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Q: I have osteoarthritis in my knees. I don't get pain, but get swelling, stiffness and a burning feeling. One knee gives way at times. Would acupuncture help with any of this?

A: As you can imagine we have been asked this question on a number of occasions, and a recent answer contained the following extracts:

 If there is serious osteooarthritic degeneration of the joint, probably the best that one could do with acupuncture treatment is to reduce some of the inflammation. With the underlying condition in severe deterioration unlikely to change, the only issue is how much relief the treatment can offer and how sustainable it may be. This may come down to a question of finances; if the cost of regular treatment is outweighed by the benefits it gives, then it may well be worth pursuing. The chances are, however, that only replacement surgery will make a great difference.

There was a huge trial in Germany some years ago, called the GERAC trial, which involved an assessment of hundreds of thousands of treatments.

The outcomes for osteoarthritis of the knee were particularly impressive, and it was a source of deep annoyance to our medical colleagues that acupuncture was not included in the NICE guidelines because the placebo control scored nearly as well as the real acupuncture. In their view, both were so much better than the conventional treatment that it would still make sense to use acupuncture even as a placebo, but that is not the way of modern healthcare policy.

The best advice that we can give is that you visit a BAcC member local to you and see what they make of the specific presentation you have. It may, for example, that there are lifestyle issues like work which keeps you on your feet all day which might adversely impact on treatment outcomes, or it may be that there are specific reasons for the pain like injury or accident which would have to be factored in to their assessment.

Clearly in your case the inflammation is quite severe to bring about a burning feeling, and while we have extracted parts of the answer which dealt with pain relief they may still have been relevant; one person's burning feeling is another person's pain.

 Such is the unique nature of each presentation of osteoarthritis of the knee it really is best to have someone have a look at the specific nature of the problem and the context in which it sits. Chinese medicine is premised on the treatment of the person, not the condition, and this is one of its great strengths. Treating symptoms alone can sometimes be successful but treatment of then person as a whole is more likely to keep the symptoms at bay. We are not alone in taking this view. The great Canadian physician William Osler often said 'The good physician treats the disease; the great physician treats the patient who has the disease.'

A:  We tend to stay away from words like 'cure' but there is no doubt that acupuncture treatment may be worth trying and will certainly not do any harm.

 As you may have read from our website the theories of acupuncture are based on a flow of energy, called 'qi', in the body, mind and emotions. How well this energy flows, its balance and rhythms, can have a profound effect on the effective functioning and health of the body. Where there is excess, or deficiency, or blockage, the resulting change in the flow will generate symptoms like pain or stiffness.

 Clearly a broken ankle may well have had a considerable impact on the channels of energy which flow through the region. Not only will the break itself have disrupted the flow but the attendant swelling and immobility of the joint will have probably added layers of further restriction to the flow. Reinstating this by using acupuncture and the other modalities we often use may well have a beneficial impact on the restoration of better function.

 There is always the caveat, of course, that if the bone has not set as it should, or if there has been some arthritic change because of the break, then there may be more challenges to get things to work better again. This might require a level of pain reduction, which is a well researched aspect of all forms of acupuncture, but this can often be a continuing treatment based on how much relief someone gets from the pain and how sustainable the changes are.

 The important thing to do, however, is to try to set measurable outcomes for improvement, things which will demonstrate without a doubt that there has been a positive change. We are always wary of getting into a 'treatment habit' where dealing with a long standing problem can often mean that a patient can clock up a dozen treatments without realising how much of an investment they are making. It is vital to review progress on a regular basis, and to make this work you really need to have something tangible to make that assessment - less painkillers, more freedom or range of movement, and so on.

 With all problems like this, though, where the heading 'broken ankle' could mean anything from a slight crack to a massive fracture, the unique nature of each instance means that it is best to seek the advice of a local BAcC member face to face. Someone who can actually look at what is going on and also see what is happening in the system as a whole which may be impeding your healing process is going to be able to give you a far better idea of what may be possible than we can at this remove. Most members are happy to give up a small amount of time to prospective patients without charge, and this also has the advantage that you can meet them and see where they work before committing to treatment.


Q:  Would acupuncture cause a rash in a totally different part of the body where the acupuncture was done?

A:  Generally speaking we would say that the answer is 'no.' The most common cause of a rash is some form of reaction to the treatment itself and in a few cases an allergic reaction to the needles or other modalities used. This is almost always where the needles have been inserted, and in almost all cases will be a short lived reaction.

 That is not to say that a rash elsewhere is not possible. This 'expert' has seen a number of cases where the release of heat in the body has meant a rash appearing along the line of a channel or meridian, the lines of energy recognised in Chinese medicine. What is again almost always the case is that if this is a reaction to treatment then it will be a transient reaction lasting for perhaps 24-48 hours and then subsiding.

 If you have a rash which has developed away from the needle site and which has lasted for more than a week, then there is very little reason to suspect that it has arisen from the treatment. There are very few recorded cases worldwide of infections from treatment, and in most cases, with nearly four million treatments being offered in the UK each year, it is simply a coincidence that a problem develops after a treatment.

