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Q: Can trigeminal neuralgia be cured by accupunture and can you please let me have names of acupuncture practitioners in Birmingham.

A: 

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

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

although this is more restricted to problems with the tempero-mandibular joint that trigeminal neuropathy.

If you click on this link

http://www.acupuncture.org.uk/Search.html?searchphrase=all&searchword=facial%20pain

you will also find a number of responses we have given to questions similar to yours.

There is also a factsheet on neuropathic pain

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

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.

A: 

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 
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/frozen-shoulder.html
 
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!   
 

Balanitis can be a very uncomfortable and distressing condition, but we have found no research articles which offer any evidence that acupuncture treatment can be of benefit. We would be very surprised to have done so, at least in English. Though not rare, the condition is not in the forefront of more common problems for which the use of acupuncture is tested, and although there are very likely to be research papers in Chinese, the vast majority of these are never translated into English and as such are difficult to track down.
 
All that we can say is that the primary aim of traditional acupuncture treatment is to treat the person, not the presenting problem with which they attend a clinic. Although people talk of seeing a BAcC member for their migraines or backache, the underlying premise of Chinese medicine is that each person is a unique balance of energies, and that understanding why the named condition appears requires a full understanding of the person in whom it appears. This is not a perspective unqiue to Chinese medicine; the grear Canadian physician William Osler once wrote 'it is much more important to know what sort of patient has a disease than what sort of disease a patient has'. From a Chinese medicine perspective the important thing to establish is why a problem such as this does not resolve of its own accord, i.e. what is happening in the energetics of the body which prevents a natural process of healing.
 
Generally speaking we find that most members are adept at treating both constitutionally to balance the whole system while at the same time using more local and targeted treatments for some of the more distressing aspects of a condition such as acute pain or discomfort. This does not necessarily mean needles in the affected area, you will be relieved to hear, but often takes advantages of energetic pathways which traverse an affected area by activating points which have an effect at a distance.
 
Our best advice is to visit a BAcC member local to you and ask whether they think, based on some of the wider diagnostic information they can glean, that acupuncture treatment may be of benefit to you. In the case of skin problems of any type, we often advise someone to seek the advice of an acupuncture practitioner who also uses Chinese herbal medicine. In our experience this is often a very potent way of dealing with skin problems. Since 90% of the Register of Chinese Herbal Medicine (RCHM) membership are also BAcC members, it is not that difficult to use both databases to locate a practitioner close to where you live.
 
The absence of evidence for treating balanitis means that you should set very clear review periods if you decide to go ahead with acupuncture treatment, and also try to establish measurable outcomes, something which will demonstrate whether or not the treatment is having an effect. In our experience, it is quite easy to clock up a large number of treatments with no discernible change unless clear ground rules are drawn up at the beginning, and if this is not done it can create dissatisfaction.  

Q:  I have had hypothyroidism for approx 6 years now, and despite endless efforts, yoga, Zumba, walking, Pilates, diets of every kind, supplements, etc etc, I have not been able to shift the extra weight I gained when my thyroid condition first presented. 
I am now approx 1.5 stones overweight and very miserable and self conscious as a result. And the constant failure despite every effort is even more disheartening. 
Now I am contemplating acupuncture for weight loss but need to check if I can have acupuncture if I have hypothyroidism? 
I also have a brain tumour, (an ependymoma in the 4th ventricle, for which I was treated 11 years ago with surgery where some of it was able to be removed, followed by 6 weeks radiotherapy) 
So, please could you advise if I am able to have acupuncture?

A:There are no contra-indications to the use of acupuncture when someone has hypothyroidism. Indeed, we are sometimes asked if acupuncture can be used to treat hypothyroidism, and a sample answer that we gave says:

A: There isn't a great deal of research to underpin a straight recommendation for the use of acupuncture in the treatment of hypothyroidism. What there is suggests that acupuncture may be of benefit, but this is a condition for which some form of maintenance medication is often essential and this makes testing it in trial conditions somewhat more difficult.

