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Q:  We have a family friend who is suffering from severe pain in his knees as a result of advanced cancer. The hosiptal has stopped treatment as there is
nothing they can do as a result he is just on medication from the local GP to reduce the pain, which  doesn't seem to be that effective. Would acupuncture be
something that could help, block / reduce this pain?

A:  Acupuncture for the treatment of chronic pain has a long history, and also some reasonably good evidence of success, as our factsheet shows  After Nixon's visit to China in the 1970s a great deal of
research was done into acupuncture and pain control after the sight of people having surgery without anasethetic. The measurements of the neurotransmitters
involved in normal pain relief are easily measured, and this fitted well with the standard research models. Much of the evidence showed that acupuncture
treatment in addition to conventional treatment had a significant impact.

From a Chinese medicine point of view, pain arises from the blockage or weakness in the flow of energy, or 'qi' as it is called. The skill of the practitioner lies in knowing precisely why the blockages or weaknesses are occurring, and treating to ensure that the problem is addressed at source. If the local problem has a systemic source, then treatment needs to be addressed at the system as a whole, which is why a similar pain in twenty patients can be treated in twenty different ways according to their individual

As far as your family friend's case is concerned, we are confident that acupuncture treatment would have some effect, and our main concern would be exactly how much effect and how sustainable that effect is. All forms of acupuncture, both traditional and western medical, would expect to be able to provide temporary relief, but it would then be a balance between the extent and duration of the effect and the cost of achieving it. Acupuncture treatment would certainly do no harm, and since we treat the person as much as the pain itself there may even be some secondary benefits to the system as a whole.

The best advice we can give, and which we do almost every time, is that a visit to a BAcC member local to you will undoubtedly give you/them a much better indication of what may be possible. What we do not know, and which limits our comments, is the kind of cancer from which he is suffering and how much the pain is a reflection of metastases in the area. If the cancer lies in the bone itself that may have a significant impact on the efficacy of treatment, and may also restrict to a degree where needles can be placed. A skilled practitioner will be able to give you a much better assessment by looking at what is happening, and by asking a few more direct questions.

Q:  Do acupuncturists specialise in specific problems. I am looking for an acupuncturist who has experience of helping people with sleep problems in the London area.

A:  The question of specialisms is rather a vexed one inside the profession. Chinese medicine is by its very nature generalist, and in ancient times the specialist was looked upon as an inferior being because he or she could only treat one range of conditions. In essence, Chinese medicine treats the person, not the disease. This means that twenty people with the same named western condition might have twenty different treatments, each being tailored to their specific needs.

There are one or two areas, however, where we have invested a great deal of time in drawing up guidelines for what we would call expert practice. These are obstetrics, paediatrics and mental health issues. The issue is not that there is an untapped pool of Chinese medical knowledge which practitioners can tap into as much as the fact that working with a specific group of patients means that the practitioner can spend more time studying the conventional treatments of these problems and develop a skill set based on their experience. There are now several fertility and childbirth networks, and several members who run children's clinics, and we have almost reached the
point of setting standards which would enable them to advertise themselves as expert practitioners in these fields.

The treatment of insomnia, however, is not an area where we have seen a specific focus, and since nearly all of us treatment people with sleep problems on a regular basis within our generalist frameworks we can't foresee much chance that there will be an expert practitioner definition. The only likelihood of this would be if a BAcC member were attached to a sleep clinic, and this might create a basis for expert practice, but we have not heard of this yet.

You can be assured that all of our members are able to help address the problem. There is a small amount of good evidence that acupuncture treatment can help, as our factsheet shows but the causes of insomnia are so diverse that it really does take, in our view, an individual approach which looks at all aspects of a person's functioning to make sense of the problem and start to put it right. Chinese medicine has this focus, and is ideally suited to treating conditions which do not have a single specific cause.

The best advice that we can give is that you contact a number of BAcC members in your area and ask what experience they have had of treating insomnia. The best option would be to  see one or two in person; even a very brief face to face assessment will give them enough information to offer you an estimate of how much benefit
acupuncture treatment might offer.

