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Ask the Expert
Q: Is there any evidence that suggests acupuncture could offer non-pharmacological assistance in the management of chronic pain syndromes or myofacial pain.
A: There is a growing body of evidence that acupuncture treatment can be used in the treatment of chronic pain. As factsheet shows
This is not entirely surprising. Some of the chemical markers and neurotransmitters involved in pain responses are easily measured, and for trials which require precise outcome measures provide a suitable basis for assessing whether a treatment like acupuncture works. Whether this is acupuncture as a BAcC member would practise it is another matter. Many trials, for example, use a specific point or set of points repeatedly on each treatment in a way which a traditional acupuncturist would not; we regard treatment as evolutionary and progressivem, and refine the use of points in response to changes in the way that the patient's presentation changes. Our position is that if sub-optimal acupuncture works, more precisely targeted acupuncture will work better. Unfortunately trials which allow for individualisation of treatment are not regarded as 'gold standard' from a western standpoint where the randomised double blind control trial of drug testing is regarded as the best model.
As far as myofascial pain is concerned, this is an area of interesting overlap between east and west. If you google 'ncbi acupuncture myofascial pain' (NCBI is a US database which consolidates searches from dozens of major research databases) you will find dozens of studies, some of which refer to acupuncture and some of which refer to 'dry needling'. The term 'dry needling' is the one used by western doctors to differentiate acupuncture needles from hypodermics ('wet needling') and one of the major systems of acupuncture in use under this heading is 'trigger point acupuncture', the insertion of needles into the trigger points in muscle fibre that are often associated with myofascial pain. The unsurprising fact is, though, that these points are often located at the precise sites where the major acupuncture points lie, and very often the treatment will use the same points.
From a Chinese medicine perspective, what are regarded as knots from a western perspective are seen as manifestations of blockage or stagnation from a Chinese perspective. Using local treatment is a legitimate strategy within traditional acupuncture, but practitioners would also be interested in discovering what had been the underlying pattern against which the pain had developed. Sometimes the cause is self-explanatory to both traditions, but we obviously believe that Chinese medicine offers a way not simply of getting rid of the local pains but of influencing the underlying balance in such a way as to ensure that the pain does not recur.
You would be well advised to visit a BAcC member local to you if you are thinking of treatment, and they will be able to give you a better assessment of how treatment may benefit you than we can give here. If the pain is very localised you may find that your GP may also be able to offer you acupuncture within the NHS. Some of our colleagues tend to be rather unhappy about recommending what they regard as 'the opposition' but we believe that our role is to do what's best for the patient, and there are a number of situations for which western acupuncture practice may be as effective as easten acupuncture practice.
Q: My wife suffers constant pain in her leg, diagnosed as L4 nerve trapped in pelvic area. Would acupuncture help her condition?
A: This is rather difficult to answer. There is no doubt that acupuncture treatment can be used to reduce chronic pain, and this has indeed been one of the most researched areas over the last thirty years, mainly because the neurotransmitter chemicals associated with pain responses are a good and easily taken measure. Scientists love the measurable!
However, in this case a huge amount depends on the way that the nerve has been trapped and on the certainty of the diagnosis. In some cases the diagnosis is done backwards, i.e. the manifestation of the pain is taken to be evidence of what is causing it. We find often that low back pains are said to be caused by arthritic deterioration of the lower spine, but most people over 50 have some deterioration so it may not always be the case that this together with the pain is a solid chain of causation. We are often able to treat low back pain successfully when the initial indications are that it is said to be caused by a mechanical problem and should not be amenable to treatment.
If, however, your wife has had scans or neurological examinations which show conclusively that impingement is what is causing the pain, then acupuncture treatment may be benefical if there are spasms of the muscles in the area which treatment might release or inflammation which might be reduced by treatment. The system of Chinese medicine has existed for over two thousand years and has addressed problems like this in its own terms, describing inflammation in terms of heat and stagnation, and developing treatment protocols aimed at reducing the former and moving the latter.
Behind this, however, is the question of the structural soundness of your wife's lower back. If there are postural weaknesses or abnormalities which are causing pressure to be applied to the nerve by surrounding tissues, then although acupuncture might over a period of time help to resolve the problem, it may be more efficient to visit an osteopath or chiropractor who can try to restore natural structure in the first instance.
