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Q: Is there an acupuncture treatment for post herpetic neuralgia?  My sister has been in great pain for 3 months now - even morphine does not
 relieve the pain.

A: We fully sympathise with your sister; along with gallstones and kidney stones, post-herpetic neuralgia is amongst the most debilitating and unrelenting pains that anyone can have to deal with. We have been asked this question before, and a recent answer was:

Q:  I had shingles which left me with severe post herpatic neuralgia.  Please can you tell me if acupuncture would benefit me? I have had to leave my job taking early retirement after working there over 26 years, due to this pain. 

A:  As you might imagine we have been asked about this many times over the years; shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet

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

says, but the quality of trials is not that great. 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 can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain 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 reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

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. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

We believe that this is still sound advice, and we hope that it is of benefit. In the course of our practices over the years we have heard of many different things which people have tried to keep the pain under control alongside and in some cases after acupuncture treatment. One rather left field option is hypnotherapy. One of the problems with the herpetic pain is that it blots out most other sensation, and there are a number of techniques within the more reputable hypnotherapy traditions for helping people to ignore the pain signals. This is obviously not a technique to use where the pain is nature's way of saying 'do something' but in the case of the zoster virus which constantly annoys a nerve root and generates pain which is not signalling any other problem, this may be worth considering.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that your sister visits a local BAcC member for advice, and hope that it puts her on a path to finding some relief.

Q:  I have been practicing auricular acupuncture for a few years now.  My work role is in addictions but the funding for this has been cut.  I was wondering if I can go self employed? I live in Scotland are there rules around this?

A:  In the absence of statutory regulation for acupuncture, the only legislation which covers the practice of acupuncture is the skin piercing legislation introduced in 2006 which is administered by local authorities. This requires that every practitioner obtains an annual licence for their practice (some authorities allow three year licences at a slight reduction).

The process of obtaining a licence is a rigorous one, involving a check on the premises from which you would be working and the manner in which you work. There are guidelines for what you have to do which you will find on your local authority's website under 'skin piercing', along with the application forms for licensing. The process could take a little while, and you cannot work until you are licensed; the regulations are policed quite tightly, and if you work in advance you risk being refused a licence. All licence applications go to a committee which meets on a regular basis, and this can sometimes be the limiting factor if you apply at the wrong point of the committee cycle.

The regulations require you to make suitable provision for the disposal of your hazardous waste, and you will also need to be aware that the Fire Regulations not place a duty of care on the practitioner, rather than the Fire Officer as was the case, to undertake a risk assessment of their premises.

As far as training is concerned, there is a requirement in the regulations for the premises owner to ensure that the practitioner is properly trained for what they plan to do, and our experience is that many local authority licensing staff have become quite expert at recognising the various levels of training which people can acquire. We have no idea how extensive your training is, but if you did not take a reasonably good length of training you may run into questions about your skill levels. You may need to establish this from the off: it will always come to light, and there's no point in making a great deal of effort to set up a practice in outline only to find that your local authority will not license you. It is unlikely but possible, and we always advise our own members never to apply in hope if there is anything about what they plan to do which might be questioned. This particularly applies to planning permission. We are not sure whether the same planning laws apply where you are, but the premises either have to have a D1 planning consent or if you work from home, have to be checked with the local planning department to ensure that there will be no restrictions. Many BAcC members have come up against resistance from neighbours because of parking. It is assumed that any clinic will involve three extra cars - one arriving, one there and one leaving - and in an area of poor parking this can be enough to tip an application out.

The bottom line is always to ask anyone who might obstruct your route to practice before they get to you. That way you can set the agenda and establish before you commit yourself whether there are going to be any hitches. 

Q:  If I may I would like to ask also about the possible benefits of acupuncture on allergies. My poor wife,who is apparently suffering from candida (not yet formally diagnosed) is also allergic to a great number of more or less day-to-day foods,including dairy,wheat,shellfish,soya, celery etc-about 20 different items all told.

A:  There is a small amount of research on the use of acupuncture to treat allergies, but most of what we have been able to locate is about the sorts of allergies which can be easily tested, like an allergy to dust mites. The problem with food allergies from a research perspective is that there are so many confounding factors which make the selection of trial and control groups difficult that few researchers even try.

