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Q: My husband has had sciatica on and off over the past 2 years he has had a lot if private physiotherapy and is under the GP for the pain having all sorts of strong painkillers.  He  had to go to A&E due to the amount of pain he was in. He has had an MRI scan and is waiting for the results but over the last 3 days has been in agony.  He seems to be taking lots of different painkillers without any effect on the pain. He is running out of options would acupuncture be of any help?

A:  Our first advice would always be to see what the scan reveals before committing to treatment. Acupuncture treatment may be able to help relieve some of the pain he is in - this was, after all, one of the main effects of treatment which came to notice in the West and into which a great deal of encouraging research has been done - but if the scan reveals something more substantial either damaged or out of alignment this may well need sorting out by conventional means. Acupuncture may well be useful for pain relief while he awaits the next option, but may not be able to sort out the underlying problem.

However, we are quite used to being the treatment of last resort, and it is not uncommon for us to have patients who come to us with pains which defy explanation by all of the sophisticated testing now available. One of our first tasks is often to describe the basics of Chinese medicine to explain how pain can arise as a blockage in the energy of the body, called 'qi' by the Chinese, and how we set about resolving blockages. This can sometimes mean treating in the area where the pain is, but is almost invariably accompanied by treatment to help the body re-establish proper energetic flow and balance. This can sometimes mean needles a long way from the site of the pain, which can confuse patients, but from a Chinese medicine perspective most local symptoms, however extreme, are often an indicator that the body's ability to sort its own problems out is not functioning as well as it might, and treating the root as well as the branch is often necessary.

Sciatica is, in fact, one of the named conditions for which considerable research has been done, and although our factsheet is cautious in summarising the results of studies

it is one of the more frequent conditions for which people seek help from BAcC members, and anecdotally one which tends to respond well. It is certainly a condition which this expert approaches with some confidence. One of the great strengths of Chinese medicine is that it takes particular care to understand exactly how the problem manifests, and this means that each treatment is often unique to the individual, even though there are a few frequently used points for all cases. We tend to find that the term sciatica is used rather loosely in conventional medicine for a wide range of problems even in orthodox treatment, and we believe that the differentiation which we do as a matter of course can often pinpoint what is going on in a way which enables us to deal with the exact manifestation.

As always, our advice is to visit a BAcC member local to you for advice. Because the term sciatica is used as a catch-all for a number of problems, it is always best to see someone face to face who can give you a much more precise assessment of whether treatment may be beneficial. Most members are more than happy to give up 20 minutes without charge to ensure that if someone books in it is with a clear idea of the possible outcome and time scale for treatment.

A:  As you can imagine we have been asked about frozen shoulders before and one of our earlier answers, to which we have added supplementary comment, was:

Can acupuncture help a frozen shoulder?

Frozen shoulder can be a difficult condition to treat. Our fact sheet on the website

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. There was very positive article in the national press a couple of years ago

which is useful because it describes a number of conventional treatments which are also used for treating the condition. If you have not been offered any of these options, or not had the full range of investigations, we strongly advise you to make sure that your GP known how much pain you are in and gets the joint scanned to see if there is something which is seriously out of place. It is possible, for example, to tear one of the tendons near the joint which will cause almost unceasing pain, and although acupuncture treatment may help to ease the pain temporarily, the problem may require minor surgery to be fully resolved.

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.

There isn't a great deal more we can add. Acupuncture has a long history of being used for pain relief, and the question which a practitioner needs to resolve for themselves when treating someone for chronic pain is whether the amount of relief they can help the person to achieve is sustainable enough to warrant the continuing expense. In most cases, however, they will make this a consideration secondary to seeing what can be done to fix the problem itself.

