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Q:  My daughter suffers from a condition called chiari malformation which results in pressure of bone pressing just below the brain stem. She has had an operation to improve the condition but still suffers from regular severe headaches can acupuncture help?>

This is a very difficult question to answer. The Arnold-Chiari malformation is a change in the physical structure of the skull, and the symptoms which result are directly attributable to the physical pressure which this causes, which is why sneezing, yawning and standing up quickly can generate symptoms, as we are sure you are aware. Although the surgery will have helped to reduce the severity of the symptoms, the underlying cause remains the same so it is more a matter of raising the threshold at which symptoms appear.

In these kinds of circumstances we have to be very cautious about recommending acupuncture treatment, not because it may not help, but because we try to avoid raising expectations which cannot be realised. We say this because from a Chinese medicine perspective, there are a number of ways at looking at headaches, each of which will be unique to the individual, and in ancient China, without a knowledge of the inner structure of the skull, the diagnosis would be based on observable signs and symptoms and would be expected to have a beneficial effect. Soliciting from the patient exactly what the headache felt like, where it was, what made it better or worse, and all the questions which diagnosticians the world over use would have led to a diagnosis within the system of Chinese medicine. This itself is very different, resting as it does on a theory of energy and its flow.

There are two possibilities which make us believe that it may be worth seeing if acupuncture treatment can help. In the first, it is possible that the energy of the body has become 'stuck' after years in the same configuration in the lower part of the skull, and while the operation has removed some of the presenting cause, the tissues themselves may still be stuck in a compressed pattern. Treatment may be able to mobilise this. The second possibility is that the headaches are partly from other energetic causes and have been assumed to be a part of the condition when they may have two sources. We find, for example, that in many cases people with X-rays of the lower spine with considerable degeneration nonetheless feel their back pain improve where the physical structure would seem to indicate this was not likely.

The best advice we can give is that you visit a BAcC member local to you for an informal face to face assessment of your daughter's condition. It should be a relatively straightforward matter of seeing what may be happening and to have a reasonably well informed view of what may be possible. Given the nature of the problem we also wonder whether cranial osteopathy may offer a further option, and we are sure that our members, who often work closely with osteopaths, will be able to refer you on if they think that this may offer more options.

Q:  My GP thinks I may have PMR and I am having bloods done soon. In the meantime, would you recommend acupuncture to help with my symptoms?

A:  We have been asked about PMR a few times. The answer we gave to one enquirer was:

In our experience fibromyalgia can be a difficult condition to treat. As our factsheet shows

there is not a great deal of evidence which would mean that we could say with confidence that acupuncture treatment will work. However, as the factsheet remarks, we are always up against a problem with the way that trials are conducted, and the fact that the so-called 'sham' treatment works as well as the 'real' treatment. From a Chinese medicine perspective, there are no points on the body which don't work at all - everything is made up of energy, called 'qi', and the classically recognised points are simply the most effective places to achieve change.

Anyway, to more specific questions, we usually recommend that someone has four or five sessions if there is any doubt about whether treatment will be effective, and to review progress at this stage. This does mean that you need to have in place some very clear outcomes or markers for what counts as getting better. The trouble with fibromyalgia and similar conditions is that on some days you can feel fine and other days be in considerable pain. It is difficult to get an objective measure, but if there are things which can be measured, such as distance walked or time slept, or painkillers reduced, these can sometimes provide evidence that there is some progress. We are a little surprised that the person treating you is concluding already that nothing is happening, but there are signs which show how well, or indeed if, someone is reacting to treatment, and if these are unchanging, that might be the basis for her view. There are a small number of patients whom one knows almost from the off are not benefiting.

It is also possible in the early stages of treatment to feel worse rather than better, although in our experience this usually only lasts for about a day or two at most, and if someone feels worse for longer than this we tend to look at what else is going on. Your mention of allergic responses is an interesting detail, and there is a small question mark about whether the needles themselves are triggering a reaction. Though unusual, it can happen, and allergic responses can persist. However, in conditions like fibromyalgia and polymyalgia, the persistence of the condition can often mean that the feeling of being slightly worse can persist for quite a while too, so it may simply fall within what is sometimes called a healing response, and be perfectly normal. However, after four or five sessions this should not really continue, and if it does, then it calls into question whether it is worth continuing with treatment.

