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Q: My friend has fractured his elbow and is in a lot of pain. He had a plaster cast but got it removed after a few weeks because the pain had increased. The pain he says is becoming almost unbearable. Would acupuncture help?

A: This is a tricky one. There is no doubt that acupuncture can be used for pain relief, and this was indeed one of the first uses in the West and one for which a considerable amount of research exists - researchers love precise definition, and there are a number of neurotransmitters involved in pain control by the body which can be measured very precisely to assess whether treatment with acupuncture has an effect. Our fact sheet is very clear on this:

The main issue is how much pain relief treatment can achieve and how sustainable any relief is. If the equation works in someone's favour regular treatment can make a fracture bearable while it heals.

Fractures are as old as time, and there are a number of points used within Chinese medicine for specific bone mending purposes. Because they have always formed a part of the teachings which we have each been given when we trained most of us routinely use specific points when patients have broken bines, and nearly always receive feedback from patients that their bones are healing quickly and well, often faster than their doctors expect. However, this has not been well-researched and although there are cases studies like this

and a number of studies using animals which suggest accelerated bone healing, there are no results which are substantial enough evidence for us to be able to give an unqualified recommendation for the use of treatment.

We are a little concerned to hear that the pain continues, and we are assuming that this is something which his health team are aware of. It may well be worth trying to have the joint X-rayed again to ensure that there is good healing of the tissue, and possibly MRI'd to make sure that there is no local nerve impingement. If this is all under control, then another factor to consider and which may bring your friend into the realm of acupuncture treatment, is that from a Chinese medicine perspective the bone itself is just a part of the energetic construction of the elbow area, and the fact that this is healing does not necessarily mean that the blockages created by the injury have all resolved. This can sometimes lead to situations where on the surface everything appears to have healed, but the energy of an area can still be severely disrupted. From the Chinese medicine point of view, the equation is simple - blockage equals pain.

Another rather more contentious way of looking at this which is to be found in some forms of osteopathy is that the shock of the accident can in some ways be still 'contained' within the healed bone even though to all intents and purposes it is as good as new. Some forms of treatment are aimed at releasing this shock, although it has to be said that this is far from universally agreed within the osteopathic world.

The best advice we can give to you to pass on to your friend is that they should visit a BAcC member local to them for an informal assessment of what acupuncture treatment may be able to do. We are sure that a face to face assessment of the problem will be enough for a practitioner to offer a very clear opinion of what may be possible.

A:'Balance problems' is probably not quite enough for us to go on to be able to offer you specific advice. There are a number of reasons why someone's balance may be starting to fail, and these can range from problems like vertigo and inner ear infections to muscular weaknesses to neurological disorders, and so on. There is no formula for 'balance' as such, and a BAcC member faced with someone who had balance problems would want to know the same things that your GP would ask, such as:

When did you first notice the problem?
Did it come on slowly or start quickly
When does it happen?
Are there any triggers you have noticed which make the problem come on or get worse?
Have you found anything which seems to help?

and so on.

Once a practitioner has this sort of information, they can begin to make sense of it within their diagnostic framework, be it Western or Eastern.

Within Chinese medicine, which has just as clearly defined an understanding of balance problems as western medicine, there may be other aspects of your general health and well-being which enable the practitioner to place your problem within the context of what is happening within your own system, and make treatment that much more strategically precise.

However, we have to be honest and say that at your age there is going to a slight deterioration in your ability to balance anyway, and the real issue is the extent to which what you are experiencing is over and above what a normal 70-year old should feel. We would advise that you talk to your GP as a matter of course because there are a number of neurological issues for which a loss of balance can be a symptom which acupuncture treatment may not be able to help, and you need to make sure that these have been discounted or, if present, treated promptly.

After that we suggest that you visit a BAcC member local to you and ask their advice, based on a brief assessment of what they can find, on whether acupuncture treatment may be of benefit to you.

Q:  Can my 15 year old son receive acupuncture? He has severe eczema.  This is a last resort we have tried everything.

A:  The use of acupuncture for skin conditions is not particularly well researched, as our fact sheet shows:

There may be a number of reasons for this, one of which is that skin conditions form a 'fuzzy' set where the definition and location are not always precise enough to be testing like with like, a pre-condition of the randomised double blind control trial much loved by western science.

That said, there is a considerable amount of anecdotal evidence within the profession about good reactions to treatment, especialy a reduction in the amount of itching and discomfort. One has to be cautious, however; a very common effect of initial treatment is a radical improvement followed by a settling back to nearly the same state as before. We have seen a number of people become even more disheartened when this has happened, even though we have said that short-term results are unlikely and if they appear usually unsustainable.

