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A:  We tend not to like words like 'heal' and 'cure', partly because the former lends itself to pejorative interpretations of what we actually do and the latter begs the question of what counts as a 'cure' anyway. However, that aside, traditional acupuncture came into prominence in the popular consciousness in the West after Nixon's visit to China in the 1970s mainly as a form of pain relief, but has a 2500 year history of being used to treat a huge range of conditions, many very successfully. The World Health Organisation, for example, publishes a list
 
 
http://apps.who.int/medicinedocs/en/d/Js4926e/5.html
 
of all the conditions for which evidence of acupuncture's benefits can be demonstrated.
 
One of the principal reasons that acupuncture treatment has not received the recognition we believe it deserves in the UK healthcare system is that the standard of evidence required, the randomised double blind control trial, is more suitable for testing drugs, not dynamic interactions like acupuncture. Setting up trials is both costly and difficult, and at the moment no-one is particularly interested in funding them. It is interesting, though, that the NICE guidelines for conditions like lower back pain and some forms of headache now recommend acupuncture as an option.
 
Of course, a fundamental difference between Chinese medicine and orthodox medicine is that CM treats the person, not simply the illness or disease which they have, and to that extent to say that it deals with conditions is to miss the point slightly. Every patient with a named western condition will probably receive a different treatment because the presentation will be unique to each patient and with that the combination of points used and the reasons for using them. There is quite a large amount of background material on our website which explains this more thoroughly.
 



Why the emphasis on pain relief? Well, one certainty in measuring the effects of acupuncture in pain relief is that there are some very specific chemicals whose levels can be determined exactly, and for the purposes of research this is a very exact outcome measure. When acupuncture was first tested scientifically it was an obvious choice, and because the results were good, pain relief became associated with acupuncture as a primary reason for its use. For some types of pain acupuncture is a good choice, although from a Chinese medicine perspective pain arises from specific changes in the system. If the treatment did no more than provide temporary relief, a master practitioner would be asking themselves what else they could do to effect lasting change, and if that did not happen, would be talking to the patient about whether the extent of the relief and the time it lasted were worthwhile and whether other options for treatment might be more advisable.    
 
 


Q:  Can acupuncture possibly help relieve severe intermittent pain in a wrist/thumb osteoarthritis problem? I currently have a splint which I wear when it's really bad and take strong painkillers{prescribed}as and when needed.  I'd rather not have to have steroid injections every 6/9 months.

A:  As our factsheet shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/osteoarthritis.html
 
there is limited but increasing evidence for the benefit of acupuncture treatment. It has to be said, however, that the bar in the West is set very high, with the randomised double blind control trial being used as the basis for makign any claims for efficacy. This is more appropriate to drug testing than for testing a dynamic and evolutionary intervention like acupuncture, and in China, where the question is not 'does it work?' but 'what works better?', there are many hundreds of studies which appear to show that acupuncture treatment can be of benefit.
 
However, a great deal depends on the extent of the deterioration of the joints. There are, from a Chinese medicine perspective, both local and systemic reasons why someone can manifest pains in a specific joint, and the art and skill of the practitioner lies in determining which this is and treating appropriately. The caution, as always in cases of osteoarthritis, is just how much the joint has been affected by crumbling of the bone or by osteophytes, bony outgrowths which often cause inflammation and aggravation. If either is significant then the treatment may be of limited value. Acupuncture is used for pain relief, this being one of the main areas of interest when research kicked off in the West, but like any pain relief the question is how much relief and how sustainable it is. If, for example, a monthly session bought continuing relief for over three weeks, then this may be an option to consider. If, on the other hand, acupuncture brought about relief for about 2 or 3 days, then unless someone has deep pockets this is not a great option.
 
We believe that there may be a limit to how many steroid injections someone can have in a single joint, so it is worthwhile exploring alternatives. Our advice would be to visit a BAcC member local to you for them to be able to give you a brief face to face assessment of whether treatment may be of value. If you did decide to go ahead we would highly recommend that you set an upper limit on treatments from the outset and then review progress. Four or five sessions would normally be enough to assess whether there was any change and how sustainable it might be.     
 