Q:  I have chronic lower back pain which often radiates to my abdomen.  A few days ago I tried Acumed pain patches. They're bioelectromagnetic patches
that contain high purity zinc and cooper in a magnetic field.  They are classed as acupuncture 'on the go'. The pack comes with the map of the body and the pressure points used in acupuncture, telling me where to place the patch/es.  I placed 2 on my lower back and 1 on my stomach. After a few hours I got many side effects, strange sensations from pins and needles in my feet and hands, to muscle aches, twitches, spasms and an all round odd body feeling.

I thought perhaps I had too many on so took off the 2 back ones in the night. It helped a tad but I still had these strange side effects, especially shoulder muscles aches, aches in my fingers and psalms of my hands and occasionally my neck.  I didn't like this feeling and got to yesterday, 4 days with the one on my
stomach left on before taking it off (it suggests leaving them on for 5-7 days for full effect).

I took the patch off last night thinking all would be gone. However today I'm still getting pins and needles, muscle aches in hands, feet, shoulders and neck. It is upsetting me.  I know these patches aren't acupuncture exactly but act exactly in the same manner. Therefore my question is that does these type of symptoms/feelings
happen sometimes after acupuncture? Do they calm down?

Any response and information/advice would be greatly appreciated.

A:This sounds highly unusual. We do see a number of relatively infrequent side-effects from treatment, but the vast majority of these resolve within the next 48 hours after the treatment. The only ones which carry on beyond that are where there has been actual physical damage, even rarer but possible. These instances can involve a punctured lung, of which there have been a very small number in the last twenty years, and nerve damage from needles or occasionally nerve impingement after a small internal bruise, which can take a while to recover.

That said, the range of symptoms which you have experienced and for the duration you have experienced them are very unusual. We have not come across a collection like this, although one or two have been reported as transient adverse events. Our only surmise is that you could be energetically very sensitive, and this treatment is altogether too powerful. We do come across the occasional patient for whom anything more than two or three needles causes a greater disturbance than the good outcomes which eventually emerge, and we treat such people very conservatively.

It is not at all unlikely that the treatment, if it has had an effect (and magnets can be very strong), could still be doing so. We hope that by the time you get this response the symptoms have started to abate. This would be our expectation. If they haven't, then we would advise that you see your GP as soon as possible. It is highly probable that the effects have been caused by the treatment, but we always advise patients in whom strange symptoms appear to visit their GPs because it may simply be a
coincidence, and it would be unwise to keep changing the mix of treatments to deal with a problem that might require conventional treatment as a solution. We
say this not because we want to deny the possibility, but because our primary concern is to identify what is going on and deal with it more than trying to establish what actually caused it. We have seen a number of cases where the patient has spent all their time trying to prove the treatment did it while not dealing with the problem.

Q:  My husband has had a stroke and he also has weakness on the left side.  He also had a heart attack this May and had a pacemaker fitted. He has difficulty walking.  Can acupuncture help him. If so how many treatments would he need to see any improvement.

A:  We are very sorry to hear about your husband's problems.  Either problem would be bad enough in itself but the two together are a major  burden.  With such a complex background it is very difficult to say sight unseen whether acupuncture would be of great benefit to your husband. Certainly there is some hope if the difficulty in walking arises from the stroke. In China it is not uncommon for people who have had a stroke to be given acupuncture daily or twice daily as soon as they are admitted to
hospital, the idea being that the energies of the body have been disrupted, and the quicker the flow is reinstated the better. In this country this is not yet a popular option, so we tend to see people a little later down the line, often after conventional treatment has reached a point where there has been no further progress. In the circumstances progress tends to be a little slower, but over time there can be some very positive changes. This is very difficult to show by research, because there is often a process of natural recovery alongside the acupuncture treatment, and deciding what has been the cause of improvement can be difficult.

The confounding factor is the heart attack. This can also be a major contributory factor to difficulties in walking, and without being able to assess the impact of the two events on the energy of the body by direct observation it is really hard to be able to offer good advice. We often advise people to see a BAcC member local to them for a chat about whether acupuncture treatment would be a good option, and in most cases they are happy to do this without charge in order to give a balanced view of whether treatment would be worthwhile.