It has to be said, though, that the collective view inside the BAcC is that skin problems are usually best treated with a combination of Chinese herbal medicine and acupuncture. There is something about the precision with which the formulae are designed and the daily routine of treatment which clearly seems to evince powerful changes in the system. Most members of the Register of Chinese Herbal Medicine are also BAcC acupuncturists, and finding someone in your area who practises both may be a very good way forward. The fact that your son is 15 may also be in his favour; although he takes up as much space as an adult, he is still a child and children can often respond much more quickly to treatment.

Our best advice to you is to see if there are BAcC members local to you who also use Chinese Herbal medicine, and to see if they can offer you a brief face to face assessment of whether they believe tahat acupuncture and herbal treatment can help your son.

Q:  ] I have osteoarthritis in my shoulders and spondylitis in my neck. Would acupuncture help with this?

A:  Generally speaking, the evidence for the treatment of osteoarthritis with acupuncture is encouraging but not conclusive. Most of that which is done tends to compare medication with medication plus acupuncture, and the latter seems to come out favourably, but as you can see from our factsheet

most of the evidence relates to knees and backs rather than shoulders. It would be fair to say, however, that there appears to be an anti-inflamatory reaction to acupuncture treatment, as well as a much more evidence-based reduction in the pain associated with the condition, so that visiting a BAcC member local to you for an informal face to face assessment may well be worthwhile.

From a Chinese medicine perspective, though, the term osteoarthritis is too broad to be immediately useful. Chinese medicine is based on a theory of energy, called 'qi', and its flow, rhythm and balance throughout the system. When this flow is disrupted it can point to either functional or positional disturbances which the use of needles can correct. Since the flow is well-defined in what are called channels or meridians, a practitioner will always assess whether there are local disturbances as well as functional problems to try to correct what has gone awry.

Of course, in the words of sales advertisements, when something has gone, it's gone, so if there has been serious degeneration in a joint no amount of treatment is going to make a difference. If there are osteophytic spurs causing inflammation then the best that acupuncture treatment may be able to offer is some limitation in the inflammation, and then the question will be how much limitation and how sustainable results are. If the sums work in a patient's favour the regular treatment can reduce the pain to manageable levels. If not, other forms of pain relief and inflammatory control may be more effective.

Spondylitis is another matter, however. The same cautions apply about sustainable relief, but if there has been visible and diagnosed fusion of the bones then treatment will be about pain and inflammation control, not about finding out whether the problem can be re-defined in Chinese medicine terms. In this case there is a real need to set very clear outcome measures and review periods if you decide to pursue treatment.

Q: I was attending a NHS acupuncturist for an abdominal ache. I had a temporary vertigo episode and mentioned it to him. He suggested inserting a needle adjacent to my left ear, between ear and sideburns.  I am having what I would describe as a pressure like an ache around the area of needle insertion which is tending to cause a slight headache. The discomfort is increased when using a phone on the left side. What could this be? Unfortunately the acupuncturist has now left the NHS practice.

A: We are sorry to hear of your experience. The first thing we have to say, however, is that long term adverse effects from acupuncture are extremely rare. If someone does have a bad reaction to treatment it is usually transient, lasting no more than 24 to 48 hours. Two safety studies conducted a decade ago independently of each other showed the same incidence of adverse effects - 7 in over 30,000 treatments - none of which were enduring. Subsequent studies have shown not dissimilar results.

Two possibilitities come to mind. The first is that the practitioner has caused a slight bruise deep in the tissue near the ear, and that this is putting pressure on the nerves which are traversing the area and causing discomfort. The fact that the discomfort increases when you use the phone suggests that either additional pressure from the phone or your 'phone calling position' exacerbate the problem.

The other possibility is that there has been an energetic reaction which has caused a blockage. You say that you had treatment with a NHS acupuncturist, but this is a zero set, as far as we are aware. We have a very small number of members who are contracted to work within the NHS, but the majority of acupuncture provision within the NHS is offered by GPs, physiotherapists and a small number of nurses. We are not entirely happy with the idea that someone has stuck a needle in to treat vertigo. because treatment within the NHS is usually limited to someone's scope of practice, and to conditions for which there is an accepted evidence base. As far as this latter restriction is concerned it is one with which we are all too familiar, since it restricts very considerably what we can say here, and vertigo is not one of the conditions for which that level of evidence base exists. This suggests to us that the treatment is a formula one, and may not be done with a full understanding of the energetics of the body.

If so, you may need to see someone, such as one of our members, who can advise you whether there is some sort of blockage in the area, and whether more treatment would be able to help you. We are bound to recommend that you discuss your problems with a BAcC member local to you anyway, because our belief is that traditional acupuncture treatment can often make sense of disparate symptoms like these, and offer some relief in a way that conventional medicine cannot.

However, we are fairly sure from what you describe that this is a short-term physical problem caused by local damage resulting from the needling. This should mean that the problem will reduce gradually and disappear. As a precautionary measure, however, you would do well to contact your GP and arrange to have the problem logged and inspected, so that in the event that it does persist beyond six weeks you can then move towards a referral to a neurologist that much quicker