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Q: I had an emergency double heart bypass whilst on holiday in Spain. It was necessary for an intra aortic balloon pump to be insorted via my right groin. This has caused nerve damage resulting in a numb thigh, painful calf muscle, stiff painful ankle and big and second toes clawing and very painful. I am, in effect, walking on my toenails. The orthopaedic surgeon has suggested surgery but I'm wondering whether acupuncture might help??

A: We are not quite sure what is causing the claw toes after a bypass operation, but the other symptoms are suggestive of a femoral nerve palsy brought about by the surgery. This may have been due to compression during the operation, bleeding into the area during the operation or actual surgical damage to the nerve. We are aware that the standards in Spanish hospitals are regarded as very good, so suspect it is one of the more 'normal' post operative outcomes rather than an accident.

Generally speaking, with nerve damage these is a limit to what acupuncture treatment can achieve. In the parlance of modern sales talk, when it's gone it's gone, and actual damage to nerves is not that easy to put right, regeneration of nerves not being by any means a certainty. We are not sure what the surgeon has in mind, but there is no doubt that procedures to deal with claw toes are fairly straightforward, if a little brutal. The outcome, though, will be a strong probability that you will be able to walk properly again, so this in itself may have some very positive secondary benefits in terms of allowing the muscles of the leg to function more correctly.

However, getting caught up in the Western medical framework does not explain what we might be able to do at all. Any surgery will involve the cutting of tissues whose healing may leave scar tissue which, aside from conventionally understood effects, may have impaired the flow of energy in the channels. As you are probably aware the theories of traditional acupuncture are predicated on flows of energy in defined pathways, and if the flows are excessive, blocked or deficient this will lead to pain and other associated symptoms, such as numbness, weakness and spasm. 

There are occasions where dealing with scarring by reinstating the flow in the area can have a major impact, but it is impossible to make this prognostication remotely. The best we could advise is that you visit a BAcC member local to you to ask if they will have a quick look at the problem and offer a professional view of whether there is something which they can find which would give them confidence that treatment may offer benefits. Our sense is that if there is, the change will be relatively quick, i.e. it is not something which you would want to have prolonged treatment for unless there were clear signs of improvement.

A great deal depends, though, on whether your surgeon is keen to proceed and is also confident that the surgery will make a profound difference. If so we would advise you to give it serious consideration but perhaps give acupuncture treatment a go before the surgery in case it does the trick. No-one would complain if you cancelled an op at a late stage and left a slot for someone else!

Q: Following a fractured toe which has now healed and several weeks in plaster my grand daughter has suffered severe pain in her ankle and calf. This has been diagnosed as chronic regional pain syndrome. She needs physio to help with muscle damage but is in too much pain to do the exercises that are needed. The only medication that has helped so far is morphine which at 12 years old is a dangerous road to follow. Would acupuncture help to reduce or remove the pain so that she can the do the required exercises without the need for medication. 

A:  This is quite a difficult question to address. The fracture, the weeks in plaster and the relative immobility are all capable of producing long term pain of the kind which your daughter is experiencing. Diagnosing the pain as CRPS (we normally call this Complex Regional Pain Syndrome rather than Chronic, but it's only a name) doesn't really refine the diagnosis a great deal. If you look at the wikipedia entry on CRPS, as we are sure that you have, there is no clear-cut cause, the term mainly being used to describe a complex array of neuropathic and sensory pains of great severity.

From an acupuncture treatment point of view, both in traditional Chinese and western medical versions, chronic pain was one of the main focuses of research in the 1970s and onwards following Nixon's visit to China and the film footage of people having operations without anaesthetic. There has been a great deal of research, as our factsheets on chronic pain and neuropathic pain show

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

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

When we are asked about the value of treatment all we can say is that it is worth trying, and that the major issue will not be whether it works but the extent to  which it works and how sustainable the improvements are. Generally speaking we do not like to continue treating someone where there is no overall improvement but simply respite from pain which always lasts only for a short while. However, patients over the years have told us emphatically that if the trade off for a little regular cost is the ability to maintain a valuable and valued lifestyle then it's their call, not ours.

However, from a Chinese medicine perspective there is often a great deal more hope than simply symptom suppression. The system of medicine is predicated on the balanced and effective flow of energies in the body, and if for any reason this flow becomes imbalanced - overflowing, weak or blocked - then pain will result. The re-establishment of proper flow will restore balance and in theory the pain should go. The major task which the practitioner faces is determining how much the problem is simply local and how much it depends on underlying systemic weaknesses for its enduring nature. In your daughter's case her youth probably means that she's in good health, and twelve year olds tend to respond well to treatment, as do most children. Undoubtedly, though, the pain and trauma will have taken some toll.

It would be well worth while contacting a BAcC member local to you for advice based on a brief face to face assessment of what is happening in your daughter's case. Although we have not yet finalised our discussions on expert practice in relation to paediatrics, it is likely that in the next few years we shall recognise the postgraduate training that many members undertake in treating children. They are not simply small adults, and it may well be worthwhile using google searches for 'acupuncture' and 'children' to see if there are, as is likely, BAcC members who have followed this path. We are not quite yet in a position to identify them directly. That said, any practitioner worth their salt will be more than adequately able to help and offer their advice.

