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]Q: Are there any studies available to show that acupuncture is beneficial for high tone muscle tension following a stroke. Could it help or harm?

A:The first thing that we can say is that acupuncture treatment will do no harm if it is done by a properly trained and qualified practitioner, as all BAcC members are. The only long term damage which a practitioner could do would be the penetration of an internal organ, and we are all trained in the careful use of needles to avoid this outcome.

Acupuncture has been very heavily researched, especially in China, for its use in helping recovery from stroke. We have a review paper on our website

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which highlights a number of the more significant studies which have been published over the last decade or so. Most of the papers are referenced in the footnotes, and there are many more which can be accessed by using the search 'ncbi acupuncture stroke' in google. NCBI is an American database which gathers together the results from several major databases, like Pubmed and Medline.

In Chinese hospitals the use of acupuncture after a stroke is routine. It is not at all uncommon for someone to have daily treatment starting immediately, and the logic is very simple - stroke, or wind-stroke as it is called in Chinese medicine, causes a disruption in the flow of energy ('qi') in the limbs and it is critical to re-establish this as soon as possible. The longer that one leaves treatment. the more entrenched the poor flow and subsequent blockages become and the more difficult to re-activate are the affected muscles. Of course, the problem in the West is that very often acupuncture is only considered some way further down the line, and so we often begin with a very much more difficult problem than might have been the case.

It is very important to be very realistic in taking on a patient with the kind of high tone muscle tension which exists three or six months after a stroke. Progress may well be very slow, and may also be difficult to discern - people have good days and bad days anyway, and judging whether there is an upward trend is hard. We suspect that the best answer, if you are considering acupuncture treatment, is to visit a BAcC member local to you and ask for a brief face to face assessment. Most will be happy to give up a few minutes without charge, and can assess better than we can at a distance whether a specific presentation can be treated or not.

 We wonder whether you mean 'tendonitis' of the wrist. If so, there is not a great deal of specific evidence about treating tendonitis in the wrist which we can offer you as solid evidence.

However, these sorts of problem are very often the ones which eventually find their way to our treatment rooms when the conventional treatments such as medication or physiotherapy, even with the use of acupuncture in physio hands, do not have the desired sustained effect. Problems like tendonitis often have their roots in over-use of some of the tendons or in poor positioning in, for example, a workplace or sporting activity, and it is quite often necessary to investigate carefully to find out how to stop the problem from re-occurring.

The critical thing to do, however, is to break the cycle of pain. The swelling and inflammation, once it occurs, can often regenerate itself, and what one aims to do is to reduce the pain and swelling at the same time as creating better working conditions and, crucial from a Chinese medicine perspective, finding out how to boost the system as a whole to stop any recurrences of the problem. For the many thousands of people who play sport or who work in difficult conditions, only a few develop significant problems with tendonitis, and it is often a consequence of an underlying imbalance in the system which does not allow the body to repair as well as it could.

There is also a great deal to be done locally for the problem. Chinese medicine developed against a backdrop of people working in extremely difficult conditions in the fields, and problems from over-use and exposure to hard climate were the bread and butter conditions of early practice. Ancient Chinese practitioners had a very complex understanding of the way that joints and tendons can be affected, and a large number of ways to treat them, and this wisdom, which is retained within modern practice, is no less relevant in modern times when the causes may be different but the presentations the same.

The best advice we can give is that you visit a BAcC member local to you and seek their advice. Most are more than happy to give up some time without charge to assess whether treatment may be helpful, and they will be able to see the specific way in which the problem presents, which is something we cannot do at a distance.

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:  About 2 years ago I experienced sudden severe pain in my hip and thigh. this lasted for about 4 weeks and stopped suddenly.  A year later I experienced the same sudden pain. this time it did not stop. In an attempt to relieve the pain I  have used various pain relief medications.
I have had xrays and an  MRI scan which have failed to find the problem. I had a steroid injection into my hip bone and this relieved the pain for about a week. I have received treatment from an osteopath and physiotherapy.  I am in constant pain day and night and find it difficult to walk at time.  > My question is will acupuncture help in relieving the pain.

A:  There is no doubt that acupuncture can be used for pain relief, as our fact sheet on chronic pain shows:

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

and indeed, pain relief has been one of the most intensely researched areas of its use. The use of sophisticated assessment tools by patients to measure their experience of pain, and the fact that many of the neurotransmitters and natural painkillers can be precisely measured means that one can get meaningful results quite quickly.

However, the only two questions to ask if treatment is used in this way are 'is the effect reasonably sustainable?' and 'if it is, can I afford the treatment which maintains the level?'. We believe that this short-changes what we do to see it in this way. Chinese medicine is premised on the flow of energy in the body, called 'qi', and its proper balance and rhythms. Pain arise from blockage, excess or deficiency, and the skill and art of the practitioner lies in determining how the problem arises and whether local treatment or systemic treatment, or both, is required. The probability is that something has been brewing for quite a while, and there has been a tipping point which has meant a blockage or change has occurred. On the last occasion this has spontaneously reversed, but on this occasion it appears to be more tenacious, and a practitioner will want to assess whether the underlying tendency is going to keep on generating these pains unless corrected, or whether you have something specific which can be unblocked locally.

Our best advice with problems such as yours, which are always best advised on with the benefit of a face to face assessment, is that you visit a BAcC member local to you and see if they find anything on a brief, hopefully free, assessment which would encourage them to believe that acupuncture treatment would help you.

A:  We drew up a review paper some years ago

http://www.acupuncture.org.uk/arrc/public-review-papers/substance-abuse-and-acupuncture-the-evidence-for-effectiveness.html

which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.

However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK (www.nadauk.com) and SMART-UK (www.smart-uk.com) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.

There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).

This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.

We think this remains basically sound advice. There are a number of issues with which one has to be careful. There is certainly an argument which we have heard advanced by many colleagues that using five-point protocols is all very well, but going to a professionla acupuncturist who treats the person and not just the condition can offer some help in treating the causes of addiction as well as the addiction itself, and we have some sympathy for this view. In fact, we have had our own patients for whom the driver for their addiction problems was an imbalance which we were able to help resolve.

However, many of the problems which lead to someone becoming addicted to alcohol or any other substance are very complex, and being able to negotiate the difficulties is something for the expert, not the gifted amateur. We have seen colleagues get themselves into very uncomfortable situations by gettig out of their depth, and we always advise them that being part of a multi-disciplinary team is pretty much always the best way to help people come to terms with and control their addictions.