The one factor which we cannot explore with you for want of detail is the fact that you are having the treatment in hospital. This might mean that you are being treated in a pain clinic or by a hospital physio, and while we are always happy that other healthcare professionals spread the word about how acupuncture works, from a Chinese medicine perspective traditional acupuncture is a very subtle and sophisticated art which relies as much on treating the person as the problem with which they present. In some cases, the kinds of formula treatment which people using western acupuncture or cookbook treatments apply may not be sufficiently geared to the highly specific nature of why someone is experiencing their symptoms. Our concern is that this leads someone to conclude that acupuncture does not work when in the hands of a full time professional practitioner using traditional acupuncture it may well be possible to achieve progress.

The best advice always in these situations, though, is to discuss these issues with the practitioner herself. Whatever system of treatment she is using, she will have a very clear idea based on what she sees and feels of whether the treatment is having an effect, and she is best placed to address your concerns.

As you can see the question was a little more specific than yours - how many treatments, is it OK to have treatment in a hospital from a 'medical acupuncturist' , and so on - but we think it still represents a good statement of what we believe. PMR, like fibromyalgia and other general muscular pains, is becoming more prevalent and it is becoming harder not to recognise that there may well be emotional and mental components to the condition which can have a dramatic effect on how it presents. The advantage of traditional acupuncture is that it treats the person, not the disease label, and that means that the practitioner can look at the case in the round, at all the aspects of someone's problems and lifestyle, to see how the problem has manifested. There are a number of recognised syndromes in Chinese medicine which can generate the kinds of symptoms which people experience, but the real skill and art lies in determining not simply the pattern which this reflects but also its deeper cause. For every person with the same symptoms generated by the same systemic malfunction there may be a different underlying cause. This is why we are so insistent that knowing a few formula points is never enough; it is working out how each unique pattern presents which makes traditional acupuncture so effective.

As we said in the earlier answer, our best advice is to see a BAcC member local to you for an informal assessment of what acupuncture treatment may be able to achieve for you. 

Thursday, 16 April 2015 00:00

Can acupuncture help with an irritable bladder?

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Q: I have seen a urologist who says i have an  irritable bladder.   Can acupuncture help with symptoms of frequency?

A: We have been asked this question a few times over the past two years, and one of the answers we gave to a similar question was:

Can acupuncture alleviate symptoms of an irritable bladder?

Q:  I have been diagnosed with an irritable bladder. Can acupuncture alleviate my symptoms, which is an urgent need to urinate.

 A: As our factsheet shows

there is some evidence to suggest that urgency of urination can be helped by acupuncture, although there is not yet anywhere near enough evidence to make substantive claims here. If you search the internet there are a number of studies such as this one

which offer some hope.

However, we have to remind ourselves sometimes that Chinese medicine has been dealing with problems like this for over 2000 years, and has a very sophisticated process for understanding patients' symptoms against a backdrop of an entirely different conceptual framework. The understanding of the body as a system of energy, 'qi', in flow and the concepts of yin and yang to describe its flow and inter-relationships is very alien to the western ear. However, the rather wider understanding of organs as functional units with effects on body mind and spirit, and the underlying premise that symptoms are alarm bells, not the problem itself, can sometimes offer possibilities for understanding a problem in a far wider context. This will often be corroborated by other problems which a patient suffers and by diagnostic signs which the practitioner sees, and can often lead to a situation where a practitioner can tell the patient about symptoms that they haven't yet mentioned. If the problem is a part of a recognised syndrome or pattern of symptoms a practitioner will be able to give a clear idea of prognosis. Even if it doesn't the attempt to re-establish balance in the system can also have an effect on individual symptoms.

We recommend that you talk to a BAcC member local to you an ask for their advice in a brief face to face consultation whether they think that they can help you. We trust that they will give you an honest assessment, and refer you on to other modalities of treatment if they felt that these offered a better prospect of success.

We have had another look at the research evidence which has emerged since we wrote this response, and there are two more papers which make encouraging noises

and evidence of a systematic review about to take place. This is a survey of all papers on the subject which is regarded very highly within conventional medicine since it irons out anomalies in smaller samples.