The imponderable would be how many sessions it might take to see improvement. This is really impossible to say. We have all had the experience of fit young people taking months to get better, and seemingly impossible cases changing overnight, so we are never happy to venture guesses. What we do say, though, is that a practitioner should review progress after the first four or five sessions, and then maintain a constant review if it seems worth continuing. We always advise members to establish with a patient a good set of measurable outcomes - distances walked, times on fee, etc - to provide some objective as possible measure of progress. Otherwise a lot will come down
to how someone feels on the day, which is never a reliable option.


Q:  I have got multiple sclerosis and a bad intention tremor in my left hand. I was just wondering if you thought acupuncture would help ease my tremor please?

A:  We have to be honest and say that if the intention tremor is a manifestation of the MS and involves irreversible changes in the cerebellum, then from a Western medical perspective there would be little prospect of being able to improve the condition. However, we look at things from an entirely different perspective, and our general approach to problems like this is summed up in an answer we gave some time ago to a question about benign essential tremor as follows:

There are occasions when acupuncture can achieve surprising results, and if you undertake an internet search you will find a case report written up by one the American medical acupuncture practitioners  which outlines a very successful intervention. There is also a paper which suggests that acupuncture alongside conventional treatment may be more effective in reducing symptoms. We have to say, however, that these are far from the norm, and benign essential tremor can prove very resistant to treatment.

The point which we also have to emphasise, however, is that Chinese medicine works on the basis of an entirely different conceptual structure from conventional medicine, premised as it is on the understanding of the body as a flow of energy, called 'qi', and what happens when that flow is disrupted or disturbed. This means that symptoms as
they are described by a patient and signs observed by the practitioner are filtered and made sense of within this 'grid', and that can mean on occasion finding an explanation which would not be a part of western medicine thinking at all. Were this to be the case, there may be treatment options which a Chinese medicine practitioner would employ to address the problem as it was defined within this system, and with 2000 years of development and refinement there are going to be occasions where a solution is found which western medicine cannot match. This is still in the realms of 'unlikely', but it would be nonetheless be possible. There is a category in Chinese diagnostics called 'internal wind', for example, which can manfest as shaking and tremors in the limbs, and a fairly direct treatment used to address it.

We could not make this kind of determination remotely, however, and you would need to see a BAcC member local to you and your mother to seek advice on whether there were elements of her condition which lent confidence to a practitioner that there was something they could do. Most members are willing to give up some time without charge to advise prospective patients on the suitability of treatment, and we would recommend this as your best option to get a clearer picture for your mother.

We think that the same point applies here, and mirrors to some extent what we do when we treat people who have recently had strokes. There is undoubtedly damage to brain tissue from the stroke but from a Chinese medicine perspective it is the disruption of the flow of qi in the limbs which generates the spasticity and paralysis as a manifestation of the same energetic problem which has affected the brain. It is not at all uncommon in China for people to have a course of acupuncture treatment starting within hours of the stroke itself to encourage a rapid return to normal flow of qi in the affected limbs.

Our view is that it would certainly do no harm to have a few sessions of treatment, and it may lessen the severity of the symptoms. As we said in the earlier reply, though, this might still be something of a long shot. The most recent review of evidence, however,

is not altogether negative, concluding that people 'should not assume that acupuncture is not effective in this population but rather that the literature is insufficient to make claims either for or against its use', which in medical research terms is a tacit admission that there may well be something good going on.

Our advice in these kinds of case is always the same. Each individual is unique, and it is, as the great Canadian physician William Osler once said,' more important to find out about the patient who has the disease than the disease the patient has.' It would be useful to have a chat face to face with a local BAcC member to get a clearer assessment. If you did decide to go ahead, we would always advise caution, though, in how many sessions you had. It can be quite easy to get locked into a treatment pattern that carries on for some time with no discernible improvements, so we like to see reviews put in place after every four sessions and try to find clearly measurable outcomes to assess whether there has been any progress.

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