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Q:  Can acupuncture help with tennis elbow? I have this problem in both of my arms.  if so, what would the probable cost be, and who would be the best acupuncturist to contact?

As far as the condition itself is concerned, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tennis-elbow.html

there is a small amount of fully researched evidence that acupuncture can provide short-term relief for the problem. The criteria for quotable research set the bar very high by employing research requirements more suitable for drug testing, the randomised double blind control trial, and in practice tennis elbow is one of the more frequent named conditions for which people seek help from acupuncturists of every persuasion, traditional, medical and physiotherapy. Our usual recommendation to patients is to have two, three or four sessions along with trying as much as possible not to have to do the sorts of things which brought the condition on. This is often a sports activity, but we have come across people in kitchens and laundries with issues from repetitive use of the joint.

The fact that you have the condition in both elbows we find a little surprising. Most examples we come across are linked to specific activities which are often one-sided, although we did come across a number of wind-surfers who over-taxed the structure on both sides. We would be minded to look at what was happening systemically to see if there was a general underlying predisposition to this kind of inflammation.

On balance we think that the best advice we can give you is to visit a BAcC member local to you to see what they make of the problem that you have and by virtue of a face to face assessment offer you a very clear idea of what may be possible. 

As far as cost is concerned, the majority of practitioners outside London tend to charge between £40 and £50 for a first consultation and then £35 to £45 for each subsequent treatment. Sessions can last between thirty minutes and and hour.

We are sorry that we cannot give individual referrals, but if you use the postcode option on our 'find a practitioner' home page facility, as we have just tried, you will find a number of members within a few miles of where you are live, all of whom uphold the high standards for which we stand. 

Q:  i had an acupuncture treatment yesterday,the second time by the same,experieced practicioner. I have had problems with my sacro-iliac and L5-S1,but all is well now and  the acupuncture was to aid healing. However,this morning,while still asleep I tried to move on my left side to sleep,but even in my dream state felt the world start tilting around. I woke up and tried again ,but the same thing happened. I can sit and stand straight ,but as soon as I lean left or right on my side I start losing the balance and would maybe faint if I kept at it. Is this normal? I have had acupunture before many times, but never with this sort of result. According to the acupuncturist I am very receptive to it and felt absolutely wiped out last night so I thought rest was the best thing.  I did have a slight stomach upset 2 days ago, but had eaten before and after the treatment so didn't think that would be the reason for this extreme tiredness and now this strange dizziness.  Any advice would be appreciated as I am a little worried about this.

This is an unusual reaction, especially in someone who has had acupuncture many times before. The chances that it is a physical problem caused by the treatment itself are very slim; acupuncture has a remarkably good safety record, even in the hands of the poorly trained, and unless someone sticks a needle in a vital organ or vessel, there is very little chance that physical harm will happen. If this is the case it is usually immediately noticeable.

There is always a slim chance that there may be an energetic effect which is causing this. The kind of vertigo/dizziness symptoms which you have can be caused by a number of imbalances within the system, and it would not be impossible that releasing a blockage in the system could unearth a secondary blockage further down the line which generated this symptom. It would be unusual, but not impossible. The person best placed to help you with this is the practitioner himself or herself. He or she will know exactly what they did, and also be familiar with your energetic balance and if there is a chance that it is a treatment-related problem in Chinese medicine terms, they can give you the appropriate advice and perhaps invite you in ahead of your next planned session to address the problem.

The most likely cause, however, is that you have some sort of mild viral condition which happens to have arisen at the same time as the treatment. If so, it may be worth contacting your GP and popping in to see them. Vertigo and dizziness such as you are experiencing can be very disconcerting, and we are not surprised that you are worried. There are a number of medications which can help, as indeed can acupuncture treatment if you want to try to avoid drugs, but it is important when something new and unexplained appears to see your GP as a precaution to eliminate any more worrying conditions.

Our advice, though, would be to call the practitioner first and ask what their view was, and then, if the symptoms persist, to contact the GP for a visit to get their advice. We hope that you manage to regain your normal balance, literally, as soon as possible.

Q:  My wife has had Parkinsons for 5 and a half years. For the last couple of years or so she has been experiencing severe pain in both legs for which the GP was unable to prescribe satisfactory analgesia. The local pain clinic recommended Oxycodone (up to 40 mg) both as controlled release and instant acting for breakthrough pain. Despite all of this her pain is still more than is bearable and we are at our wit's end to find something to help. Would acupuncture be of value in such a case? I realise I have not given any other clinical info, but would welcome any comments you can make.