One of our members has studied this problem for several years and given presentations at our research gatherings and conferences, so we are confident that there is something of importance emerging in the use of traditional acupuncture in this field. However, each individual person is different, however similar their symptoms may be, and the strength of Chinese medicine is that treatment is tailored to the unique needs of the patient, not simply offered as a one size fits all option. Visiting a BAcC member local to you would seem to us to be your best option. Here you will get advice for your own unique presentation.  

Q:  I hold a Master degree in Chinese medicine , Herbalist and Acupuncture from US accredited Universities (California), also I am a  US Citizen. my
question is what do I need to do to start practice in UK?


A:  The main issue for you about working in the UK is your entitlement to be in the UK and the kind of visa which you may be able to obtain. We are understandably cautious about giving advice in an area which is not our field of expertise, so you will have to check with the UK Borders Agency by following sites like this

to determine your potential entitlement.

Once here there are very few legal restrictions on practice. Since there is no statutory regulation of acupuncture in theory everyone has what is called a common law right to treat. In practice there are specific local, rather than central, government laws which impact on the safety standards of the practitioner and the premises in which they work. These differ depending on where you might choose to work in the UK. The three main variations cover Greater London, Scotland and the rest of the UK except these and require either annual licensing or one-off registration. In Greater London, there can be an exemption from this if you are registered with what is called an 'exempt body' , of which the BAcC is one.

Although the laws for registration and licensing are mainly concerned with premises and practitioner safety, it has become more common for local inspectors to check the qualifications of the practitioner, and some local authorities have set the bar at equivalent to BAcC standards to block people with very short training from setting up.

Apart from that, the situation will be pretty much as you find it in the States, with professional indemnity insurance being the main requirement. This is freely available through a number of brokers.

We would obviously recommend that you join a professional association, and we like to believe that the BAcC is the foremost for traditional acupuncture in the UK. Generally speaking, most US qualifications are more than adequate to meet the BAcC entry requirements, subject to health and criminal record checks, but we do not as yet have reciprocal recognition of qualifications, so someone has to follow what we call our 'external applicant' route.

As we said at the top, though, it's the entitlement to work in the UK which is the first and most critical step, after which the process is relatively straightforward.

Q: I'm a physiotherapist and  recently frequented an eletropuncture three-day course. When we were practicing some points (specifically the 3R - third point from the meridian kidney) my colleague put the needle a little above the point and touched/hitted the tibial posterior nerve. I immediatly felt sharp pain in the plantar side of the calcaneous.  After that "incident" and until today I have little to no pain on walking, but when I stretch the entire posterior chain or only the sciatic nerve (with dorsal flexion) I have that sharp strong pain. I talked with the person responsible for the course and she told me that in a matter of days the pain will be gone. What is your opinion?

The person running your course is very probably correct; the vast majority of transient adverse events disappear within a matter of a few days. Exceptions to this are rare, and when they happen it is often because of small bruises forming beneath the skin which cause nerve impingement when the body is moved in particular directions. This is quite common where there are natural channels in the body, like the ankle or wrist, where there is a higher concentration of blood vessels and nerves travelling in narrow compartments.

We are not clear from your e-mail whether the needle being used to practise was wired up to the EA device or not. If it was a practice run the chances are that it wasn't but we do occasionally hear of patients whose treatment involved EA delivered at higher levels than they can tolerate, and this can occasionally cause longer term irritation of the nerves. The warning signs are very clear, however, and unless a practitioner spins the dials carelessly it is unusual for someone to go from no-pain to pain that quickly.

Our recommendation is, as we're sure you're doing as a qualified professional, to keep an eye on how things go and try to estimate whether there is a qualitative change in the symptom over time. If, however, it still persists after a week, we would probably advise you to visit your GP and possibly line up an appointment with a neurologist. The GP is more than likely to say 'wait and see' after only a week, but it can be helpful to have marked the spot.

Injuries which happen on training courses are often a source of confusion. There are usually disclaimers in place where people on the course use each other as testing apparatus, but that does not mean that a person on the course signs away their right to redress if the damage causes detriment, as they say in the insurance world. The course and the person running it should be properly insured, and if there are consequences which impact on your health and work, it would be entirely legitimate to make a claim.

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