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Q:] I have peripherial neuropathy in hands and feet for almost a year caused by chemotherapy for breast cancer. I also have lymphodema in my arm. How many acupuncture treatments before I should notice benefit or when should I consider stopping. Is it safe to have acupuncture in lymphodema arm?
A: The first question is difficult to answer, and is usually described as a 'how long is a piece of string' question. Our usual recommendation to patients in giving answers here is to review progress every four or five sessions, and to try to establish clear and measurable outcomes so that there is some objective evidence of whether the treatment is taking effect. We are really concerned that our colleagues avoid situations developing where a treatment 'habit' can run to fifteen or twenty sessions without discernible change - it's just very easy to book week after week with no sense of time passing. This tends to lead to discontent and occasionally complaints.
In this expert's view, there has to be some evidence of progress, however limited, after the first five sessions to have a good sense that it's worth continuing. This need not necessarily be in the main symptom; in Chinese medicine we treat the person, not the condition, and there can sometimes be good evidence from other systems of beneficial change which means the main problem will also be likely to move. This does not always mean drawing a line, but it does mean that if someone does decide to carry on it is with clear understanding of what is happening.
As far as needling a lymphoedematous arm is concerned, our current recommendation to members is that this is not to be done. Although there is little or no evidence to support the almost universal prohibition of acupuncture by consultants, we have to acknowledge that there is an increased risk of cellulitis and other infection from needling a limb below where lymph nodes have been removed. However, there are many ways of using the interconnections within the system as a whole to treat successfully at a distance within the body, and a qualified practitioner will have many ways at their disposal to effect change and improvement.
Indeed, one of our members, Beverley de Valois, has published several landmark papers in this area
and has shown that treating constitutionally without needling an affected limb can be very beneficial.
Q: I have been diagnosed with inclusion body modified a muscle wasting disease ,would acupuncture be of any help to me?
A: There are number of myopathies like inclusion body myositis where many people turn to forms of complementary and alternative medicine in the absence of any clearly defined successful treatment protocols in conventional medicine. Inclusion body myositis is a particularly difficult condition to treat conventionally since it shows features of having genetic, autoimmune and environmental factors.
Although people occasionally make grandiose claims for what acupuncture treatment can achieve, but in the face of a condition which is chronic and degenerative the best that one may be able to hope for is a slowing down of a problem. As one patient we have quoted before said to us, 'do you know, I think I'm getting worse slower.' However, we would not want to sound unduly pessimistic. Chinese medicine has confrontted conditions like this for over two thousand years, and had to make sense of them through an entirely different understanding of the way that the body functions. The premise on which Chinese medicine rests, that the body mind and spirit are a complex flow of energy called 'qi', allied to an understanding of the Organs of the body which have functional as well a physiological roles, means that disturbances in these flows or functions create symptoms. When symptoms occur in generic types of tissue in the body it is theoretically possible to track back to the area which is out of balance and to assess whether this is a primary cause or a secondary cause, a reaction to another and even possibly asymptomatic problem.
It would be well worth talking to a BAcC member local to you to see what their take on your problem is. There is no doubt that their view will be better informed that we can offer here; we have no idea of the extent of the deterioration which has occurred, nor where it presents, both of which have a major bearing on what may be possible.
As we said earlier, however, it would be unreasonable to have too high an expectation of what might be done, and a sensible practitioner will be very cautious about the prognosis.
Q: Can you recommend a practitioner in or around York/Harrogate who could offer my husband acupuncture for post shingles pain. He has Bell's palsy type symptoms and acute pain in his face and eye area with some facial paralysis. The condition is known as Ramsey Hunt syndrome.
A:We do not recommend individual practitioners. Our view is that all of our members are sufficiently well trained to treat all patients within the limits of their competence, and there are very few areas where we would seek to define standards of expert practice where we might want to recommend that people seek out a member with specific additional training. The only three areas where we are likely to head down this path are obstetrics, paediatrics and mental health problems. Otherwise using the practitioner search fucntion on our homepage www.acupuncture.org.uk should take you to a BAcC member very local to you, especially if you use the postcode search function.
The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet
says, but the quality of trials is not that great. Bell's Palsy
has a slightly better success rate when acupuncture treatment is applied, but neither has evidence of such a high standard that we could make an unqualified recommendation. We have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know to your cost can be excruciating.
However, there is no point in being unduly pessimistic. There have been cases both of pain and paralysis where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to free up some of the blockage and stagnation which paralysis represents. The earlier that treatment commences after an attack, the better, before the area becomes 'settled' in a fixed pattern which can be difficult to shift.
The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress.
Q: Can trigeminal neuralgia be cured by accupunture and can you please let me have names of acupuncture practitioners in Birmingham.
