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Q: I have had urticaria for almost 2 years now and I have been on antihistamines for a year. Traditional medicine does not offer any solution in my case - none of the doctors can establish what causes it and no one knows how to get rid of it. My only hope at the moment is alternative medicine and I have heard that acupuncture could offer a solution. Do you have any record of it helping with my condition ?

A:   We were asked about the treatment of urticaria with acupuncture a little while ago, and our response then was:

Can acupuncture treat urticaria with any level of success?

Success is a very loaded word in the context of what one can now claim in marketing and advertising. The standard of proof in all healthcare advertising is the randomised, double blind control trial, the model most often used for testing drugs, and it has to be said that it is not very well suited to assessing whether acupuncture 'works' or not. Reducing variables is the last thing a practitioner would try to do in Chinese medicine; understanding and interpreting their variations is integral to the way that the system works. Hence a paper such as this one from 1998
 
http://www.ncbi.nlm.nih.gov/pubmed/9828874
 
is a great example of the problems we face when asked questions such as this. The manifestations of urticaria, understood in Chinese medicine terms as a description of the specific symptoms, have always been around and like any complete system of medicine, Chinese acupuncture has ways of understanding how the heat and swelling develop, and within the system has developed clear protocols to deal with the problem.
 
However, as the paper acknowledges, getting precise enough definitions if urticaria itself to assemble a trial is a problem, as indeed would be the next stage, ensuring that the test and control groups had the same western and eastern conditions to guarantee objectivity. However, when one takes into account that in Chinese medicine the person with the disease is as important, if not more so, than the disease which the person has, it becomes rather difficult to talk meaningfully of treating a named condition.
 
That said, there are papers which examine the presentations and treatments of urticaria such as this one
 
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276885/
 
where there is a very positive reference (60) to a paper which on the surface appears to meet the criteria for inclusion in a growing body of good evidence.
 
We prefer to hold to the view that each patient is individual, and that it is the unique assessment of their energy by a skilled practitioner which is the best judgement of whether treatment may be beneficial. It is true that many patients present themselves for treatment with urticaria-like symptoms, and anecdotally we here of success in both acute and chronic cases. However, if you wanted to establish whether acupuncture treatment was a good option for yourself or someone on whose behalf you are asking, then a brief face to face assessment by a BAcC member local to you is your best way of establishing this. 
 

We think that this still represents the best advice we can give. Anecdotally we have all had some very positive experiences of treating people with urticaria. Of all the skin conditions this appears to be the most amenable to acupuncture. For many other conditions, like psoriasis or eczema, we have often recommended the use of Chinese herbal medicine alongside acupuncture treatment. There are a considerable number of BAcC members who are also members of the Register of Chinese Herbal Medicine, and there may be some advantage on seeing someone who uses both, although as we have said, you may well find that acupuncture treatment by itself can offer a solution.

If you do go ahead, it is very important to set measurable outcomes and to ensure that your review the treatment at regular intervals. It is quite easy to run up a large bill in pursuit of success without realising, and the responsible practitioner will always check on a regular basis that there are enough signs of improvement to warrant carrying on. 

 

Q: My daughter is in Anerqerque where her little boy with cerebral palsy is being treated with scalp acupuncture by Dr Jaso Hao. Daniel is 3 yrs 5months old. Intensive physio both on and off horses has had a monumental effect in getting him to walk, albeit still unsteady.However, after only 3 sessions of treatment with Dr Hao he is walking with confidence and speed. I have seen the video she sent me and it phenominal what this has done for him. Her story may of great interest to you. We need this here in the UK

A:  Many thanks for getting in touch with us about your grandson. We are very heartened to hear of his progress.

We have been aware of Dr Hao for some time since the publication of his book by Blue Poppy Press in the States, and also of Dr Yamamoto and his system of scalp acupuncture. This is fairly cutting edge material; although it has its roots in the classical traditions it is a modern development. This means that at the moment it does not form a part of the mainstream training in Chinese medicine, and slightly more problematically for us, does not yet have recognised training standards which have been accredited. When something is being offered, often as a last resort for people with desperate needs, it is crucial that there are some forms of standard and accepted evidence to support the claims which practitioners make and to underpin any training they offer.

That said, we note with interest that a number of UK practitioners have undertaken postgraduate work in scalp acupuncture and are quite quickly and easily traced. When stories such as your about your grandson start to circulate it will be relatively straightforward for prospective patients to track down a local practitioner.

We hope that your grandson continues to improve and that his success is an inspiration to others.    