A:  It is no surprise to us that there is little or no research published in English about the use of acupuncture treatment for trigger thumb. The vast majority of case are treated rapidly and successfully with steroid injections, and the important task is to determine whether it is a single problem in itself or whether it is the tip of a much larger iceberg for a condition like rheumatood arthritis. We are sure, though, that your GP will almost certainly have made this assessment when he or she saw you.
 
We do find that many people, however, try to avoid steroid injections because while they work, they can often need to be repeated and there is usually a limit to the number of injections that one can have in a specific area of the body, usually two or three. Many people want to find a solution that is as effective and can be repeated, and there are a number routes like diet and massage which are popular complementary approaches to the problem.
 
As far as acupuncture treatment is concerned, our systems of medicine are premised on the flow of an energy called 'qi' in Chinese whose steady flow, rhythm and balance ensure the health and good functioning of both the internal organs and the musculo-skeletal structure. When the flow is interrupted or blocked for any reason, symptoms will appear, and not necessarily only at the site of the blockage. A systemic problem, for example, could lead to the appearance of a number of problems throughout the body, and the skill of the practitioner lies in being able to assess and interpret all of the information that he or she collects and determine the best way to treat a problem. If it is local this can often mean that the simple reinstatement of flow can achieve considerable change, although the note of caution is that if a local problem has already caused a structural change, like the growth of more bone or the hardening of tendons, there may be limits to what treatment may achieve.
 
It is always sensible to draw a sharp line in the sand after a number of treatments to assess progress and evaluate whether treatment in having the desired effect. It is all too easy to rack up ten or fifteen sessions without discernible change, and we always recommend that after four or five sessions there should be small signs of change at very least to encourage further work. If the practitioner can tell from diagnostic signs that change is imminent that may be reason to carry on, but the patient's experience is the most important.
 
The best advice we can give is to consult a BAcC member local to you and seek a brief face to face assessment of whether acupuncture may be of benefit, or if not, what other options they might recommend. Nothing beats seeing a problem directly to give an honest and accurate assessment of possible success.
 

Q:. At the beginning of December I had acupuncture performed on my lower back for the very first time. It was recommended to me because for a few months beforehand I was suffering from a lot of stomach pain which occasionally affected my lower back. 

Anyway, I had the acupuncture on my lower back at the beginning of December and later that evening I was in a great deal of pain and discomfort around the entire lower back area. I contacted the acupuncturist and he confirmed this was normal and it'll take a couple of days to ease. Well it is now the middle of January and is far, far worse.

Not only is the pain far worse and intense but it has spread considerably around my lower back and also now in my upper back, shoulders and even my arms. I am also feeling pain around the 'love handle' areas and some in my upper abdomen.

I have complained to my acupuncturist and he denies all wrong-doing and states it can't still be the result of acupuncture but the fact of the matter is that I didn't have this pain before I had it performed and now I do, and I even felt it come on the very evening of the day I had it done.

It is ruining my life as I am now laid up in bed unable to do anything and have been like this for over 2 weeks. I have been to A&E but they only checked my bloods and urine, which were normal, gave me some strong pain-killers and sent me home.

Hot baths and hot water bottles don't help, neither does resting in bed.
 

Is it possible that this acupuncture session has done something to me or perhaps triggered something?

It almost feels muscular or strained and certainly inflamed constantly. It is tender and there is severe aching all over my entire back.

If you can please put my mind at ease or explain what it could be or even what I should do next?