A great deal depends on the reason for the entrapment. In some cases people are beginning to show deterioration of the cervical spine through age, and the compression which this can cause, with consequent nerve impingement, is not something which treatment can reverse.

However, this is to take a somewhat pessimistic view of what is happening. We tend to look at structure first. Although acupuncture can be quite effective at treating chronic neck pain, as our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

if there is a structural misalignment which is the likely cause you may be better off seeing a chiropractor or osteopath in the first instance to pop the neck back into place. After this, there may well be good reason to have acupuncture treatment because the adjustment might be resisted by muscles which have become 'set' in an abnormal state, and need some help to re-adjust to normal function. Many members work closely with osteopaths and chiropractors, referring backwards and forwards to nudge the system back into place.

A:  This, though, is to take a very western view of what is happening. From a Chinese medicine perspective the pains which are described as 'trapped nerve' or 'muscle spasm' can often be a direct expression of a blockage in the flow of energies or a more long standing systemic weakness. If this is the case, no amount of manipulation will hold changes in place, and acupuncture may treatment well be the best option.

The best advice we can give, without knowing the wider context of your problem, is to pop in to see a BAcC member local to you and seek a brief face to face assessment of what may be possible. We are confident that they will offer you advice which is geared to your specific needs, not simply book you straight in without demur.

A: As you can imagine we have been asked about peripheral neuropathy on a number of occasions. One of the more recent answers we gave was:

There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet

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

shows but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.

Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achevement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.

The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.

This remains the best advice we can give you. A practitioner may see something in your state of balance which is a basis for treating the system as a whole with some expectation of change, however limited. The question may well be how much change and how sustainable. If it managed to quell the worst symptoms during an attack, which based on evidence for acupuncture and pain relief may be possible, then treatment may be very worthwhile.

This is still the best answer we can give. PN usually arises as a secondary manifestation of a major condition, usually Type 2 diabetes, and much of what can be achieved depends on how well controlled and managed the predominant condition is. If someone follows a healthy eating regime alongside the medications then we have seen cases where the rate of deterioration has slowed down considerably and where the symptoms have been reduced. If, however, someone continues to eat in a way which further affects the circulation and nervous system there isn't much we can do. However, we have to bear in mind that acupuncture treats the person, not simply the condition, and the determination to maintain a healthy lifestyle is often an unforeseen consequence of treatment as someone generally 'feels better in themselves'.

A:  It may sound a little like one of those silly advertising statements, but all of our members are the best practitioner in Cambridgeshire!  We are very confident that the degree level training which all our graduate entrants receive more than adequately equips them to deal with a problem like yours, and your best way of locating the nearest member to you is by using the postcode search facility on our home page.

Reflux is a fairly common presentation in clinic, which is why when we answered a query earlier this year we said:

There is surprisingly little research on the use of acupuncture for the treatment of acid reflux even though it is a very common presenting condition in our clinics. There are one or two studies like this

http://www.ncbi.nlm.nih.gov/pubmed/20697939

and 

http://www.ncbi.nlm.nih.gov/pubmed/17875198 

and occasional articles like this one

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080874/

which suggest other possibilities for the appearance of heartburn symptoms, but not the solid body of evidence one might expect based on the usually quite effective treatment of this problem.

Obviously there are physical problems such as hiatus hernia where there has been a physical change in structure of the oesophageal tract which can cause heartburn. If this is the case, then it will seriously limit the possibilities for treatment in any system of medicine. If investigations show that this is not the case, however, then there may be some value in using acupuncture treatment.

From a Chinese medicine perspective the classic presentation of reflux or heartburn is described as Stomach Fire or Rebellious Stomach Qi where the energy of the Stomach does not follow its normal pattern of causing food to descend but lets it stay in the Stomach or reverse its flow to create the classic symptoms with which people suffer. Knowing the immediate precipitating cause, however, does not mean that one goes straight to this for treatment. The flow of energy in the body, called 'qi' in Chinese, is a complex interweaving of channels connecting Organs whose functions are also inter-related. The art and skill of the practitioner lies in determining what the primary underlying imbalances are, in the belief that treating here will cause the symptom to go and stay gone rather than be treated simply as a symptom.

This is one of the primary differences between Chinese and conventional medicine. From the Chinese medicine perspective the symptom is an alarm bell telling the practitioner that the system is out of balance. Thus twenty patients with the same symptom could have twenty different underlying causes and therefore twenty different treatments, in contrast to the standard western procedures which have two or three main strategies for a problem. In Chinese medicine the balance of the system is unique in every patient, and this means that each treatment plan is also unique.

It follows that this does limit what we can say about individual cases and why we invariably advise people to visit a local BAcC member for an informal assessment of what is going on and whether treatment would be of benefit. Most practitioners can get an idea in a very short time of what is going on and as a consequence give a good informed view of what might be possible. This would invariably take into account other changes in the way that everything functions which are perhaps not significant enough to concern anyone but from our perspective enrich the picture which we have. Reflux and heartburn are often accompanied by changes in digestion and bowel habit, and secondary information can refine the diagnosis a great deal. A practitioner can take all sorts of other factors into account, including mental and emotional ones, to offer you a much more precise assessment of what may be possible.

This remains the best advice we can possibly give to determine whether acupuncture really is the best option for you, and also to reassure you that this is such a commonly addressed issue that all of our members would tend to regard it as a 'stock' item.

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