What we do find very commonly is that when the body is reacting strongly to one set of allergens, and we would class candida as something of this nature, the whole system tends to go on red alert, and people discover that they have become or are also allergic to a wide range of other things. We have often seen patients who have been tested with EAV machines, and they come back with immense lists of allergies and intolerances which leave them with only a couple of staples left to eat. We think that this is perhaps overstating the problem. Reducing the number of foods for which someone has intolerances will obviously reduce the burden on the immune system but finding the one(s) which is really the major factor will do a great deal more.

Not so simple as it sounds, though! We have come across two cases where patients were actually sensitive to electrical power circuits, and a rather strange case history published twenty years ago by a scientist reported that once his wife was effectively insulated from the house's power supply she sat down and ate a cheese and tomato sandwich which would in previous times have had an almost instant and debilitating effect.

However, when we are asked about allergies, our response from a traditional Chinese medicine perspective is that the over-reaction of the body's immune system is a sign that the overall balance has been disturbed. There are treatments which we can use which can affect the defensive energy (called 'wei qi') of the body directly, and we might use these if we felt that during an acute episode there was some kind of pathogen which we could remove or quell. The more common approach, though, would be to go back to basics and simply work hard to re-establish the overall balance. Chinese medicine was predicated on the simple basis that when a system was in balance, symptoms would resolve spontaneously, being themselves only indicators that the balance was out. When we have published PR stories on our website (which you can find if you go to our home page and under site search type allergies) most often this is the simple strategy which the practitioner has used.

Allergies and allergy testing belong to a field where desperate people are often relieved of large amounts of money for something which has no provenance or proposes strange solutions. In our view the tried and tested therapies with a long history of effective use - acupuncture, herbal medicine, homeopathy - in conjunction with some carefully controlled elimination diets can often bring things under sufficient control to make life more bearable and convenient.  

Q:  I had my third treatment last night with a traditional and experienced practitioner. Last night she treated an ankle injury and blocked sinuses. She used a needle in my left ankle, 2 on my elbows and one in my left ear. She had also spent some time doing Chinese and Thai massage. Immediately I got up I had terrible cramping in my left rib, below my breast. This has continued all nightand is still there this morning. Previously I have had an issue with intercostal muscle strain.   I am wondering if the treatment last night released something? I still have shooting pain but otherwise feel fine.

A:  This is certainly unusual as a possible consequence of acupuncture treatment. We usually, although quite rarely, receive questions about problems which arise in the area directly where the needles have been inserted. For a rather unpleasant problem to emerge some way away from the needling site, there are really only two options:

1) the one you have mentioned, that there has been some sort of release of a previous muscle strain. We think that this is probably unlikely; in our experience it would be most unusual for a muscle strain to be re-visited as a consequence of treatment. This is much more common with symptoms like headache or digestive disorders where it is tied to a sense that something is being cleared from within. Most muscle strains are not related to pathogenic factors trapped inside, and where we do see them they are more often to do with the body returning to its proper structure and muscles which have been tightened to accommodate the change now get forced to stretch again.

2) it is a contingent result that just happened to fall immediately after a treatment. This does happen sometimes. With over 3 million treatments a year given by our members, there are going to be a small number of cases where a symptom emerges just after a treatment randomly.

However, it is undoubtedly an unpleasant symptom and we would strongly advise you to see your GP if it carries on for more than another two days. While it is very probably a strained muscle, something which occasionally be brought on during sleep, especially if the body is exposed to cold draughts, there are a number of other conditions which present in this way which might need to be followed up promptly, and your GP will not worry about double-checking just in case.

We are sorry to hear of your experience, and hope that this feedback helps. We are always a little uneasy when we say that a problem is unlikely to have been caused by treatment because we are aware that some therapists use this as their stock response to any suggestion of culpability. Our concern is your health and well-being, and if we think something is not a result of treatment we want to ensure that a patient gets the appropriate treatment as soon as possible. You could actually do a lot worse than popping in to see your practitioner and asking her advice. She may well have some very useful suggestions about the best course of action, and if it is a muscle strain, some practical tips for helping you to recover. Intercostal strains are a nuisance, as we know you already know; it is very difficult to guard them from body movement and even any deeper breathing.