For the same reason our members are always told to be cautious in treating conditions where someone is on essential medication. Recommending that someone stops their medication is out of the question - only a doctor should be making this decision in the case of essential meds - and there is always an issue about adjustment. If the treatment as the effect of improving someone's thyroid function it may then mean that the dose of medication which they take may no longer be suitable. Since it often takes a long time to achieve a stable balance with the medication in the first place, it is important to avoid as much as possible the kind of yo-yo adjustments which people often experience when they are first prescribed their medication.

That said, the important point to make is that the Chinese would have recognised the symptoms of hypothyroidism two thousand years ago but have no idea about the relationship they had to a thyroid malfunction. The symptoms would have been analysed within the diagnostic systems of Chinese medicine, and a treatment plan devised to help correct them. The Chinese understanding of human physiology was entirely different, and rested on a concept of energy, called 'qi', and its various functions and inter-relationships. The kinds of symptoms which someone experiences with hypothyroidism would be linked to a failure of organic function as understood by the Chinese, and even where there was no explicit correspondence, the underlying premise that where there is balance symptoms disappear would nonetheless apply.

If you are thinking of having treatment it would be good to see if you can discuss your specific presentation first with one of our members, and see if they feel that this is something which they feel would be of benefit to you.

We would offer the same advice today and re-iterate the fact that it can quite often take a long time to stabilise thyroid medications. If acupuncture does have the effect of improving the residual function of the thyroid it may take a while to balance the doses of medication again.

We are always cautious when people ask us about using acupuncture for weight loss. There are a number of well-defined and easily recognised syndromes in Chinese medicine where additional weight gain, often in the form of retained fluids or precipitated by an under-performance of parts of the system, may be amenable to treatment. However, even here there is no guarantee that someone will lose weight, and evidence overall for acupuncture and weight loss is poor. It is also, even when part of a successful regime, not entirely clear what causes what. Very few people do only one thing to try to lose weight, and it might be any factor or all in combination which achieve a result.

What we can say is that there may be some aspects of managing one's diet according to Chinese medicine principles might be of benefit, and most practitioners will be only too happy to share this simple wisdom whether you proceed with treatment or not. The best and only advice we could give, though, is to see a BAcC member local to you for a brief assessment of your own unique situation and whether they think acupuncture treatment may be of benefit.

Q: I fractured my ankle 2 years ago and had metal put in (later removed). I still have aching and stiffness. Could acupuncture cure this?

A:  A great deal depends on the cause of the aching and stiffness. There is no doubt that acupuncture treatment can have beneficial effects on chronic pain and on various forms of osteoarthritis, as the factsheets on our website clearly show. The evidence in some cases is very good, while in others slightly more equivocal, but it would be fair to say that we tend to see many cases like yours where from a conventional perspective recovery has been very good but there remains residual pain and discomfort.

The theory which underpins Chinese medicine is based on a concept of energy('qi') and its proper flow and balance within the system. When the body is damaged this can interrupt the flow of qi in a quite profound way. This can mean that even though recovery appears to have been complete, there remains blockage or stagnation in the area which will remain and continue to cause problems long after the patient has been signed off. This is most clearly the case with scar tissue which can have surprisingly powerful effects, but broken bones can be equally troublesome.

How much a practitioner might be able to do is not easy to predict, however. From a Chinese medicine perspective each patient is unique, and even though they might have the same injuries, the overall pattern of energy as the context in which healing takes place can make a huge difference. That is why twenty people with the same problem could receive twenty different treatments.

The best advice that we can give you is to visit a BAcC member local to you and ask advice about your specific problem. Most are only too happy to set aside a few minutes without charge to assess face to face whether a problem is amenable to treatment, and to give you a sense of how much treatment may be necessary. In the absence of any published evidence for the treatment of this kind of problem it is critical that if you go ahead with treatment you set clear review periods and try to set measurable outcomes, something which demonstrates that change is happening. We are always concerned that slightly less well-defined problems can quite quickly run to ten or twenty treatments without discernible change, and therein lies potential disgruntlement.