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Q: I have pulsatile tinnitus, it is extrely distracting as I can hear my heartbeat in my ear constantly. The only thing that eases it is putting pressure on my neck near my ear. Would acupuncture be of any help to me?

A:  Although our factsheet on tinnitus is relatively upbeat
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html
 
our own clinical experience of treating the condition is that unless it relates to one or two very specific syndromes, tinnitus can be one of the more intractable conditions. There is no doubt in our minds that acupuncture treatment can often make the tinnitus sufferer better able to handle the problem, but shifting the problem itself is a more difficult problem. As the various support group magazines ably demonstrate, there is always something which works for some people but nothing that works for all people, so you will often read articles that suggest that almost anything you may name can work. Cynics tend to take the view that tinnitus can often disappear of its own accord, and like pass the parcel, whatever someone happened to be doing as a treatment at the time is given the credit. This may not always be far of the mark.
 
However, pulsatile tinnitus is a much more specific presentation, and although tracing which blood vessels may be causally related to the condition is difficult, from a Chinese medicine perspective the sense that there is blockage and constriction in an area is one with which a practitioner could work from a Chinese medicine perspective. One of the strengths of Chinese medicine is being able to take the symptoms which a patient experiences together with some of the signs with which they present and make a diagnosis of patterns of imbalance within the system which treatment may be able to adjust or correct. This can result in improvement.
 
To make this assessment, however, someone would have to see you face to face, and the best option is to use our find a practitioner option on the home page www.acupuncture,org.uk and arrange to see a BAcC member local to you for a brief assessment. We also think that you might want to hold in reserve a possible referral to a cranial osteopath. If there has been some change in the subtle structure of the skull this may be affecting blood vessels locally and causing the condition. Cranial osteopathy may be another possible modality for trying to address this problem.
 
 

Q:  My husband has had sciatica on and off over the past 2 years.  He has had a lot if private physiotherapy and  is under the GP for the pain.  He is taking  all sorts of strong painkillers.  He had to go to A&E due to the amount  of pain he was in. He has had an MRI scan and is waiting for the results but over the last 3 days he has been in agony. He  seems to be taking lots of different painkillers without any effect on the pain. He is running out of options would acupuncture be of any help to him?

A:Our first advice would always be to see what the scan reveals before committing to treatment. Acupuncture treatment may be able to help relieve some of the pain he is in - this was, after all, one of the main effects of treatment which came to notice in the West and into which a great deal of encouraging research has been done - but if the scan reveals something more substantial either damaged or out of alignment this may well need sorting out by conventional means. Acupuncture may well be useful for pain relief while he awaits the next option, but may not be able to sort out the underlying problem.

However, we are quite used to being the treatment of last resort, and it is not uncommon for us to have patients who come to us with pains which defy explanation by all of the sophisticated testing now available. One of our first tasks is often to describe the basics of Chinese medicine to explain how pain can arise as a blockage in the energy of the body, called 'qi' by the Chinese, and how we set about resolving blockages. This can sometimes mean treating in the area where the pain is, but is almost invariably accompanied by treatment to help the body re-establish proper energetic flow and balance. This can sometimes mean needles a long way from the site of the pain, which can confuse patients, but from a Chinese medicine perspective most local symptoms, however extreme, are often an indicator that the body's ability to sort its own problems out is not functioning as well as it might, and treating the root as well as the branch is often necessary.

Sciatica is, in fact, one of the named conditions for which considerable research has been done, and although our factsheet is cautious in summarising the results of studies

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

it is one of the more frequent conditions for which people seek help from BAcC members, and anecdotally one which tends to respond well. It is certainly a condition which this expert approaches with some confidence. One of the great strengths of Chinese medicine is that it takes particular care to understand exactly how the problem manifests, and this means that each treatment is often unique to the individual, even though there are a few frequently used points for all cases. We tend to find that the term sciatica is used rather loosely in conventional medicine for a wide range of problems even in orthodox treatment, and we believe that the differentiation which we do as a matter of course can often pinpoint what is going on in a way which enables us to deal with the exact manifestation.