It is always worthwhile visiting a BAcC member local to you for advice. Most are more than happy to spend a little time without charge determining what options may be best for a prospective patient.
A: We're afraid that this is not something we can answer with an individual recommendation. There are a variety of schools and university courses, all of which are slightly different and offer unique training. The BAcC is closely associated with the British Acupuncture Accreditation Board, and a graduate of any course accredited by them is granted automatic eligibility for entry to the BAcC, so in that sense we endorse all of the accredited colleges.
The best thing to do is visit the Board's website www.baab.org and see the list of accredited colleges, find which ones are close to where you live and see what prospectuses you can obtain or when the next open day is.
Q: I'm am thinking about acupuncture for reactivating & stimulating my left leg & glute due to a sport injury from many years ago. I have been having physio for a year with no affect will acupuncture help?
A: As out fact sheet shows
there is a growing body of evidence that acupuncture is being used more routinely for dealing with sports injuries. Anecdotally we are aware of a number of world athletic teams who use acupuncture as a routine part of their maintenance programme, and many physiotherapists now specialise in sports medicine in which acupuncture plays a prominent role.
If you have been having physio for over a year with little impact, it suggests that whatever is causing the blockage or restriction in the flow of energy to your gluteus muscles and legs is not straightforward. We are assuming that you have had a full neurlogical assessment, and if you have not, then we woudl recommend that you see your GP and arrange for this to be done. If there has been nerve damage in the lower spine, then you may need to seek specialist advice on your options.
Assuming that this is a straightforward failure to repair, from a Chinese medicine perspective it will be a matter of exploring whether the blockage or loss of flow, which is often the case with this type of presentation, is down to a local obstruction or whether the problem overlies a more systemic weakness or difficulty which is hindering your progress. A skilled practitioner should be able to tell you very quickly what kind of problem this is and offer you advice on how best to proceed. Visiting a BAcC member local to you will give you the clearest assessment of what can be achieved.
One thing we need to mention is that we often find that people trying to regain fitness tend to over-exercise in pursuit of their former levels of performance. Exerting full force on muscles, even in the super-fit, can cause micro-tears which take a few days to recover. If someone starts to exercise too soon, or carries on to work through it, it will simply a low level but continuous niggle which will not improve. We would recommend that alongside your acupuncture treatment, should you decide to go ahead, you might want to seek the advice of a specialist in sports injuries to assist your recovery. Many of these are associated with or attached to professional sports teams, and it should be relatively easy to track down one who works in your area. If they are any good their reputation will go before them!
A: De Quervain's syndrome or disease can be alarmingly painful. Conventional treatment ranges from steroid treatment, for which the evidence is quite poor, surgery, for which the outcomes are unclear, or simply splinting and rest. The condition is self-limiting, but can flare up again because the evidence suggests that it may be degenerative and therefore likely to recur.
From a Chinese medicine point of view, all sorts of focused ostearthritic pains or tenosynovitis pains such as this represent blockages or interruptions in the flow of energy, called 'qi' in Chinese medicine, and the use of acupuncture restores the natural flow and with it addresses the pain which the blockage causes. Obviously if the cause is osteoarthritis of the first metacarpo-phalangeal joint, acupuncture treatment cannot repair physical damage, and the best that could be achieved is a temporary reduction in the pain or inflammation. This may, however, enable the spiral of pain - inflammation means compression means pain means inflammation - to be broken to let the area recover. If the problem is to do with inflammation of the tendons, the same may well apply. As our fact sheet on arthritis shows
there are a number of encouraging studies, as indeed there are with similar conditions like tennis elbow and carpal tunnel syndrome.
In our experience the majority of cases like these are usually local rather than systemic problems, although in most people there are often underlying systemic weaknesses as a backdrop for why such specific problems develop, and if the condition is going to respond to treatment it will respond very quickly. This is our roundabout way of ensuring that you should not get locked into a long course of treatment. If treatment works, it is a matter of assessing how much improvement there is and how sustainable it can be. If there is no improvement within three or four sessions, then it is better to draw a line.
The best advice is to seek a brief face to face assessment with a local BAcC member to give you a better sense of whether your specific problem my be benefited by acupuncture treatment.