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Q: I'm wondering if acupuncture with eg Allegra Wynt, Oxford who is experienced with cancer patients, could help with peripheral neuropathy in hands and feet: side effects from my chemotherapy (incl Cisplatin). This finished in January, but side effects persist. May disappear within  6 months. Can acupuncture help? Would it interfere with ongoing Herceptin (I/V) 3 weekly, which will hopefully keep cancer cells at bay ? Don't want to jeopardise my treatment. I have cancer of unknown primary (? upper GI tract) with secondary in lymphatic system. Chemo is successful.

A:  We have been asked a number of times about peripheral neuropathy, but this has mainly been where the problem has arisen of its own accord or where it forms part of a broader medical condition like diabetes or Charcot Marie Tooth disease. Clearly this places limitations on the potential outcome, since these conditions are not usually reversible, and the practitioner is usually limited to 'things getting worse slower'.

However, there is a growing body of evidence which suggests that acupuncture can be very effective in helping to reduce the severity of peripheral neuropathy (PN) induced by chemotherapy and to speed up the rate of recovery. If you search on google using the terms ' ncbi acupuncture neuropathy chemotherapy' you will access a major American research database gathering studies from all of the established online collections like PubMed and Medline. The first half dozen results point to a number of recent studies which show very encouraging results, but most of which conclude that a much larger study is warranted before any definite conclusions can be reached. This is not uncommon; research funding for acupuncture is not that freely available in the West, and Chinese studies are often regarded as methodologically unreliable. There is certainly enough to say that acupuncture treatment will probably help.

As for interfering with your current treatment, there is no evidence of any kind that acupuncture treatment can interfere with the function of medications which people are prescribed for cancer treatment. Indeed, there is no evidence from outside the acupuncture profession that treatment can interfere with any drug regimes, although we are understandably careful where we use points which are said in Chinese medicine to affect the blood flow, blood pressure and the like when someone is on medication to try to achieve the same result. Our usual response, however, is that the treatments are apples and oranges, two entirely different ways of treating the person which do not interfere with each other. There are even advantages to acupuncture treatment alongside western medication routines where unwanted side effects, like PN or nausea, can make a patient's life difficult, and treatment can make the regimen more bearable.

We tend to avoid comment on individual practitioners, but we are happy to say that Allegra is a vastly experienced practitioner, and you could not wish to be in safer or more experienced hands.

Q: My mother,  who is now almost 80,  is suffering from arthritis in her foot but also a condition known as menieres disease - like an intense sea sickness where she will vomit and almost pass out. Sometimes it wakes her up too and the only thing she can do is to try and sleep it off. Can accupuncture help with both of these and is there a practitioner in the S Wales area you would recommend?

A:  We were asked about arthritis in the foot some time ago and we responded:

We have produced a fact sheet on osteoarthritis

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

and as you can see, research into the treatment of arthritis in the feet is not that common. There are many hundreds, if not thousands, of studies published in Chinese every year, but only a small percentage are translated, and we are sure that there has probably been research but we are unlikely to see it.

Although acupuncture has a reasonably good record for offering relief in cases of osteoarthritis, it would be fair to say that arthritis in the feet can be much more difficult to treat. The very tight 'fit' of the foot bones means that where osteoarthritis starts to develop it can be very difficult to overcome the constant rubbing and inflammation which this causes in order to break the cycle of pain - inflammation leads to pain leads to more inflammation and more pain, and so on.

However, one of the great strengths of Chinese medicine is that it looks at symptoms as a part of a much wider pattern of energy flow in the body, and can sometimes make sense of systemic conditions which manifest in specific areas. Treatment may involve not just the affected area, but also points elsewhere on the body which can begin to put right the underlying imbalances which are the true cause of the problems. Arthritis has been around as long as men have walked upright, and the ancient Chinese had their own ways of differentiating the various types based on the nature of the symptoms - better with heat or cold, movement or rest, etc etc. This has led to some well-established protocols which may offer some benefit.

However, each person is as unique and different as their symptoms, and in some cases the deterioration will have gone beyond the point where treatment will be of benefit other than as short term pain relief. The best advice we can give is that you visit a BAcC member local to you for an informal chat and brief face to face assessment of what they think might be possible. We are confident that they will give you an honest and realistic assessment of what they think acupuncture treatment might offer.