 

Q:  I think I have been suffering with anxiety and depression for 4 years.  I am going to see a mental health doctor also I will be having a mri scan shortly to see if there is anything else wrong.I am wondering if acupuncture may help?

A:  We have produced factsheets on both of these areas:
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html
 
and

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html
 
which give some cause for optimism, as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recently
 
 http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001518

 

There is also a link on our home page today to a new study about anxiety


http://www.acupuncture.org.uk/public-content/public-pr-press-releases/3546-anxiety-the-silent-sufferers.html


However, we could do worse than reproduce the text of a piece we provided for Anxiety UK some months ago.


ANXIETY AND ACUPUNCTURE

Anxiety is more than just being anxious. Just as migraine sufferers get righteously indignant when someone claims to be a fellow sufferer but can still get to work, eat and stand the daylight, so anxiety sufferers know that they bear only the slightest resemblance to people who feel a bit nervous or have ‘butterflies in the tummy.’ Clinical anxiety is a crippling affliction which can sometimes defy all of the medications and talking therapies that someone can throw at it.


Why, then, has acupuncture been found to be successful in treating it? The main reason is that in conventional medicine, there is no single treatment for each sufferer as each person has differing symptoms. However, in traditional acupuncture every patient is considered to be unique, and this means that the practitioners will be looking and listening very carefully to everything that the patient says to establish a diagnosis and find the specific keys to unlocking the patterns of the symptoms the patient is suffering. They will aim to identify the imbalances which cause the symptoms of anxiety, not just treat the symptoms themselves. This whole ‘package’ – taking the patient’s individual story seriously and giving them time to tell it, trying to hone precisely the diagnosis, and selecting the optimum way to use the least needles to achieve the greatest effect – has been found to be very effective.


The theory of traditional acupuncture is very straightforward. The free flow and internal balance of energy (Qi) is seen in eastern medicine as essential for good health. Any prolonged exposure to extremes or intense situations, be they physical, mental, emotional or spiritual, will cause the flow and balance to be affected. This disruption in balance then ripples through the whole system, causing symptoms which sometimes bear little apparent relation to the underlying causes. An acupuncturist’s skill lies in making sense of seemingly unconnected symptoms and understanding the unique nature of someone’s energies in such a way as to restore balance. A treatment plan may simply involve needles and moxibustion, the use of a warming herb, and tui na, a form of traditional Chinese massage, but can extend to address issues in someone’s diet, their exercise patterns and their lifestyle.


People sometimes ask why, if acupuncture is so successful, there isn’t much research to back up its claims and make it more freely available within conventional care. A major reason for this is the unique nature of treatment which resists putting people in pigeon holes and which changes as the person’s balance begins to improve. Both of these confound attempts to organise research according to western models where a named condition receives a single treatment and all other variables are taken out of the equation. In Chinese medicine the variables are called patients!


Where do our patients with anxiety come from? Word of mouth still remains the most common and most reliable form of referral, and more people have had acupuncture than you think. If you ask around your support groups you are almost certain to find someone who has tried acupuncture and found that it works. Perhaps this time it’s your turn!


People also usually want to know whether the treatment will ‘stick’, whether they have to keep on having acupuncture. Some don’t – a single course of treatment can set them on a good path which, as long as their life remains well-balanced and relatively stress-free, means that they will stay anxiety-free. Many, though, like to keep ‘tuned up’, and realise that spending a fraction of what they spend on keeping their cars roadworthy keeps the driver in good shape too.

 

As always, though, we still think that the best advice we can give is that you contact a BAcC member local to you to see if acupuncture would be appropriate for your own unique circumstances. 

We think that this remains sound advice, although the fact that the doctor has ordered an MRI scan does leave open the possibility that were factors involved in the onset and not mentioned in your question which may point to a physiological basis. However, in cases where there is a clear external cause the problems tend to be self-generating, i.e. people who are anxious start to become anxious about being anxious, so even when a physical cause has been identified a pattern may have developed where the anxiety continues.

In any event, acupuncture treatment will certainly do you no harm and the style of the consultation, which usually allows patients a great deal of time to talk through the issues which affect them can often be very helpful in itself.

 

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