A:  A great deal depends on what you mean by 'self-management skills.' If you mean teaching people how to needle themselves and sending them off with a packet of needles, the answer is that they shouldn't. Although some sections of the medical acupuncture community feel that this is OK, as witnessed by this oft-cited paper offering a debate between the two camps:
We at the BAcC have shared Val Hopwood's view that the risks outweigh the benefits, and that there are other methods for pain relief which offer similar advantages. We are less concerned about the risk to patients, although it is real if someone does not treat themselves with a keen eye for hygienic practice, than the risk to the public in the form of safety of handling, storage and disposal of needles. Our members are very thoroughly scrutinised by Environmental Health Officers when they register their practices in all these aspects, and we do  not believe that someone can be given adequate training on a few short minutes. If a member took the step of instructing a patient in self-needling techniques and something went wrong, the responsibility would come back to them and ultimately us through our bloc insurance cover.
We have heard of a few areas where self-needling takes place. One such is a project in Cornwall for needling a specific point to relieve post-chemotherapy nausea, and as far as we could judge the information leaflets they handed out were fairly good. However, it did not change our view that this was all predicated on everything going smoothly all the time, and we don't believe that this is an accurate assessment of the potential risk.
There are a number of alternatives which practitioners do suggest to patients. Acupressure can in many cases provide a perfectly acceptable follow-up treatment, and is advantageous because of the slightly wider margins for error in point location. For pain across larger areas some practitioners lend patients TENS machines which are widely used by physios. These deliver a steady current which provides pain relief. There are a few practitioners who give moxa, the Chinese herb we burn on or over points, to patients to use at home. We have some very clear guidance which members can give to patients if they choose to do this, some of which is very practical - smoke alarms will go off, and the stick form which is used over larger areas is difficult to extinguish.
Practitioners will also give advice about lifestyle and diet if they think these will make a difference. Sometimes people's specific pains are intensified because the system as a whole is weakened, and a practitioner might well suggest changes in diet or habit if they felt that this would make pain more manageable. Each person is unique, and the practitioner will invariably tailor what can be done to the needs of the individual and according to their capabilities.  

Q:  When I had acupuncture  a needle was put in the Li 4 on my hand, I felt pain shoot down my left forefinger. She said it was fine and left it there. The pain continued for several days.   I  emailed the acupuncturist and have made an another appointment . I have  no pain on my straight finger just when moving to the left. Does this sound normal?

A:  We wouldn't want to describe this as normal but it is certainly possible. When this does happen it is usually because the needle has caused some bruising quite deep inside the fleshy area surrounding the point and this may be causing an impingement of the nerves which run down from the wrist. The problem should resolve within two weeks to a month at very latest. If it hasn't by this point then it would be wise to contact your GP and see if you can arrange for a neurological assessment.
However, we have a small concern over the fact that the pain is enough to warrant taking ibuprofen. This suggests that it is interfering with your daily life by being triggered by straightforward movements. We would certainly want to examine the area and palpate gently to see what is going on, and we would also want to check that the pain was caused by a physical factor like a bruise and was not a manifestation of an energetic blockage. Unlikely as it sounds this can happen, and a needle or two in the area might well help. Even from a Chinese medicine perspective bruising can be helped considerably by enhancing the flow of energy through an area, although generally speaking most people seem to resort to arnica, either in tablet form or as a gel to run on. This usually seems to help, even though the clinical evidence for its effectivesness remains sketchy.
Your best resource, though, is your practitioner. She will be able to offer the best advice based on what she can see and feel, and the problem should resolve relatively quickly.

A:  In the hands of a properly trained and fully qualified practitioner, acupuncture is perfectly safe during pregnancy. There are a number of points which are contra-indicated, some because of where they are and some because of what they do energetically, but all practitioners are trained in avoiding their use. It is fair to say, however, that the kinds of vigorous needle technique which underpin this restriction on their use are relatively little used in the UK. We all tend to be much gentler than practitioners in China.
There are, of course, reasons to be especially careful when treating  a pregnant woman, and most practitioners make sure that they keep treatment very simple or use well-documented treatments for the common problems of early and mid pregnancy, such as morning sickness, backache and indigestion. However, over the last decade the development of postgraduate courses in treat all stages of pregnancy and fertility has meant the growth of groups of practitioners who spend the majority of their time working with this group. We have been working hard for the last few years to generate guidelines for what we describe as expert practice, and once these are agreed we may have a benchmark through which we are able to identify and recommend members with these skills. Until then we have to advise prospective patients to check websites; most of our members with this kind of practice focus tend to be very clear about this in how they promote themselves.
There are also a number of networks to which many members belong and which disseminate best practice in this field. Again, because some of them are commercial franchise-style operations we are unable to make recommendations or publish lists, but these are all very easy to track down through google.
As a footnote, however, we have to remind everyone that the skills with which all our members graduate are perfectly adequate to deliver safe and effective treatment to the pregnant woman. The advantage of expert focus is not that it imparts special Chinese medicine knowledge which others don't have, but the practitioners who work in this way develop greater experience in the presentations of energetic changes in pregnancy and can refine what they do with slightly greater precision.