This is one of a small number of conditions which, because they are often intractable to conventional treatment, lead people to try acupuncture treatment as an alternative. Not surprisingly we have answered a number of questions like this in the last few years, and the most recent answer last year summarised many of the previous ones as follows:
Can acupuncture help with chronic facial pain?
Q: Could you tell me if acupuncture can be used to help with chronic facial pain? The actual condition is known as 'post traumatic trigeminal neuropathy'.
We have produced a fact sheet on this question
although this is more restricted to problems with the tempero-mandibular joint that trigeminal neuropathy.
If you click on this link
you will also find a number of responses we have given to questions similar to yours.
There is also a factsheet on neuropathic pain
which offers a useful summary of the various studies of the use of acupuncture to treat trigeminal neuralgia.
If you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.
We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, and subtle manipulation may offer possibilities.
We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficient to warrant making a recommendation to try to use acupuncture as a long-term pain relief option.
If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to estbalish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accurately bad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.
We do not recommend individual practitioners; our view is that all of our members are well enough trained and qualified to deal with the vast majority of patients who come their way. Our tradition is based on treating the person as much as it is on treating the condition, and apart from a few patient groups (pregnant women, children) where a case can be made for additional skills being advisory, every other patient can expect the same high level of service from our members. Using the postcode search facility on our home page www.acupuncture.org.uk will, we are sure, generate the names and addresses of a number of members within easy reach of where you live or work.
Q: I have a frozen shoulder (and have had it now for 6 months with no sign of recovery). Can acupuncture help and how much does each session cost? On average, how may sessions are needed to treat a frozen shoulder ( know that's like asking 'How long is a piece of string?, but there must be some guideline.
You will not be surprised to hear that we are often asked this question, and we tend to repeat an answer we gave some time ago.
Can accupuncture help a frozen shoulder?
Frozen shoulder can be a difficult condition to treat. Our fact sheet on the website
is not overly encouraging, but the main point to note here is that there haven't been a great many studies. What counts as 'frozen shoulder' can vary considerably and creating a number of groups with identical problems for trial purposes is not that straightforward.
One major problem with the shoulder joint is that it's mobility means a dependence on groups of muscles and a relatively open socket into which the head of the humerus fits. It is very easy for there to be a minor displacement or small dislocation of the joint, and equally easy for a problem with one set of muscles to cause a ripple effect throughout all of the groups holding the shoulder joint stable. There are often secondary problems which may need to be addressed.
Chinese medicine has obviously been used to treat problems like this for thousands of years, and as well as treating locally to where the problem is on the body there are a number of functional treatments which are aimed at affecting all muscles and a couple of 'empirical points', points which have been used for centuries to help with all shoulder problems. There are also points which can be used to help reduce some of the pain and inflammation which results from the muscle and tendon strains.
However, there is no doubt that it really pays to have treatment with someone who fully understands the dynamics of the joint in great detail and can make an informed and careful assessment of the precise problem. There are a considerable number of BAcC members who are also trained in osteopathy and physiotherapy, and equally a number of osteopaths and physios who use acupuncture on a regular basis, and the combination of manipulation, movement and acupuncture may be the optimum package.
It may be helpful to seek the advice of a BAcC member local to you. Most know of colleagues within their area who specialise in this kind of condition, and many also work very closely with local osteopaths and physiotherapists, and maybe able to put together a co-ordinated package of treatment to get you back to good health and mobility.
This remains an accurate summary of our views. Since publishing this, this particular expert has had a couple of good outcomes treating the problem, but the fact that it came as a surprise that it worked so well probably tells you what you need to know about how unpredictable the outcome of treatment can be.
The average cost per session depends largely on where you are. For the first session, in London you might be paying £50-£75, for each follow up session (which can last between half an hour and an hour) you might be paying £40-£50. In the provinces this cna be a little lower, £40 - £60, and £30 - £45, but again, it depends on the kinds of premises which you visit. Like any business, the more salubrious the surroundings, the greater the cost and the more likelihood that this will get charged on to the patient.
The first session costs more because it is generally longer and is a full diagnostic session. As the great Canadian physician William Osler once remarked, 'tell me about the patient who has the disease, not about the disease the patient has', and this is fundamental to Chinese medicine. The body has a fantastic ability to recover, and looking at the whole picture enables the practitioner to see what is preventing recovery, whether something is simply stuck where the problem is or whether the 'stuckness' is happening because of weaknesses elsewhere.
Most practitioners will set a defined number of sessions when taking on a problem like yours and do a thorough review to see if any progress has been made. This is usually four or five sessions. It is very helpful to have some objective markers for checking whether anything has changed, and the degrees of abduction, extension and flexion are usually a reliable indicator of whether joint is is improving or not.
We like to avoid situations where treatment just carries on and on after some hold grail of change long after it has become clear that acupuncture treatment is not working. Herein lie complaints!