Q:  I have suffered from pudendal neuralgia for 2 years. I would like to know if acunpuncture can be used to treat this condition? Also, details of practices that can treat this condition. I live in Newcastle-upon-Tyne

A:  Pudendal nerve problems can be a source of immense discomfort and can often lead to severe depression, especially if entrapment of the nerve not only causes the neuralgia but also affects functions in the lower abdomen.

We would first want to ask a great many questions about what brought the problem on, or if there was no obvious cause what was happening at the time of onset. We would also probably want to know whether the onset was sudden or gradual, whether you had found anything which seemed to relieve the problem, and what tended to exacerbate it. These questions would be standard fare for any doctor, but the underlying theory of Chinese medicine can often make sense of symptoms and how they present within an entirely different framework.

The bottom line, though, is that quite often pudendal nerve problems result from physical changes in the lower spine or in the internal musculature, and these can often be difficult to reverse. Occasionally there is a level of entrapment brought on by a hobby like cycling or working for long hours in a fixed position, but these are easily identified and easily remedied. The majority of cases are more treatment resistant, and it would be unfair to give you unrealistic expectations of what was possible. We have trawled through the research databases and found very few studies which even look at the problem, let alone indicate that it might be amenable to treatment.

However we must not sell ourselves short! Acupuncture treatment is often the last resort for intractable problems, and occasionally generates results in the most unexpected cases. If a practitioner can make sense of the presentation you have from a Chinese medicine perspective then there may be some cause for hope that the symptom can be reduced in severity or even removed. The best way to establish this would be to see a BAcC member local to you for a chat and brief face to face assessment.  The only caution we ever offer is that where we are not sure whether treatment will work it makes sense to try to find measurable outcomes and to review progress regularly, and certainly after the first four or five sessions. If there has been no change of any kind then it may be wise to call it a day early rather than run up a large bill going nowhere.

As generalists all of our members are capable of treating this problem, and using the postcode search facility on our home page www.acupuncture.org.uk will generate a list of members geographically closest to you. 

 

Q:  I have alodinya feels like permanent sunburnt but also results in pain in different areas. I have had an MRI scan and the  results they don't think are anything to do with spine damage. They think it is difficult to associate it with sensory symptoms.  Would acupuncture help?

A:  We are very sorry to hear that you have this problem; it can be very disheartening to have something for which no clear-cut cause can be found.

We have searched the literature for any evidence of acupuncture being used to treat this, but weren't at all surprised to find nothing of significance. The condition usually presents itself as a feature or symptom of something which is already named and classified, and treatment usually focuses on that specific problem.

However, the great strength of Chinese medicine is that it has a 2500 year history of treating problems not by name but by how things appear, and understanding them within a system which is based on energy flow. This has evolved to use a great many classifications based on observation and lived experience, like feelings of heat and cold in the body, and also a complex understanding of the inter-connectedness of parts of the system. Once one steps aside from the disease label and asks more specific questions about where the sensations are, how they feel, and what makes them change this can often point to a series of possible causes, many of which are treatable.

It has long been received wisdom in the acupuncture and Chinese medicine world that skin problems are often best treated with a combination of acupuncture and Chinese herbal medicine. Since most of the practitioners on the Register of Chinese Herbal Medicine are also BAcC members too this may be the best option to pursue. However, herbs are to everyone's taste, and we are pretty confident that acupuncture alone could be just as effective.

The best advice that we can give, and often do give, is that seeing a problem face to face is always the best way to establish whether something is treatable. Most BAcC members are more than happy to give up a few minutes without charge to have a look at the problem and give more specific advice, and this also gives you a chance to meet them and see where they work before committing to treatment.

 

Q:  I have suffered heel pain for 3 years.  I have plantar fascitis in  both feet after running on a trend mill in flat shoes.  Now  my right foot is very troubling,  I  stopped having cortisone injections about a year ago,  I have tried all types of gel pads which have made no  difference.  The pain is crippling like having a nail inserted through the heel, does anyone have answers regarding acupuncture, 

A:  We were surprised to find that we had been asked a similar question some time ago and managed to trace some research; we didn't think that this would have been chosen as a research topic. The answer we gave then was:

There are a small number of encouraging studies, summarised in this systematic review:


http://www.ncbi.nlm.nih.gov/pubmed/23099290

We use the word 'encouraging' because the researchers used a protocol for gathering data which was partly devised by acupuncturists themselves within the framework often used to gather material, and the results reflect far more accurately than usual the probable benefits of acupuncture.

However, all reviews of this kind will conclude that more and better studies are needed. This is just a reflection of the fact that while acupuncture is regarded as a fringe activity it will never attract the levels of funding which are required for studies of sufficient size, and we shall be continually reporting that there are encouraging but inconclusive signs!

We would really like to know a little more about how the condition which you have developed. This is quite often associated with exercising or jogging, and this impacts on the possible solutions. What we can say is thatwe would want to know what had been ruled out by conventional tests before we gave a professional view of whether we could help. There are some forms of damage in this area which would not be amenable to acupuncture treatment, and might only be corrected by surgery.

However, the majority of cases involve inflammation and tightening of the tendon, and from a Chinese medicine perspective this points either to local blockage and stagnation through over-use or accident, which might be amenable to local treatment, or a much more wide-ranging systemic condition of which this is the earliest manifestation. The skill and art of the practitioner is what enables them to determine the extent to which the problem is a reflection of a wider pattern of imbalance, and this in turn ensures that the treatment is not applied just locally as a quick fix which may not last that long.

