Q: My GP is referring me to have acupuncture treatment for my neck. I have a partial fear of needles and a low pain threshold . I am suffering with bad headaches and my GP thinks it's coming from my neck.
A: The GP may well be correct; a considerable number of headaches arise from problems in the neck, often to do with gradual changes in the vertebrae which can impinge nerves and affect blood flow. There is quite a great deal that acupuncture for both problems, as our factsheets show:
Obviously we have to qualify these kinds of sheet with the statement that traditional acupuncture treats the person, not the condition, so we treat a person with a headache, not just a headache. This can make a profound difference to the treatment. Twenty different patients with the same presenting symptom might be treated in twenty entirely different ways as the practitioner sought to balance their own specific patterns of energy. This is one reason why we believe that acupuncture can be more successful than some conventional treatment because it is tailored to the unique needs of the patient.
As far as needles are concerned, there is no reason to fear them. The majority of members use needles which are 0.18mm ot 0.25mm and usually only an inch long, of which the top 3mm-5mm is actually inserted. The use of guide tubes helps even more, the pressure of the tube deadening most of the sensation in the area. Most of us have treated people who are needle phobic, and the simple expedient of showing someone what is going on, perhaps on an area where they can see what's happening, and talking through the process is usually more than effective. There are very few cases where the needling itself has stopped people having treatment, and most of us know how to start as gently as possible in order to keep people happy! The best thing to do is to visit a local BAcC member for a pre-commitment chat to be reassured about them, where they work and what needles look like. You will also get the benefit of a straightforward assessment of how well acupuncture may be able to help you.
Q: I've recently developed sensory nerve discomfort on my shoulder blades .I already have idiopathic peripheral neuropathy so I know what nerve pain is . This is touch related as there is no discomfort when there is no clothing touching my shoulder blades . I did a simple experiment with 3 shirts/t-shirts . The first had a rough/course texture , the second had a gripping texture , the latter was soft & smooth . The first two both caused discomfort , the latter virtually none , I had a friend present & we both agreed on the descriptions regarding the "shirts" .I would also add that I use a thoracic brace for exercising & the pressure of the brace on the my shoulder blades seems to alleviate the discomfort .I thus thought , albeit from a very limited understanding of acupuncture : its use of pressure points & the fact that a GP at my practice has used acupuncture for many years for a variety of maladies for the benefit of practice patients is there any evidence of its efficacy in treating sensory nerve discomfort .
A:We do have a number of fact sheets on our website about neuropathic pain and also a number of answers to earlier queries about diabetic neuropathy, but none really quite addresses the problem which you describe.
We suspect that with your problem it really is a case where going back to first principles may offer the best chance of finding some relief from the problem you have. As you probably already know from background reading, the theories of traditional acupuncture are based on the flow of energy called 'qi' and its rhythms, flow and balance in the body. Understanding how problems occur means being able to identify and understand how the flow might have been disturbed where the problem is and also how this fits against the overall backdrop of someone's health. The practitioner invariably, as with any pain, asks questions about whether the problem area feels hot or cold, responds to hear or cold, responds to pressure, is better or worse at different times of day, and so on. The answers to these questions all point to specific disruptions in the flow of energy and hopefully towards solutions.
There are a number of formula points which can be used as short term palliatives, and on occasion these may provide a permanent solution. The majority of cases like this, though, where there is an area of skin and superficial muscular discomfort, require something more sophisticated by way of treatment. Of course, in saying this, we would ourselves be looking at the other possible environmental factors which might be causing the problem, but we assume that you have probably done an exhaustive check on things which might have affected the area.
The best advice we can offer, since it is an unusual and specific presentation, is to visit a BAcC member local to you for a brief assessment of whether acupuncture might be of benefit. A skilled practitioner could usually elicit in a very few minutes how treatable something is, and most of our colleagues are happy to give up a short amount of time to make this determination
Q: My dad had a heart attack in 2005 and he has an stent in his heart. He has recently had a lot of pains in the back of his shoulder going to his neck and his left arm. Do you know if acupuncture is the solution for it or if it's good for him or not please.
A: We think we can safely say based on what you have told us that there is no reason not to have acupuncture. There are very few contraindications for acupuncture, reasons why we could not treat someone, and having had a heart attack and stent fitted does not pose a problem.
Whether acupuncture could help or not depends a great deal on what the cause of the pains is. For the kinds of pains which your father is getting, and taken together with his medical history, I think most of us would probably want to refer him back to his GP or cardiologist for further testing and an all clear for all involvement of the heart or other internal organs. Some of the aches and pains which people have are what is known as referred pain, where the pain is actually starting in an internal organ but is perceived by the body as a muscular problem on the surface. The classic example is angina pectoris which can present as a pain the left shoulder and arm. Given that your father has had a stent fitted it implies that there has been some atheroma/plaque-like material in the arteries and this may have caused another artery to be sounding warning bells.
