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Q:  Would acupuncture help with a chronic nerve pain which I have in my shoulder which refers down to my forearm?

A:  A great deal depends on whether the pain is caused by impingement of a nerve, either in the shoulder itself or higher up in the neck, which can also produce similar sensations. If there is a structural problem, then while acupuncture treatment may help to reduce any inflammation which results from the trapped nerve, the problem will recur until the structure is fixed. While acupuncture treatment aims to restore natural function, and may eventually encourage the structure to right itself, the quickest way to deal with a problem such as this may be to visit an osteopath. They will be able to tell you whether there is a problem, and perhaps re-refer you to an acupuncturist after they have corrected it. We find this kind of cross-referral often works well; once the structure is settled it is important to get the muscles and tendons to re-assume their correct positions and tension. Acupuncture treatment seems to help well with this.

However, this is to take a very Western view of what is going on, and there are many occasions when the sensation which someone describes can be explained, understood and treated in Chinese medicine by using a different way of looking at the body. From a Chinese medicine perspective, which is premised on a good flow of energy (called 'qi') in the body, pain arises from deficiencies, excesses or blockages in the flow. The exact nature of the pain will inform the practitioner about the exact nature of the blockage. It is perfectly possible that working in this way the pain can be treated.

The best advice we can give, though, is to visit a BAcC member local to you for a brief face to face assessment of whether they can help with the problem. It is very difficult to tell at one remove what the best course of action is, and a visual inspection would help to determine whether or not an onward referral to an osteopath is more appropriate.

Q:  My farther has had his leg amputated 4 years ago and still has very painful phantom pains, can this be treated with acupuncture?

A:  Phantom limb pain can be a very distressing phenomenon.

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:

http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97

Hecker H. -U et al (2008) Color Atlas of Acupuncture 2nd Ed. Thieme, Stuttgart

Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142

Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112

Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213

Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in 'conventional' Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

The best advice we can give, especially when there is so little case evidence to point to, is to visit a BAcC member local to your father for advice on his specific circumstances. There may be a number of initial soundings which he or she could make to determine whether treatment may be of benefit.

The problem with conditions like this is that there are case studies which offer encouragement, but nobody publishes the results of case studies where things don't work, so for the small number which have been successful there may be ten times as many where treatment was tried and failed. It is best not to over-excited by the fact that some treatments work. Everything works for someone, but that doesn't mean that somehing works for everyone.

Q:  i had my first acupuncture session and the therapist put the needles through my clothes is this the proper practice?   The needles went into my buttock and leg.

A:  The short answer is 'no'.
 
This question was raised a very long time ago when a member queried whether it was acceptable to needle through by thin fabric when treating patients whose religious or ciltural sensitivities made it impossible for them to uncover areas of the body which the practitioner felt needed to be needled. The categorical advice was not to do this. Either the practitioner must find other ways of treating the problems through the use of available points, which can often be done, or the patient must be referred on to a practitioner in front of whom the removal of some clothing is acceptable.
 
The possibilities for infection or the accidental contamination of the puncture site with foreign bodies are so obvious that the prohibition is self-evident, i.e. one would never expect to have to gather evidence to support it.
 
If your practitioner has done this with you it is fair to assume that this is a standard practice, and it is important that they cease and desist immediately. If he or she belongs to a professional association, it would be a good idea to approach them with this information. Even if you chose not to make a formal complaint we are confident that they would instruct the member not to do this again on pain of removal from the Register if they failed to comply. If this person is a BAcC member, you need to contact our Ethics Secretary on 0208 735 1205 for further advice. If the practitioner does not appear to belong to a professional body then a word with the Local Authority Environmental Health Department is merited. 
 
We should reassure you by saying that the chances of an infection are remote, but even though they are remote, the treatment is nowhere near as safe as that undertaken with proper preparation and precautions.
 

Q:  I've suffered from an accident a couple of months ago. I broke a couple of ribs, they've all healed except one.  I'm in a lot of pain and unable to sleep properly and sit still for long. Can acupuncture help? What does it involve?

A:  Two months is certainly a long time to be suffering the after effects of a broken rib. As we are sure you know already, the management of broken ribs is very conservative, mainly involving a routine of pain relief and avoidance of binding or exercising, and the fractures heal within two to four weeks. If the pain continues, you will almost certainly be prescribed, or advised to use, more painkillers in the expectation that the pain will eventually resolve.

From a Chinese medicine point of view, the use of acupuncture for pain relief is well-documented and probably the first major use which people started to investigate as acupuncture treatment became more prevalent in the 1970s. Theories like the 'Pain Gate' Theory, where it was assumed that the needles over-rode pain signals in the brain, were very popular, and even westerm medicine took on board the fact that endorphin and enkephalin levels (the body's own painkillers) appeared to rise after treatment. However, from our perspective we are looking more at the flow of energy, called 'qi' in Chinese thought, which is disturbed by injury and can sometimes remain disturbed after the physical injury appears to have healed.

Re-instating the flow can often involve needles applied locally to the problem in conjunction with needles some distance away, and the practitioner will always be looking at the overall picture to see if there is any underlying reason why the energy has not successfully been restored in the affected area. If someone is quite depleted, for example, a small blockage may persist because the system is too weak to cope with proper recovery.

Naturally, when treatment is administered on the thorax near the ribs, the needles are inserted to a very superficial depth and always obliquely to avoid going anywhere near the lungs. Pneumothoraxes are rare, and a well-trained and qualified practitioner will always make sure that they take no risks. Needles are usually left in for a short time and often manipulated gently to encourage the flow to re-commence.

The best advice we can give is to visit a BAcC member local to you for a face to face assessment of whether they think that acupuncture treatment may be of benefit. We are also aware that many osteopaths who use cranial osteopathy have a basis for understanding the same phenomenon, the continuation of pain after the physica injury has healed, and this may be another option to consider. There are a number of other therapies - cranio-sacral therapy, zero balancing - which also have ways of dealing with post-traumatic pain, but we aren;t really in a position to recommend anything specific because the evidence base is not that well-established.

For acupuncture treatment, however, there is a very considerable evidence base in both eastern and western versions of acupuncture that acupuncture treatment can offer pain relief, and the major issue is how much relief and how sustainable. Clearly if something offers only a day or so of relief on each occasion and then the condition reverts, it may be worth drawing a line in the sand and trying something different. Change should be sustainable and incremental, unless the pain is so severe that any relief is welcome. The only issue here is a financial one, and we have known patients with large resources to continue to have treatment with short-lived benefits because the financial element is not an issue. For most of us, though, it is, and that has to be taken into account.

Hopefully, however, the treatment you choose to have will accelerate your recovery and sidestep some of these concerns.

We drew up a review paper some years ago

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

which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.

However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK ( http://www.nadauk.com/) and SMART-UK (http://www.smart-uk.com/) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.

There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).

This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.