We think that this is still sound advice. It would be fair to say that treating arthritis in the elderly means that progress can sometimes be a little slower, but it is impossible to generalise; this expert has seen young people in whom it has been impossible to help and a ninety-year old whose life was transformed. In Chinese medicine, though, each patient is unique and different, and it would be best to see someone who can offer a better view based on a face to face assessment.

As far as Meniere's disease is concerned, there is a slightly better evidence trail. Our factsheet on vertigo, which scoops up all problems in balance in the ear and nearby

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

offers some encouraging evidence that acupuncture treatment can help, although we have to qualify this by saying that it probably falls short of the standards required for us to make definite statements. This, however, is more to do with the application of an appropriate standard against which research is measured in the West as it is about the research itself. There are many Chinese studies which start from the premise that acupuncture works and try to establish what works best, but in the West there is still scepticism about acupuncture working and these studies are ruled out.

From a Chinese medicine perspective there are some clearly defined syndromes in which nausea, vomiting, loss of balance and tinnitus play a part, and a skilled practitioner can quickly gather evidence from other signs and symptoms to see if there is a clear pathway which offers immediate treatment options. It is not essential that this is the case; Chinese medicine treats the person., not the condition, and many of the more traditional systems are asymptomatic, i.e. symptoms are seen as a general indicator that the whole system is not working well, and treatment is directed at getting the overall balance back in the belief that this will correct symptoms. 2000 years of treatment history suggests that this might have some success!

Finding a practitioner could not be easier: simply use the 'find a practitioner' function on our home page, and a list of members near you will appear. We do not make individual recommendations, partly because we treat all members equally and can't be seen to have favourites, but mainly because we believe all have trained to an exemplary standard even to become members and are all capable of delivering first rate care.

We hope that you find someone who can help your mother and have every confidence that you will.

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Q:  Can acupuncture help with burning tongue syndrome? I have suffered for many years with no physiological reason for this and the constant pain is driving me mad.

There is a very small amount of encouraging evidence from small-scale studies such as this

http://www.ncbi.nlm.nih.gov/pubmed/23336607

as well as a number of studies which involve the use of electro-acupuncture and laser treatment. However, to be able to make a whole-hearted recommendation we would need to have a great deal more to go on.

However, the human physiology involved in Chinese medicine is very different from that which underpins conventional medicine. The central concept of qi, or energy, is similar to concepts of ki and prana in other South East Asian medical traditions, a life force which constitutes everything and whose balance, flow and movement determine overall health. The Organs of the body, which are much wider in meaning that the equivalent organs of the same name in western medicine, and the flow in the channels which they govern contribute to all our functions. A Chinese medicine practitioner will try to make sense of the symptoms which someone has as either a local blockage or a systemic problem of which this is the tip of the iceberg. In many cases it is both; a system out of balance tends to let small problems arise elsewhere which are not on the surface directly related to each other.

This is a rather long-winded way of saying that when a symptom like yours starts and persists, the practitioner will look at the whole system to see how it has manifested and what can be done to correct it. It goes without saying that each person is unique and different from this perspective, but the appearance of heat anywhere in the body can usually be made sense of within Chinese medicine, where the patterns often use the language of heat, cold, damp and other climate factors to describe some of the manifestations of disharmony.

The best advice we can give is to visit a BAcC member local to you for a brief face to face assessment. They are much better placed than we to offer advice, and may well pick up a number of factors in the system which point to why this has started. If so, they will be able to give you a reasonable idea of how much treatment you may need.

In conditions like this we tend to the view that there will always be some improvement, and the key question is how much improvement and how sustainable it is. This can sometimes become an issue of cost effectiveness - is the expense worth it for three or four days of relief - but what we ask members to avoid is getting locked into a long course of treatment without clear outcomes or reviews, and without any clear sign of improvement. If nothing happens after three or four sessions it is important to consider whether it is worth continuing.

We have been asked this question several times before, and a typical answer has been:

Can acupuncture help hypothyroidism?

A: There isn't a great deal of research to underpin a straight recommendation for the use of acupuncture in the treatment of hypothyroidism, as our factsheet demonstrates:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/thyroid-disease.html

What there is suggests that acupuncture may be of benefit, but this is a condition for which some form of maintenance medication is often essential and this makes testing it in trial conditions somewhat more difficult.

For the same reason our members are always told to be cautious in treating conditions where someone is on essential medication. Recommending that someone stops their medication is out of the question - only a doctor should be making this decision in the case of essential meds - and there is always an issue about adjustment. If the treatment as the effect of improving someone's thyroid function it may then mean that the dose of medication which they take may no longer be suitable. Since it often takes a long time to achieve a stable balance with the medication in the first place, it is important to avoid as much as possible the kind of yo-yo adjustments which people often experience when they are first prescribed their medication.