However, if the pains are simply muscular, there is a good chance that acupuncture treatment may be of benefit. As we point out in our factsheet
there is some reasonable evidence for the successful use of acupuncture as a means of relieving this kind of pain.
We always advise people to see a BAcC member for a brief face to face assessment; this is by far the best way to establish just how much benefit acupuncture may be able to offer. In your father's case this is doubly so, just to make sure that these are not pains which we would do better to heed as a warning sign than simply treat and try to disperse.
Q: I suffer from cervical spondylosis with radiculopathy in my upper right quadrant and wear and tear in my thoracic and lumbar spine. Suffered badly for years up to this past year finally getting best nerve pain med. Female aged 62, take pregablin Lyrica 100mg x 2 for past 4 months. I was paying for private physio for past year which was working well. Was offered a plate and pins to stabilise neck last year but have defferred as I'm still at work. I begged for and am getting a nhs course of acupuncture - just a few pins in the top of head, neck, right thumb and shoulder. Hoped to get off meds which have side effects. 3rd session of acupuncture and I now feel like the pain has come back and the pregablin not working. Is it normal for this reversal to happen or should I cancel? Would you recommend I ask for a new scan of my neck to see if it has got worse?
A: Based on what you have told us we think that it is very unlikely that the acupuncture has caused the reversal of progress which you describe. In traditional acupuncture we do warn people that there can be situations where a chronic condition can sometimes sign off with a flourish, and it is not unknown for a migraine sufferer to have a really bad migraine after a first or second session. However, this tends to be a very good sign that a pattern has been broken and a pathogen expelled, so the effect is short lived. Occasionally after treatment for musculo-skeletal problems the same can occur, and along with osteopaths and chiropractors we do tend to warn people to expect a day or so of disruption. The effect, however, is invariably transient.
There are two possibilities which we can think of. The first is that something has in fact really changed, and that your intuition that a new scan may be appropriate is a good one. We always express this with great care, but it is possible that changes have absolutely no causal relationship with the acupuncture treatment but just happened at the same time. This can sound like evasion of responsibility if not spoken with care, but what we worry about is that people can get distracted into arguments about causation while the problem goes unattended.
The second is that the treatment itself has not exacerbated the existing problem but generated a few new symptoms in similar areas. Most of the practitioners working in pain clinics are safe and well trained, but they do tend to use what we would call formula acupuncture on the basis of western medical theory. This variant, called western medical acupuncture, can often be applied a little more vigorously and with slightly thicker needles than most traditional acupuncturists would use. This can sometimes generate problems of its own, but we have to say that if this was the case they would start pretty much as soon as the needles had been inserted, not appear gradually over time.
A third possibility is that the acupuncture treatment us having a rather good effect in terms of helping to relieve some of the tension in the muscles of the shoulder and neck, but this has had the unfortunate consequence of allowing slightly greater flexibility in the neck itself which in turn generates a little more pain. We do see this on occasion with backs, where a kind of unhealthy stability is achieved where a lesser problem, chronic muscle ache, is traded off against a more sharp pain like sciatica. It is rare but there are times when succeeding in helping the lesser pain can bring on the worse pain.
We think the best thing to do is to discuss this with the person giving you treatment. This is not a case of wasting anyone's time; this is all about ensuring that you get the best possible treatment for a really unpleasant chronic condition. If there are over-shoots or under-shoots in the treatment, then that is simply a useful guide to getting the balance absolutely right, and your healthcare professionals will welcome the feedback to be able to make the appropriate adjustments or, if need be, decide that another scan may be appropriate.
We hope that you manage to find a good balance of treatment to help you to continue without a plate for as long as possible.
A: This is quite a difficult question to answer. All forms of impingement and entrapment can arise for a number of reasons, and these determine whether there is a realistic chance of success. If the problem arises from a displacement of the physical structure of the body, like a joint having been knocked slightly out of alignment then it may be more appropriate to see a practitioner like an osteopath or chiropractor who can manipulate the structure back into place. It is probably possible to do the same thing with acupuncture over time, but re-arranging the bones first and then using acupuncture to consolidate the change is how many of us work alongside osteopaths and chiropractors.
If the changes in structure are due to deterioration of the bones, the problem can be more intractable. We find that impingements of nerves where the spine is starting to collapse with age are often difficult to address, especially in the neck and in the lower back. This is a simple mechanical fact; if the gap between two bones closes then nothing short of surgery is going to fix it.
In some cases, however, inflammation arising from structural changes or simply inflammation can cause the entrapment, and in this case there is some evidence suggesting that acupuncture can do more than simply offer short term pain relief and can break the cycle of inflammation which is causing the discomfort.
The short answer, though, is that each case is unique and different, so it is very difficult to quote general principles about what is best. The advice we tend to give all the time is to arrange a brief face to face consultation with a local BAcC member to see whether in their professional opinion a problem is amenable to acupuncture treatment. The majority are quite open to suggesting alternatives if they think a patient would be better suited to another form of treatment.
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