As always, our advice is to visit a BAcC member local to you for advice. Because the term sciatica is used as a catch-all for a number of problems, it is always best to see someone face to face who can give you a much more precise assessment of whether treatment may be beneficial. Most members are more than happy to give up 20 minutes without charge to ensure that if someone books in it is with a clear idea of the possible outcome and time scale for treatment.

Q: My husband has had sciatica on and off over the past 2 years he has had a lot if private physiotherapy and is under the GP for the pain having all sorts of strong painkillers.  He  had to go to A&E due to the amount of pain he was in. He has had an MRI scan and is waiting for the results but over the last 3 days has been in agony.  He seems to be taking lots of different painkillers without any effect on the pain. He is running out of options would acupuncture be of any help?

A:  Our first advice would always be to see what the scan reveals before committing to treatment. Acupuncture treatment may be able to help relieve some of the pain he is in - this was, after all, one of the main effects of treatment which came to notice in the West and into which a great deal of encouraging research has been done - but if the scan reveals something more substantial either damaged or out of alignment this may well need sorting out by conventional means. Acupuncture may well be useful for pain relief while he awaits the next option, but may not be able to sort out the underlying problem.

However, we are quite used to being the treatment of last resort, and it is not uncommon for us to have patients who come to us with pains which defy explanation by all of the sophisticated testing now available. One of our first tasks is often to describe the basics of Chinese medicine to explain how pain can arise as a blockage in the energy of the body, called 'qi' by the Chinese, and how we set about resolving blockages. This can sometimes mean treating in the area where the pain is, but is almost invariably accompanied by treatment to help the body re-establish proper energetic flow and balance. This can sometimes mean needles a long way from the site of the pain, which can confuse patients, but from a Chinese medicine perspective most local symptoms, however extreme, are often an indicator that the body's ability to sort its own problems out is not functioning as well as it might, and treating the root as well as the branch is often necessary.

Sciatica is, in fact, one of the named conditions for which considerable research has been done, and although our factsheet is cautious in summarising the results of studies

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

it is one of the more frequent conditions for which people seek help from BAcC members, and anecdotally one which tends to respond well. It is certainly a condition which this expert approaches with some confidence. One of the great strengths of Chinese medicine is that it takes particular care to understand exactly how the problem manifests, and this means that each treatment is often unique to the individual, even though there are a few frequently used points for all cases. We tend to find that the term sciatica is used rather loosely in conventional medicine for a wide range of problems even in orthodox treatment, and we believe that the differentiation which we do as a matter of course can often pinpoint what is going on in a way which enables us to deal with the exact manifestation.

As always, our advice is to visit a BAcC member local to you for advice. Because the term sciatica is used as a catch-all for a number of problems, it is always best to see someone face to face who can give you a much more precise assessment of whether treatment may be beneficial. Most members are more than happy to give up 20 minutes without charge to ensure that if someone books in it is with a clear idea of the possible outcome and time scale for treatment.

A:  As you can imagine we have been asked about frozen shoulders before and one of our earlier answers, to which we have added supplementary comment, was:

Can acupuncture help a frozen shoulder?

Frozen shoulder can be a difficult condition to treat. Our fact sheet on the website

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

is not overly encouraging, but the main point to note here is that there haven't been a great many studies. What counts as 'frozen shoulder' can vary considerably and creating a number of groups with identical problems for trial purposes is not that straightforward. There was very positive article in the national press a couple of years ago

http://www.dailymail.co.uk/home/you/article-2082722/Health-Take-pain-frozen-shoulder.html

which is useful because it describes a number of conventional treatments which are also used for treating the condition. If you have not been offered any of these options, or not had the full range of investigations, we strongly advise you to make sure that your GP known how much pain you are in and gets the joint scanned to see if there is something which is seriously out of place. It is possible, for example, to tear one of the tendons near the joint which will cause almost unceasing pain, and although acupuncture treatment may help to ease the pain temporarily, the problem may require minor surgery to be fully resolved.