That said, the important point to make is that the Chinese would have recognised the symptoms of hypothyroidism two thousand years ago but have no idea about the relationship they had to a thyroid malfunction. The symptoms would have been analysed within the diagnostic systems of Chinese medicine, and a treatment plan devised to help correct them. The Chinese understanding of human physiology was entirely different, and rested on a concept of energy, called 'qi', and its various functions and inter-relationships. The kinds of symptoms which someone experiences with hypothyroidism would be linked to a failure of organic function as understood by the Chinese, and even where there was no explicit correspondence, the underlying premise that where there is balance symptoms disappear would nonetheless apply.

If you are thinking of having treatment it would be good to see if you can discuss your specific presentation first with one of our members, and see if they feel that this is something which they feel would be of benefit to you.

We feel that this remains very sound advice.  There are many anecdotal accounts with which we are familiar where people have generally felt a great deal better after acupuncture treatment for underactive thyroid, but that may simply be a reflection of the fact that people love to talk about a success, love even more to talk about an adverse event, but largely move on without comment if treatment does not seem to be of benefit.

The one thing which we always look at with care, though, is the general presentation of the patient and the reasons which may explain some of their complaints. Thyroid problems, like diabetes, are sometimes a catch-all explanation for almost everything which happens in the body, and this may not always be the case. Poor vitality and weight gain, for example, may not be entirely attributable to thyroid malfunction, and a practitioner may see disturbances in the energy which mean that some aspects of a presentation could be amenable to treatment. The advice we gave above, to visit a BAcC member who can offer a view of what may be possible, is all the more important in this context.  

Q:  I've had one session of acupuncture done for the first time ever. I had the needles pretty much all over the top of my body including the temples.  Two  weeks on and I am now experiencing this pressure on my temples almost like someone is pressing each side with their thumb.  Is this normal, I feel really worried about it as I never had this sensation before.

A:  The first thing to say is: don't panic! Adverse events and injuries after acupuncture treatment are very infrequent, and those which do occur tend to be short-lived and relatively minor. Having said that, to have an off feeling two weeks after treatment is slightly unusual, especially on both sides of the head. 

There are two distinct possibilities. The first is that the practitioner has inserted needles quite deeply in this area and there has been bruising a little way under the skin which has not yet, or may never, appear on the surface of the skin. There are a many blood vessels and nerves travelling in this rather confined area, and slight pressure on any of them can feel very painful, sometimes out of proportion to the amount of tissue damage. The fact that it has appeared on both sides is unusual - bruising is not that common - but if someone is using a fairly heavy needle technique or inserting the needle quite deeply ot is not impossible to generate identical bruises on both sides at once.

The other possibility, and one which we might perhaps consider more likely, is that the treatment has caused a blockage in the flow of energy. From a Chinese medicine perspective pain arises when the flow of energy in the channels is either in excess, deficient or blocked. Needles help to correct these problems, but cam sometimes also cause them unwittingly. If the overall flow is quite weak and is suddenly stimulated it can occasionally reveal where things are blocked 'downstream', as it were. A good analogy is a blocked gutter on a house. When the rain is light, it can just about cope; when the rain is heavy, it overflows.

The best resource that you have in this case is the practitioner him- or her-self. Knowing exactly which points were used, and what the overall balance was, as well as the symptoms which made you seek treatment, will all help to pinpoint exactly what is going on. We are a little surprised that it is a fortnight since the treatment was done, and aren't sure whether you mentioned this when you went back after a week, often the normal interval at the beginning of a course of treatment, or whether you weren't sufficiently reassured by what the practitioner said and still have the pain. In any event, you need to call them to ask their advice. They will almost certainly be as concerned as you that a troublesome symptom like this persists, and will want to ensure that it is dealt with.

It is also worth adding, by the way, that it is not always the case that a symptom has been caused by treatment even when it appears roughly where the needles were inserted. We are always careful to help patients and practitioners getting locked into a 'it's you fault, no it isn't' exchange while a symptom persists. It is far better to seek medical advice by visiting your GP than to argue the toss about whether the acupuncture caused the problem or not. The main aim is to understand what is happening and deal with it first; discussions about causes can come later when it is sorted. If the symptom carries on much longer a short trip to your GP may be the best idea.

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