A: We are very sorry to hear of your problems, but we tend to agree with your practitioner, that it is extremely unlikely that the acupuncture treatment has caused this problem to exacerbate in this way. The overwhelming majority of disturbances caused by treatment are transient and minor. We undertook a survey in 2000, as did the medical acupuncture profession at the same time, which together produced evidence of only 14 minor transient adverse events from 66,000 treatments. A second survey of patients three years later showed a not dissimilar pattern, and where serious adverse events have occurred from the use of needles, these tend to be more to do with penetrating organs of the body, such as in a pneumothorax, and contrary to popular belief these are extremely rare.
 
That said, your symptoms are very real, and our advice in circumstances such as yours, which we see two or three times a year, is to try to get an immediate referral to specialists within the conventional medical system. Your case would probably fall within three specialties: neurology, orthopaedics, and rheumatology. You may need to put as much pressure as you can on your GP to make a referral.
 
We, and our members, are not trying to abdicate responsibility in cases like this, but we have seen several occasions over the years where there has been protracted argument over whether or not the acupuncture treatment could have caused a problem to occur, and our view has been that the time spent arguing would have been better spent tracking down a solution. The bloods will have ruled out infection, and in our experience a spasm in a muscle caused by treatment, unusual in itself, is usually localised and short-lived, usually responding to heat and massage. Since neither have worked in your case, you need to have further and more complex investigations to find out what is happening in order to be given the appopriate treatment as a matter of urgency.
 
We are sorry not to be able to offer you much more than this. If you do hold to the view that the acupuncture was the causal factor, we need to assure you that all of our members are fully and well insured, and that should you wish to make a claim either your practitioner or our Office can give your the full details. However, we think that this is one of those cases where the treatment and your problems are an unfortunate coincidence. 
 

Q: Is there any evidence for the use of acupuncture in the treatment of Lupus? I have been told it is considered to be a contraindication by the Lupus organisation.

A:  There is a small amount of evidence that acupuncture treatment may be of benefit for people suffering with lupus/SLE. Studies such as this:
 
http://www.ncbi.nlm.nih.gov/pubmed/19029279
 
seem to point to a worthwhile benefit, but it is a single study with a relatively small sample group, so we cannot really put too much emphasis on the results. A much larger study would need to be done, and also need to be replicated by other researchers for us to make any specific claims.
 
One problem, of course, is that SLE can manifest in dozens of different ways, and at various levels of severity. There are very likely to be cases at the less serious end of the spectrum which go undiagnosed, and some which are diagnosed where the symptoms are relatively few and possibly respond well to treatment. At the other end of the scale there are severe cases which do not respond at all, and many of us have find memories of a professional colleague who died from SLE many years ago for whom enormous amounts of acupuncture were of no benefit.
 
The best view to take is that from a Chinese medicine perspective we treat the person not the disease. This means that although twenty people may have a standard named western condition, each one of the twenty may be diagnosed differently in Chinese medicine. The theoretical basis of CM is underpinned by a concept of energy, called 'qi', and its correct flow, rhythm and balance, and by an understanding of the Organs as functional units which do more than the western correlates (hence the capital letters). A skilled practitioner would look at the unique presentation of symptoms and make sense of these in terms of changes or disruptions in the flow and changes in the function of the Organs. This could mean that some cases were more amenable to treatment than others, but in every case would mean that the treatment was unique and different just as each individual is unique and different.

 Our best advice is to visit a BAcC member local to you and seek their advice. There is no substitute for a face to face assessment of what may be possible. From a western perspective there is no 'cure' for SLE, but from our practical experience this is just one of a number of auto-immune diseases where we have seen a considerable slowing down or halt in the disease process, and for many patients 'getting worse slower' is a viable and valuable treatment aim.

 As far as contraindications are concerned we have looked at all of the lupus organisation websites and have not seen anything which seems to contraindicate the use of acupuncture. If you have seen one we would be grateful to be sent details. If there is actual evidence of potential detriment we need to see it, and if not, we may need to discuss with them why they are 'dis-recommending' acupuncture. In severe cases where the immune system is badly compromised, our members all have clear guidelines to ensure that they minimise the risk of opportunistic infections, but we have never heard of any cases of problems arising as a consequence of treatment.