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A: Trigeminal neuraligia is a very painful and quite often intractable condition. We have been asked about it a number of times, and although we have factsheets about both facial pain and neuropathic pain
there isn't a great deal of hard evidence to which we can point by way of underpinning a recommendation for acupuncture treatment. In a previous response on the same question we said: If you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.
We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, andsubtle manipulation may offer possibilities.
We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficientto warrant making a recommendation to try to use acupuncture as a long-term pain relief option.
If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to establish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accuratelybad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.
We think that this still remains the best that we can say. Our experience is that where acupuncture does work it can often work very rapidly when the reason, understood from a Chinese medicine perspective, is very clear. However, we have to be honest and say that where there is no clear pattern, i.e. where the symptom is clear but the energetic disturbance which causes it is not, we have seen cases which have remained intractable and where patients have had to remain on western medication as away of controlling the symptoms.
A: Generally speaking, the track record for acupuncture treatment of migraine is very good. Although the evidence is not quite to the rather strict standards which would enable us to give an unequivocal recommendation, as our factsheet shows
there have been a significant number of high quality trials, and we expect that over the next decade the evidence will be better still. This is certainly the case with cluster headaches for which NICE now recommends acupuncture as a primary treatment.
Your specific mention of vestibular migraine suggests, however, that your symptom are more vertigo-like than the nausea and pain associated with the 'classic' migraine. Here again, acupuncture treatment has been well-researched
and there are some good quality studies suggesting that treatment is beneficial. Both migraine and vertigo, in fact, figure in the twenty conditions for which treatment is most frequently sought.
Of course, the point we have to make is that these are both western disease classifications, and the great strength of Chinese medicine is that it can take the symptoms, which are the same in anyone's language, and re-interpret them in an entirely different theoretical grid based on a concept of energy, called 'qi', and the disturbances to its flow, rhythms and balance which generate symptoms. This can often lead to a much more precisely targeted treatment than the treatment of a named condition, and mirrors what the great Canadian physician William Osler once said: 'don't tell me about the disease the patient has, tell me about the patient who has the disease.' Each person isunique and different, and although the same reason might exist for the symptom to appear, the chain of causation may be entirely different.
This is important, because the parts of the system connected with balance also have a major involvement in the function of sight, and it would not be impossible that the photophobia shares the same root cause from a Chinese medicine perspective. Certainly the 'darkened room and absolutely no noise please' symptom which we often hear is one which does appear to be eased by treatment for migraine.
As we said, though, each patient is unique and different, and the best advice we can give you is to visit a BAcC member local to you and seek their face to face assessment of whether they believe that acupuncture treatment may be beneficial for you.
Q: I'm having severe skin itching all over since having accupunture on Wednesday afternoon, today even antihistamine is doing nothing to relieve. I suffer withsystemic candidiasis which I keep in check with pau d arco etc. I'm literally tearing at myself constantly.
A: This is certainly a very extreme reaction to treatment, and also quite unusual. However, that fact that you suffer from systemic candidiasis for which you appear to have sorted out a maintenance strategy with other forms of treatment suggests that the addition of a random element may just have upset this balance slightly.
That said, we have occasionally seen cases like yours where the reaction is a healing one, and if this is the case by the time you receive this reply things may have become a great deal easier. If this is the case, then the next treatment should be unremarkable. if, however, you get the same reaction, then it might be an indicator that acupuncture treatment is not the best therapy for you.
We are always cautious when someone has an extreme attack of an existing problem. There is a line of thought that says that things get worse to get better, and we do have a theoretical model which suggests that the energetic imbalances which cause problems like migraine or digestive problems can be expelled with extreme reactions as they leave the system. However, we have also seen cases where things were getting worse because they actually were getting worse, and equally things which have been generated by treatment because acupuncture is not the best form of treatment for the individual, so we are a little concerned when someone just responds 'healing crisis' without giving the problem much thought.
A: Our advice is that you discuss the outcome with your practitioner. It may be, for example, that the treatment can be adjusted with less needles, less manipulation or even a different treatment strategy to ensure that the benefits are not outweighed by flare-ups of your problem. It may also be that the practitioner, based on your feedback, may decide that the treatment is not the best option for you and may recommend other forms of treatment which do not interfere so radically with the condition you have undercontrol.
We sincerely hope, however, that this was a short-lived reaction and that it has settled down with some improvements over where you started.
