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Q: I have suffered from peripheral neuropathy for 16 yrs which is a nerve damage problem. I walk with the aid of crutches. Would acupuncture help this problem?

A:We have been asked several times about the treatment of peripheral neuropathy, and one answer which still seems to sum up our position says:

Q: Is there any evidence that acupuncture can help with peripheral neuropathy and if so is there a distinction between chinese and western acupuncture?

A: There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet

but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.

Western and Chinese acupuncture operate from entirely different conceptual bases, although in practice many of the acupuncture points they use will be in the same places. Most western acupuncture is based on a neurophysiological understanding of acupuncture, that its effects are caused by stimulation of local and distal nerves. There are other variations on this theme, but in essence the practitioner works with a western medical diagnosis and very often uses needles in and around the affected area. Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achievement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.

The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.

We are mindful of the fact that you have suffered for 16 years and have been forced to use crutches to move around. This suggests perhaps a greater level of damage than that about which we are often asked, and perhaps the expectation from treatment has to be geared down. However, we are always careful to remind ourselves that we are talking about an entirely different way of looking at the body and how it functions, and there are occasions when making good a blockage or imbalance which has lain untreated for many years can have extraordinary effects.

As we said in the earlier reply, though, the best advice is to visit a BAcC member local to you and let them make a face to face assessment. This is likely to be far more informative than we are here, and may well generate other treatment options for your specific problem.

A:There is no evidence that we can find, at least not in English, that acupuncture has been successfully used to treat bunion pain. There may well be papers amongst the many thousands published in Chinese each year, but none have as yet been translated. Working on the premise that important papers often make it into English you could probably assume that this means that there are no landmark studies.

From a western perspective once a bunion, always a bunion, unless you have an operation. The thickened skin and additional bone growth are not likely to be dealt with by anything short of surgery, and the best that is usually offered is anti-inflammatory medication to reduce the secondary inflammation and management advice - wider shoes, forms of cushioning.

There is a long and well-researched tradition in Chinese medicine of the use of acupuncture to deal with chronic pain, and the question in this case is simply how much pain relief treatment may provide and how sustainable it is. If treatment offered relief for a week or so, then it may be a worthwhile continuing programme, but it would not be realistic to look for anything beyond temporary relief alongside conservative management strategies like better footwear and padding.

There may be some merit in talking to a BAcC member local to you who can give you advice on the unique presentation of your problem, but as a general rule we would have to say that the chances of radical change in an area which it is difficult not to irritate in daily life are relatively small.

Q  My daughter, while on holiday, had treatment for a torn shoulder muscle. The acupuncture was Tung Style acupuncture and very successful.(one session).  Since returning home she has tried to locate one in our area, without success. Could you please tell me if we have a Tung Style Acupuncturist in West or North Yorkshire ?

A:We are pleased to hear about the success of your daughter's treatment using this style of acupuncture, but we are afraid to say that we do not record the individual styles which our members practise. There are simply too many variations within a complex tradition to provide a simple key to any list. We have checked the website of the association which claims to be the primary one for the training and accreditation in this style

and the only UK practitioners also happen to be BAcC members. We have located another member who has trained in this style, but our searches did not get us any further, and the practitioners are all based in the South East.

The best that we can suggest is that she contact one of them to see if they know of any colleagues in the UK who have also trained alongside them - the informal network is usually pretty strong. Other than that we would have to say that just as there are many styles of practice, there are many ways to travel to the same destination and it is probable that practitioners working in other styles will be as effective. Chinese medicine is predicated on the same shared structures, and the difference in styles does not have as much impact on the outcomes as people may assume from a cursory look.

If she cannot locate a Tung style practitioner near you it may still be well worth her while speaking to a BAcC member local to her about what they believe they may be able to offer.

Q:  I can't give blood within a period of time since having acupuncture unless the acupuncturist is registered with a recognised (by the NHS) council, the BAcC is not included, although my acupuncturist is registered...what a shame, any ideas?

A:  None at all, we're afraid to say. We fought this ruling long and hard when it was first introduced, having enjoyed before that a perfectly satisfactory certificate scheme. However, harmonisation with European standards unfortunately meant looking for an easily understood line in the sand, and statutory regulation was chosen as the criterion. We protested that this disenfranchised us, with degree level training and very thorough background in safe and hygienic practice, while at the same time enfranchising SR professionals with tiny amounts of training, and this when blood stocks were at a record low. However, this was a victory for simplicity over common sense, and we had to give ground.

However, since then we have been accredited by the Professional Standards Authority, and have managed with their help to negotiate a study which, if it is successful by the middle of next year, pave the way for us to be able to let members know that their patients will once again be exempt from the four month deferral period.

Until then, however, there are no legal or ethically acceptable ways around the system, and we have had to advise patients who have worked the angles that while we understand their frustration we cannot condone what they have done.

Q:  Following an MRI scan I have been diagnosed with a sacral stress fracture.   I am 63 - Could accupuncture help accelerate the repair of the fracture?

A:There is very little research evidence on the acceleration in the healing of fractures with acupuncture, at least not on human subjects. In the field of animal acupuncture research, several studies point to faster recovery, but whether these results can be extrapolated to cover human fractures is a major debating point. Anecdotally, of course, we hear many stories of patients who have used acupuncture alongside conventional treatment with great success, and there are specific points within the tradition of Chinese medicine which are believed to have a direct effect on the healing of bone. None of these is sufficient to allow us to make an unqualified recommendation.

What we can say is that there is likely to be some benefit from acupuncture treatment for the pain which you are undoubtedly experiencing. In fact pain relief has been one of the most heavily researched areas of treatment, not least because there are some very sophisticated systems for patients to be able to express the extent to which they are in pain and because the chemical markers, the levels of neurotransmitters involved in pain relief in the body, are easily measured and assessed for change. The only question, as with all treatment, is the extent of the pain relief and how sustainable it is.

However, on the assumption that this is something which you are managing, the best we can say is that acupuncture treatment may be able to assist with the healing process, but it may be difficult to find sufficiently robust outcome measures to know whether there has been an effect.

The best advice that we can give, however, is that you visit a BAcC member local to you and ask their advice in a brief face to face consultation. There may be factors in your overall balance which are slowing down you recovery as well as the specific issues of the fracture itself, and a well-trained and experienced practitioner should be able to give you a clear sense of what can be done.