 If it is a bothersome or worrying rash which is raised and red/inflamed then it may well be worth booking an appointment with your doctor just so that he or she can assess what is going on.

Q: My sister lives in Malta. She has been suffering from debilitating pain from slipped disc at the top of her neck and the second disc is also damaged. Would acupuncture give any pain relief ?

A: As our factsheet on neck pain shows

 there is some evidence that acupuncture treatment can help neck pain. However, the kinds of pain which arise from loss or damage in the discs of the cervical spine are not always that amenable to treatment. There is no doubt that acupuncture treatment will generate some pain relief; this is, after all, what really brought it to the fore in the West after Nixon's visit to China in the 1970s and the picture of people having operations with acupuncture anaesthesia. Pain relief has been researched many thousands of times, and the best one can say is that there is no doubt that acupuncture can relieve pain, but what cannot be predicted is how much relief, and how sustainable the relief is.

 What this may unfortunately come down to is a financial question about how much relief someone can afford. We have seen patients with thriving businesses have treatment weekly for years because it enables them to carry on working and earn far more than the treatments cost, but we have seen many cases where someone does not get enough long term relief to justify the expense. The only way to establish this is to have a course of four or five sessions to see what benefit it can bring.

 What we can say, however, is that we have treated many cases where there has been significant deterioration in the cervical vertebrae where the patient has felt that things haven't got any worse for longer than they expected. Whether this means that the rate of deterioration has actually slowed down or whether it means that the patient is able to handle the pain better is difficult to say. We would rather hope it is both.

 It will certainly do no harm to try acupuncture treatment, however, and may have tangible benefits.

A: We have received relatively few enquiries about the treatment of psoriatic arthritis and the most recent, three years ago said:

  We have to be honest and say that the research studies which exist for both rheumatoid arthritis (which from a Chinese medicine perspective is very similar to psoriatic arthritis) and psoriasis are not that helpful. Our factsheets

point out that studies are few and far between, and often methodologically weak. 
This does not mean that acupuncture may not be able to help at all. Many patients with auto-immune arthritic conditions often use acupuncture for relieving specific symptoms, such as pains in a particular joint, and we do hear of people deriving considerable benefit. This is principally about limitation of discomfort and pain relief, however, not about reversing the main condition.
When people have enquired about psoriasis in the past, we have also offered very cautious advice. The last response we gave in October said:
There hasn't been a great deal of research in the use of acupuncture for the treatment of psoriasis, and where small studies have been done there has not been a great deal of success on which one could base a positive recommendation.
This is not to say that acupuncture treatment may not be of benefit. Skins problems such as eczema and psoriasis can have a variety of causes, some of them mental and emotional as well as environmental and the universal 'idiopathic', which is western medical speak for 'it just happens', or 'we don't know what causes it'. Traditional Chinese medicine was initially premise on the simple but profound belief that symptoms were merely alarm bells that the system as a whole was out of balance, and that a skilled physician would be able to assess what was needed to restore balance and by doing so eradicate the symptoms. There is no doubt that each year many people have acupuncture on this more general basis and experience some very encouraging results.
However, we have to say that the received wisdom in the acupuncture profession is that Chinese herbal medicine often generates better results for skin conditions, possibly because the regular daily or twice daily treatment is better suited to dealing with the problem or possibly because the precise adjustments of the prescription achieve what broader techniques may not. In any event, it may well be worth your while contacting a member of the Register of Chinese Herbal Medicine (RCHM) for advice. You will probably find that the person you speak to is also a BAcC member, since more than 90% of the RCHM membership is dual-registered.
This does not mean that we would entirely rule out acupuncture as your first option, and you may still find it valuable to discuss your own unique presentation with a BAcC member local to you. He or she will be able to give you a better face to face assessment depending on the spread and location of the condition than we could do here.

Looking back at this we think it might be a little over-cautious. While it would be foolhardy to suggest that there is a cure we have seen a number of cases where someone's rate of deterioration has slowed down, or at least they have perceived it as such, or where symptoms which were assumed to have been a part of the overall picture have been considerably lessened because they were not as closely connected with the 'headline' problem as was believed to be the case.

 On that basis it would certainly do no harm to see what acupuncture treatment can offer. The key concern is of running up a large bill for treatment which really has not achieved very much. It is really important to set regular review periods and, difficult as it may be, to set measurable outcome targets, things which would let you know without doubt whether things were improving or not. Greater endurance, better grip, etc etc - something which can be measured and not simply be a reflection of how you feel on the day.

 There is no set cost for treatment. We tend to distinguish between London, where first sessions can cost between £50 and £75 and subsequent sessions £40-£60, and the rest of the UK where first sessions are often a little less £40-£60 and subsequent sessions £35-£50. In reality, though, there is a difference in the overheads of working from home and working from a Grade 2 Listed building in a city centre, and this is often reflected in the cost of treatment. There is also a growing number of members offering treatment in multi-bed clinics where the aim is to reduce the cost of treatment by working in a group setting. For someone with long term treatment in prospect this can be a welcome development.


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