Q: I've had 2 sessions of acupuncture with the NHS for chronic lower back problems over the past 2 weeks. I've had it before privately for my back and my bad knees. Inthe past. I just felt tired and a bit sore afterwards and was thinking it could be similar this time. However, at both sessions I have experienced pain on needles going in and being removed. I have felt very faint afterwards and my chronic pain has become far worse (I know that this can happen). I have also been having blurred vision on and off since I started. Is this a possible side effect? Also, is it likely that being treated for the same issues would cause me to feel so different or should I assume that the first practitioner had an approach that suited me more?
There are three issues in your question.
It is possible that acupuncture within the NHS, if administered by a doctor, physio or nurse, is slightly different from the treatment you would receive privately. Most private treatment is traditional acupuncture, based on theories of energy which have a 2500 year history and generally speaking employing a relatively gentle technique. Some practitioners manipulate the needle quite vigorously to generate a sensation called 'deqi', a dull aching feeling, but for the most part there is very little needle sensation. By contrast western medical acupuncture tends to use slightly larger needles and often aims to work on trigger points, knots in the muscle, which can be very painful. Also, it has to be said that the majority of acupuncture providers within the NHS use the treatment as 'another tool in the toolbox' and may not have the same subtlety as someone for whom it is a primary practice. However, it has to be said that treatment of any kind is very safe, with a remarkably good record.
That said, the adverse effects of your treatment are a little concerning. The fact that you feel faint after treatment would generally indicate that the treatment is too powerful for you. This has long been a point of debate with medical acupuncturists. Our experience is that some patients are sensitive to the movement of energy, and we have to adjust our treatment accordingly, using fewer needles, more gentle insertion and less manipulation. However, since medical acupuncture is not based on theories of energy, this would not necessarily be taken as a reason to change the style of treatment. It may just be that you are sensitive to acupuncture, which means that you may benefit from a lighter touch.
The adverse effects themselves warrant comment. Back pains can often get worse before getting better and we often warn patients that the couple of days after a session may just see the pain exacerbated. If this is the case, however, there is usually improvement thereafter. If there is pain for a couple of days and then everything returns to the status quo, the discomfort may be a direct reaction to the treatment and nothing more.
We are a little more concerned about the blurred vision, though. If it is connected to the treatment this would be very unusual. We have looked carefully at the adverse events reporting over the last decade and apart from a couple of blogs on the web there are no actual case reports. It may simply be that the symptom is to do with the fatigue which many people experience after treatment of any kind. However, blurred vision is always worth checking, and if it has happened completely contingently, i.e. just happened to come on at the same time as the treatment but not actually connected to it, then it would be worth checking sooner rather than later.We have seen a numberof cases where people have assumed something has been caused by acupuncture treatment when it simply occurred around the same time, and our greatest concern is that they sometimes get diverted into arguing about whether or not the acupuncture caused the problem when the main priority is to get it sorted. Our advice would always be to go the style of treatment which seems to suit you better. This is not a matter of one treatment being better or worse than another, just a recognition that people are different and find some treatments and some practitioners more to their taste.
Q: am an acupuncturist in Portugal and I wonder what the parameter settings are to be able to exercise the profession in England
A: There are very few parameter settings for the UK. In the absence of statutory/government regulation of acupuncture, it is in principle free for anyone simply to set up in practice. There is very little likelihood that statutory regulation will happen in the near future. The only laws which actually govern practice are the more general local, rather than national, laws about skin piercing which require practitioners to register or be licensed depending on where they choose to work. In Greater London it is a matter ofannual licensing unless you belong to an exempt membership body (the BAcC is one), in Scotland annual licensing unless you are registered member of regulated profession like doctors and physios (we aren't exempt), and everywhere else a one-off registration for every practice in which you work.
It used to be possible to set up in business with only the most rudimentary qualifications , but the last decade has seen many local authorities adopting byelaws (local laws) which require practitioners to have standards roughly in line with the degree level education recommended by the World Health Organisation.
As a citizen of an EU country you would be entitled to work here without a visa under the free movement of labour rules within the EU, so it would simply be a matter of deciding where to work, finding somewhere to work and the getting the appropriate license or registration. Setting up in business can be a slow affair. We advise new graduates that it can take two years or more to have a practice able to sustain them, and in the current recessionary times that may be even longer. We advise people not to give up their current work until they can comfortably switch to being free-standing practitioners, and for graduates for who this is a primary career to try to have some other form of steady income to keep them going.
Of course, joining a reputable professional association like the BAcC brings with it a great many resources and support, so we would obviously encourage you to give that serious thought if you do decide to come to work here.
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