One major problem with the shoulder joint is that it's mobility means a dependence on groups of muscles and a relatively open socket into which the head of the humerus fits. It is very easy for there to be a minor displacement or small dislocation of the joint, and equally easy for a problem with one set of muscles to cause a ripple effect throughout all of the groups holding the shoulder joint stable. There are often secondary problems which may need to be addressed.

Chinese medicine has obviously been used to treat problems like this for thousands of years, and as well as treating locally to where the problem is on the body there are a number of functional treatments which are aimed at affecting all muscles and a couple of 'empirical points', points which have been used for centuries to help with all shoulder problems. There are also points which can be used to help reduce some of the pain and inflammation which results from the muscle and tendon strains.

However, there is no doubt that it really pays to have treatment with someone who fully understands the dynamics of the joint in great detail and can make an informed and careful assessment of the precise problem. There are a considerable number of BAcC members who are also trained in osteopathy and physiotherapy, and equally a number of osteopaths and physios who use acupuncture on a regular basis, and the combination of manipulation, movement and acupuncture may be the optimum package.

It may be helpful to seek the advice of a BAcC member local to you. Most know of colleagues within their area who specialise in this kind of condition, and many also work very closely with local osteopaths and physiotherapists, and maybe able to put together a co-ordinated package of treatment to get you back to good health and mobility.

There isn't a great deal more we can add. Acupuncture has a long history of being used for pain relief, and the question which a practitioner needs to resolve for themselves when treating someone for chronic pain is whether the amount of relief they can help the person to achieve is sustainable enough to warrant the continuing expense. In most cases, however, they will make this a consideration secondary to seeing what can be done to fix the problem itself.

A:  A great deal depends on what you mean by 'self-management skills.' If you mean teaching people how to needle themselves and sending them off with a packet of needles, the answer is that they shouldn't. Although some sections of the medical acupuncture community feel that this is OK, as witnessed by this oft-cited paper offering a debate between the two camps:
 
http://acupmed.bmjjournals.com/content/22/3/141.full.pdf
 
We at the BAcC have shared Val Hopwood's view that the risks outweigh the benefits, and that there are other methods for pain relief which offer similar advantages. We are less concerned about the risk to patients, although it is real if someone does not treat themselves with a keen eye for hygienic practice, than the risk to the public in the form of safety of handling, storage and disposal of needles. Our members are very thoroughly scrutinised by Environmental Health Officers when they register their practices in all these aspects, and we do  not believe that someone can be given adequate training on a few short minutes. If a member took the step of instructing a patient in self-needling techniques and something went wrong, the responsibility would come back to them and ultimately us through our bloc insurance cover.
 
We have heard of a few areas where self-needling takes place. One such is a project in Cornwall for needling a specific point to relieve post-chemotherapy nausea, and as far as we could judge the information leaflets they handed out were fairly good. However, it did not change our view that this was all predicated on everything going smoothly all the time, and we don't believe that this is an accurate assessment of the potential risk.
 
There are a number of alternatives which practitioners do suggest to patients. Acupressure can in many cases provide a perfectly acceptable follow-up treatment, and is advantageous because of the slightly wider margins for error in point location. For pain across larger areas some practitioners lend patients TENS machines which are widely used by physios. These deliver a steady current which provides pain relief. There are a few practitioners who give moxa, the Chinese herb we burn on or over points, to patients to use at home. We have some very clear guidance which members can give to patients if they choose to do this, some of which is very practical - smoke alarms will go off, and the stick form which is used over larger areas is difficult to extinguish.
 
Practitioners will also give advice about lifestyle and diet if they think these will make a difference. Sometimes people's specific pains are intensified because the system as a whole is weakened, and a practitioner might well suggest changes in diet or habit if they felt that this would make pain more manageable. Each person is unique, and the practitioner will invariably tailor what can be done to the needs of the individual and according to their capabilities.