The treatment of Parkinson's disease when it starts to manifest in the kind of muscle tightening and freezing is not that well researched. We tend to be a little tentative when we have discussed this in the past. A not untypical answer was:

From the perspective of research studies alone it would be difficult to give any firm recommendations for acupuncture as a treatment of Parkinson's Disease. There are a number of studies, some undertaken in the US but the vast majority in China, which show some positive signs, but not of sufficient change in a significant number of patients under study to draw any firm conclusions. You can see some of the studies if you google 'ncbi acupuncture parkinson's disease' - the National Centre for Biotechnical Information in the States is a convenient way to find many of the the more significant papers. There is also a Cochrane Review of a protocol for assessing the value of acupuncture, but as far as we are aware this has not been put into action yet.

  

With all chronic degenerative conditions the extent to which acupuncture can help has to be carefully explained. It is often, as one rather ironic patient said, a case of 'getting worse slower', and this is extremely difficult to quantify in a condition like Parkinson's where the disease progression is neither smooth nor predictable. Anecdotally there are many accounts of patients finding that treatment helps with some of the manifestations of the disease, such as the periods of rigidity and freezing, and a general sense of well-being, but these are not documented sufficiently well to be able to claim any undisputed levels of efficacy.

 

The best course of action is to see whether a BAcC member local to you will give you an honest assessment from an eastern perspective of what they might be able to achieve for your own unique patterns. There may be elements of how the condition manifests which they may feel that they can help.

That said, acupuncture has a long track record of being used as pain relief. When it first became more public in the West after Nixon's visit to China in 1976, one of the main areas of research was into the use of acupuncture for pain relief and control, driven by graphic images of people having operations while awake and needled. It is also a very straightforward area for measurements; the neurotransmitters are well known and researched, and the levels quickly determined to establish whether treatment is increasing the amount the patient has. The usual question with acupuncture used in this way is not 'does it work?' but 'how much does it work and how long does the effect last?' If it does, the ultimate determinant is the cos-benefit analysis: is the relief sufficient to warrant the expenditure? For people with deep pockets this is not an issue; for the majority of us it is.

Another useful indicator is that acupuncture is very widely used in China after strokes, often being applied on the same day as the stroke, to overcome paralysis and spasticity in the muscles. The firmly held belief is that this reinstates the flow of energy which has been disturbed by the stroke as soon as possible and before the body had 'set'. Evidence suggests that this is being taken more seriously in the West.

In summary, we think it is an avenue worth exploring, but given the nature of the problem we would expect the judgement of how effective treatment is to be fairly rapid. If it is going to work, it will offer some relief pretty much immediately. It may take two or three sessions to reach a definite conclusion, but where we have seen it used (one of our close friends suffered from Parkinsons and we were used to his episodes of freezing and muscle locking) when acupuncture was used it did help fairly quickly. Of course, from a Chinese medicine perspective everyone is unique and different so one cannot generalise from single cases or case studies, but we believe that there is sufficient anecdotal evidence to warrant a short course of treatment to see what level of relief it can offer.  

,Q: I have had 3 sessions of acupuncture for lower back pain. An MRI showed a herniated disc L4/L5 and I have been trying to find a helpful treatment for 9 months. I saw a couple physiotherapists and the exercises they gave me did help a lot but not fully. Five hours after my second acupuncture session I had a lot of pain in places I've had pain previously, and in new places and pain evoked by movements that previously were painfree. I'm worried  the acupuncture just undid 9 months of work. Also, it hurts when he puts the needles in - it is tolerable and he modified it to be less painful in my third session. However, 15 hours after that 3rd session and I am in pain still. I don't know if I should continue for the 10 recommended sessions. Also he suggested herbal medicine to help the imbalance/ weakness of my kidneys and liver. Please advise!!

A: We can start immediately by saying that it is highly unlikely that the acupuncture has undone any of the progress you have made over the last few months. It remains one of the safest forms of treatment available, even compared to many forms of conventional medicine, and unless someone is poorly trained and sticks a needle in a vital organ, itself extremely rare, there is very little chance that physical damage has been caused.

That said, it is not unusual for people to experience a noticeable reaction to treatment, especially after the first one or two sessions, when musculo-skeletal conditions are the order of the day. This expert always warns patients with neck and back problems that for up to 48 hours after a session there may be some additional discomfort and stiffness, but after that there should be some progress. Opinion is divided about why this should be so, but most of the explanations are plausible. The two most commonly accepted are that the body 'immobilises' itself to allow healing to take place, and that the body has often been in an unstable posture because of the problem the patient has/had, and the discomfort arises from the musculature adapting as the structure rectifies itself. This sort of reaction should not continue after the first few treatments. Osteopaths tend to give the same warnings to patients.

