section or hysterectomy, and in the rarer cases of heart surgery or emergency surgery leaving large vertical scars in the midline.

There are occasionally short studies published about specific individual cases, and one such is

 http://aim.bmj.com/content/29/1/2.full

with some interesting photographs for what is deemed to be a good outcome. There are a number of others, but these are probably the exception rather than the rule.

The bottom line, though, is that a great deal depends both on the nature of the scarring (why it is there, how long it has been there, whether it has changes at all) and also the underlying reasons for it. If these are post-operative scars, for example, the condition which required surgery may itself be fairly serious and need to be factored in to any estimates of whether acupuncture might be able to help.

The only advice which we can give is to visit a BAcC member local to you for a brief assessment based on a sight of the scarring and the causes of it of whether they think that acupuncture treatment might be beneficial.

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