 

Q: Nearly 6 years ago I had a cancerous tumour removed from my mouth , following the successful operation I then had radiotherapy treatment. In a nutshell since the operation I have been suffering with chronic pain in my mouth which makes life unbearable I am taking up to 16 strong painkillers everyday.  My surgeon referred me to A  pain relief specialist,  but the tablets he prescribed me sent me crazy.   Someone has mentioned today I should consider acupuncture.  I would be greatly obliged if you could give your thoughts and if you have had previous success with acupuncture treatment for this problem

A:  There is no doubt that acupuncture has been used successfully in treating some of the consequences of radiotherapy treatment in the mouth. Most notably we were asked not long ago about a condition called xerostomia (dry mouth) which is quite common after radiotherapy in the area, and our answer was:

We were asked this question once in relation to xerostomia induced by radiotherapy, and our answer was, taken from our factsheet on palliative care and further supplemented:

Dry mouth (xerostomia)

A systematic review found possible benefits with acupuncture for radiotherapy-induced xerostomia (O'Sullivan 2010). Not all the inter-group differences were significant but this is typical in trials comparing acupuncture with sham acupuncture, for the latter is commonly viewed as being an active treatment itself, not a placebo, and hence may underestimate the effects of the therapy (Lundeberg 2011; Sherman 2009; Paterson 2005).The RCTs to date are few in number and small in size. Although they have produced encouraging results, and are supported by observational studies (for example, Meidell 2009), larger trials are required to achieve more robust evidence. Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

There is some evidence for the value of acupuncture treatment for dry mouth after radiotherapy, and the two studies below certainly seem very positive.
 
http://www.ncbi.nlm.nih.gov/pubmed/23104718
 
http://www.ncbi.nlm.nih.gov/pubmed/22072272
 
Clearly there is a considerable difference between the kinds of functional disturbances caused by disruption of the balance of the body's energies through normal wear and tear and the kinds of damaged brought on by injury or accident. This does mean that it is more difficult to predict whether acupuncture treatment might be of benefit. Treatment of the kind used in the studies tends to be localised or precisely targeted, and this can mean that it does not really conform to the patterns of treatment which a Chinese medicine practitioner would employ. In broad terms, however, acupuncture treatment is aimed at putting the whole system back in balance with the underlying belief that a body in balance tends to deal with symptoms itsef, and on this basis it may well be worth talking to a BAcC member local to you to see if a combination of systemic and local treatment may, in their view, be of benefit. Most BAcC members are more than happy to give up a little time without charge to give a face to face assessment of whether treatment would help.
 

There is a chance, of course, that the xerostomia which you are asking about is not related to cancer treatment. From a Chinese medicine perspective this makes no difference. The understanding of the mechanics of the disruption of the physiology of salivation from within the Chinese medicine paradigm will be the same whatever the cause, although the cause, again seen from this perspective, may have a considerable impact on the treatment. By this we mean that radiotherapy might be seen as a cause of great heat and dryness within the system as a whole or locally, and this would almost certainly feed into the treatment strategy.
 
As we said above, speaking to a BAcC member local to you who can assess the problem face to face may well be the best option for you before committing to treatment.  

The reason we quote this at length, although it is not the identical problem to that from which you suffer, is that if we start to trawl research databases for the treatment of specific problems, we always run up against the problem that the treatment offered is rarely good quality traditional acupuncture and most often uses a very reduced palette to meet the dictates of the trial design which seeks to reduce the number of variables. The huge strength of Chinese medicine is that it treats the person, not simply the condition, and the this is even reflected in the wisdom of the great Canadian physician William Osler who said 'it is more important to find out about the person who has the disease than the disease the person has.'

The confounding factor in your case is that six years of powerful medication are going to have generated secondary problems which someone will have to take into account, and therefore any assessment of what may be possible will have to look at this as a part of the overall picture. We are sure that if you contact a BAcC member local to you they will be only too happy to spare some time to discuss whether acupuncture treatment is a good option.

We have to say, though, that when we researched the treatment of another cancer recently we were very pleasantly surprised at the number of recent studies which show that acupuncture is used increasingly often for palliative care and for the reduction of post-treatment pain, a pattern which seems to be reflected across a number of different areas. Radiotherapy is a necessary but brutal treatment which causes massive disturbance of the energies of the body, and there is a growing body of evidence which suggests that acupuncture treatment, even some time after the treatment, can have a significant impact in restoring proper flow. Hopefully you will find that there is still good reason to hope for improvement even after this length of time.

Q:  Can acupuncture be used to treat cancer of the pancreas? If not, are there any other alternative remedies which would help?

A: We have to be as careful as we can in answering questions like these. Our view of traditional acupuncture is that it treats the person, not the named condition, and this has been the basis on which it has been practised for over 2000 years. This means that we believe that treating the system as a whole corrects imbalances in the system which generate symptoms, and successful treatment can reverse symptoms.

However, and this is a really big however, it is really easy for people to mis-hear this as a claim to treat anything and everything, and the word 'treat' is then misunderstood as 'cure', in the way that a doctor might say that he can treat headaches, i.e. you hear 'can help to get rid of them.' Cancers are not usually thought of as treatable by acupuncture practitioners in this sense. Once the system has gone this far into disrepair, there is not much that any practitioner can offer except some relief from the worst symptoms and also some help in dealing with the side-effects of the medications on which people become more reliant as the disease progresses.