We don't want to make unwarranted assumptions but the recommendation of ten sessions along with herbs does suggest that you may have visit a Chinese practitioner in one of the High Street shops. This is very much the norm in traditional Chinese medicine practised within the Chinese NHS - a course of treatment is defined as ten sessions and usually administered daily. Fine when it's free, but most people in the UK would be stretched to stump up ten fees in ten days. If this is the case, then you may find that the needle technique is a little more vigorous than that practised by someone trained in the West. A prerequisite of good treatment in China is to elicit a dull aching sensation, called 'deqi', at the point where the needle is inserted and the needles are often inserted a little more deeply and manipulated until the patient can feel what is happening. This is often too much for western patients, and many ask the practitioner to tone it down. Many others, it has to be said, exhibit a true British diffidence about complaining and walk away, but a responsible practitioner will always take heed of what a patient reports and asks. If they don't, walk away.

As far as the treatment itself is concerned, a herniated disk will normally self-repair within about three months unless it is a really bad one or the patient overdoes it by straining their back. Keeping moving is now the recommendation from conventional medicine, but don't overdo it. In a previous answer we wrote:

Slipped discs can take a long time to recover, even when using therapies which are known to help. Where the standard treatment in conventional medicine used to involve a great deal of bed rest, continual movement is now the order of the day to help the acumulated tissue to disperse.

There are a number of small studies which underpin documents like this overview

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0048469/

which mentions that there is a weak evidence base for acupuncture. Our own fact sheet on sciatica

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/sciatica.html

mentions a number of studies which show some encouraging results for the kinds of secondary problems which can arise from a slipped disc.

Sight unseen it is very difficult to offer a detailed opinion, but speaking in very general terms, there is often an accident or underlying pattern of weakness which predisposes someone to have a slipped disc, and there are often ways of understanding the disease process from a Chinese medicine point of view which offer treatment possibilities. This can often be the case when someone has reached a plateau in the conventional treatment they are having.

However, it is not uncommon for people to seem to plateau and then for the condition to resolve after 3-6 months, and you may well find that you suddenly begin to make progress again. Acupuncture treatment certainly won't do you any harm, and given that the area where you have been affected will have been quite immobile and 'stagnant' for a few months it is possible that from a Chinese medicine perspective there are significant blockages whose clearance may help to speed up your recovery.

and we believe this is sufficiently encouraging to warrant using acupuncture. Certainly in our clinical practice we have been able to help patients with this problem, and the real question is how much help and how sustainable, rather than works/doesn't work. As long as there are frequent reviews to ensure that a treatment habit with no real progress builds up, it would be worth continuing.

Q:  I have had an MRI and been  diagnosed with arthritis in neck and lower back. Nothing can be done except to take pain killers. Could acupuncture help?

A:  Acupuncture treatment certainly has a good track record for treating chronic back pain, to the extent that it is one of the treatments recommended by NICE, the body which sets out recommendations for the NHS. Our factsheet on back pain mentions this and other research:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html

However, in all cases of arthritis of the neck and back, the question of much help acupuncture can offer depends on the extent of the deterioration of the spine, and especially the neck. If there is a great deal of degeneration of the bone and also the inter-vertebral discs, the chances are that acupuncture may offer only limited pain relief. This is not to be under-valued; someone who is in chronic pain may well think that two or three days of relative ease are well worth the expenses. In the end it may come down to affordability, the balance between the expense and the level of relief.

On a brighter note, however, the pains not be entirely related to physical structure. We have come across many patients whose X-rays have shown significant deterioration of the lower spine, yet whose back pains have been brought under control by the use of acupuncture. This can sometimes be because the treatment can reduce the inflammation, breaking the cycle of discontent which means that inflammation cause swelling causes more inflammation. This cycle is what doctors try to break with anti-inflammatory medication. It can sometimes be the case, however, that the back pain and the deterioration of the spine are unrelated, and that there are reasons which can be understood within the Chinese Medicine system which are the cause of the discomfort.

Each person is different in Chinese medicine terms, and so there is a limit to the specific advice which we can give.The best advice is to visit a BAcC member local to you and see if they will offer you a brief face to face assessment of your specific problem. This will be much more informative than anything we can offer here, and they should be able to offer some advice on how much treatment may be necessary, if indeed they think it is worthwhile.

The key thing with conditions like this is that you set measurable outcomes and review progress on a regular basis. It is very easy to get into a long-term treatment pattern without realising, and suddenly find that fifteen or twenty treatments later nothing much has changed. This is why we often use outcome measures which can be measured (time between medications, distance walked) to avoid the good day/bad day problem of it depending on what happens on the day someone is asked. 

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