As you are probably well aware, pancreatic cancer is one of the less treatable cancers within conventional medicine, and the most that doctors will offer is the possibility of slowing down the progress of the disease and dealing with symptom relief. To that extent we would say that our experience of acupuncture treatment as a part of this process of relief has been good, and that the control of symptoms in the palliative care stage has helped many patients lead a generally less pained life. 

There have been a number of studies published in the last two or three years which offer some support for the use of acupuncture treatment. Three such are:

http://www.ncbi.nlm.nih.gov/pubmed/24280575

http://www.ncbi.nlm.nih.gov/pubmed/20683216

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734160/

and there are a number of other studies about the use of acupuncture in palliative care

http://www.ncbi.nlm.nih.gov/pubmed/24338183

http://www.ncbi.nlm.nih.gov/pubmed/23868190

which also offer encouragement for experimenting with treatment.

You will find that many of the other complementary therapies to which people turn, like herbal medicine or homeopathy, take the same stance, steering well away from any misunderstanding about possible cure and focusing instead on the control of symptoms and pain reduction. Our view is that as with all forms of complementary medicine it is worth trying a variety, perhaps one at a time, to see which seems to have the greatest effect on you, or which combination seems to work best.

This is an area where you need to exercise great caution. Anyone who makes excessive promises for what might be possible needs to be avoided, in our view. If you visit a BAcC member local to you for a brief face to face assessment we are confident that they will be able to give you an honest and realistic assessment of what may be possible. 

Q: I have long term conditions and neuro damage as a result of near fatal RTA, plus Ehlers Danlos et al. I have had acupuncture on the NHS in the pain management clinic for 14 years now. It helps with the severe muscle spasms which heighten the neuro pain.It allows me to have a quality of life and not take as much morphine as I would otherwise need to do. The local CCG have now said all acupuncture will be stopped except for a 6 session course for new patients. Their reason is they say all research shows acupuncture does not help with long term conditions/long term use! Any information on efficacy of acupuncture long term with spasms/pain would assist.

A:  We are sorry to say that this is a depressingly familiar situation. The evidence supporting the use of acupuncture for a wide range of conditions does not often meet the somewhat unrealistic 'gold standard' for research in the West, the randomised double blind control trial, called RCTs in the trade. This was designed for drug testing, and tries to reduce variables to the point where there is no doubt that a drug is working.

Of course, for acupuncture treatment this format is completely inappropriate. Not only would a skilled acupuncturist not repeat the same treatment over and over again, he or she would also amend the treatment as the patient progressed, gearing it to their current individual needs. We often find ourselves in a strange situation that when trials like this show good results we benefit from the good publicity of what isn't really good acupuncture, but all the good evidence from 2000 years or more of effective use is dismissed as 'anecdotal', used in a slightly pejorative sense.

While we are never happy to see provision being reduced we have a certain amount of sympathy for the new CCGs. Hidden in the revised funding arrangements were budget cuts of nearly 20% over the next five years, and although doctors have greater control of their affairs, they have less money, and some services on which people have relied are bound to suffer.

We have no evidence available for Ehler Danlos syndrome which is sufficiently robust to convince a CCG. However, there may be some mileage in looking at the study of low back pain undertaken by Hugh MacPherson and his colleagues in York several years ago. Hugh has written a large number of articles over the years, and on his website pages lists all of the ones dating back a decade or so

http://www.hughmacpherson.com/journal-articles.html

Amongst these is a paper cited here

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1570795/

which shows quite clearly that in what are called 'pragmatic trials', where practitioners use their normal treatment approach and this is compared with conventional treatment, the use of acupuncture is extremely cost effective compared to conventional treatment.

It may be possible to assemble a case that if you have to resort to medication as a long term alternative this will cost more than the acupuncture you were having in direct costs, and that is before you add in the long term health consequences of the medications themselves. Many of these can, over time, prove very serious, and once this has been factored in the cost of acupuncture treatment in a facility which is already providing treatment is negligible.

The one thing in your favour is that although the CCGs are having to save money where they can, they are now doctor led and there is a greater chance that you may be able to argue for an ad hoc decision on clinical grounds. We hope that the information we have cited may help you to make that case, and are only sorry that we don't have the kind of evidence at our disposal to provide you with a clinching argument in one go.

Indeed, one of our great challenges is to argue that 2500 years of successful clinical practice is as robust as any modern study, and that the reason for the survival of our tradition is that it works. Unfortunately we live in times where the definition of 'evidence based' has been narrowed to the point where more than half of conventional techniques do not meet the criteria, so our chances of succeeding on this front in the short term are slim. 

 

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