The advice in all of these cases, where we lack the specifics of the problem and cannot make a face to face assessment is to visit a BAcC member local to you and see if they are happy to give up a short amount of time without charge to give you a more balanced view of what acupuncture treatment may be able to achieve. If they think there are other and more effective options, they are likely to say so.      

This probably remains the best that one can say. We are assuming that the various investigations have ruled out a calcaneal spur, which if it were the case is not really going to shift without surgery. If it does arise from tendon problems, however, then there may well be some hope that acupuncture may be able to offer something. Even as pain relief treatment can be very beneficial, but the question then becomes how much relief and how sustainable it is. This can sometimes become a financial equation - is the expense worth the extent of relief - but for some people it is important to buy some pain-free time when they need it.

Our advice always remains the same in these cases: visit a BAcC member local to you for an informal assessment, hopefully without charge, of what acupuncture treatment may be able to offer.

 

A:  There are no rules as such about anyone attending a clinic with a patient. We do have a provision in the BAcC Code of Professional Conduct which says

You are allowed to have acupuncture students, potential acupuncture students, or other individuals present as observers in your practice.  An observer may only be present with the explicit permission of the patient and may not carry out any part of the treatment. You must take care to avoid ‘coercive consent’ where a patient feels that they are under pressure to allow an observer to be present.but this is primarily intended to address the situation where a practitioner wants to have other people in attendance.

Most of us are more than happy to oblige if someone wants to bring a friend or relative along. In the case of children under the age of 16 or adults lacking capacity this is not a choice for the practitioner but mandatory. The only problems which we encounter are where the friend or relative interferes with the normal process of treatment. This 'expert' had one occasion where a husband booked his wife in for treatment and then answered all the questions on her behalf, including how she experienced her menstrual cycle! She happily acquiesced in this, and diagnostically it was interesting and valuable but after a while I had to explain that it really was for the patient to answer questions. 

We have heard of a very small number of occasions when a practitioner has refused to let this happen, and the only advice we can then offer is 'find someone else who does'. Acupuncture is something which many of us have done for thirty years or more, and this shouldn't make us blase about the fact that for many people it will be a novel and potentially scary situation. It would also not be common to have a chaperone in place at all times, and having a friend or relative in situ can make the difference between attending and not attending a clinic. 

If the question is based on a less than positive experience and you have been treated with less than appropriate sensitivity when making such a request we have procedures for people to follow this up and can advise you accordingly.


A:  We are always cautious about answering questions about conditions for which there has been little research evidence. The one summary of trials on the use of acupuncture for glaucoma really does not say very much

http://www.ncbi.nlm.nih.gov/pubmed/23728656

A part of the problem here, as the author of the review says, is that the standard method of testing procedures in the West, the randomised double blind control trial, involves one group getting a real treatment and the other group getting a sham treatment, to test the difference in outcome. No physician, however, would leave a condition like glaucoma untreated because of the potential for serious sight loss, so until someone tests the effects of standard treatment against standard treatment plus acupuncture there will be nothing definitive to point to.

All of us have treated people with glaucoma, either as a primary condition or as a secondary condition after a patient has presented with another problem, and I'm sure all of us can report some success. As the author of the review says, blockages in the flow of energy which prevent the free flow of fluids sums up what glaucoma is, and it would seem intuitively possible that acupuncture would have an effect. This expert's experience, though, has been that it takes a long time to achieve sustained and sustainable results, and the medications remain a part of the picture throughout. What acupuncture seems to do well is to prevent uncontrollable variations in pressure, but there is no statistical evidence to which we can point.

We have searched the internet and found surprisingly little patient feedback about the treatment of glaucoma with acupuncture. Most of the official charities and organisations do not have a great deal of feedback from patients on their websites, and we have not been able to trace many forums of sufferers. That these exist is not in doubt; the internet has created thousands of forums across the globe. The best that we can say is that if you search, you will find quite a few, and our experience is that they tend to be  a great deal more measured than used to be the case. Where it used to be 'it works, oh no it doesn't' the entries now tend to reflect the wider range of outcomes and views.

We do not ourselves 'bank' feedback on specific conditions, primarily because we take the generalist view that we treat the person as much as or more than we treat the condition. However, our best advice as always is to go to see a BAcC member local to you for a brief face to face assessment. This will enable someone to see your problem not simply as it is but against the backdrop of your overall health. This will enable them to offer a much better view of what might be possible and also enrich any basic understanding of how your problem may have arisen from a Chinese medicine perspective.  

On this basis we would always recommend that someone should visit a local BAcC member to seek a face to face assessment and also to try to understand the problem in its overall context in the body, not just as a specific manifestation. This is how Chinese medicine works, treating people not conditions.

What we would say, however, is that occasionally you come across websites for people treating eye conditions, especially two clinics in the USA and one clinic in India, which claim amazing success rates for these kinds of conditions. Our view is that if something was that effective we would all be doing it, so there may be something unique to the character of these set-ups which is driving such spectacular improvements. We tend to agree with the last answer; success can take a while, is always relative, and often reduces the impact of the condition more than totally removing it.

However, acupuncture will certainly not do any harm, and may well do some good.

Q:  I have had a terrible experience. I had acupuncture  for a  neck problem and tingling sensation on my 4th and 5th finger..She put the needle in scm muscle.. After that I had an odd feeling  around my left ear like somebody pulling my ear down to my  collarbone and numbness in the back of my neck. After that I saw her and  was given a massage. but it hasnt gone.  For the past 10 days I  have felt like  I am in a prision. For  the numbness I went to a massage therapist which has made it worse .  I am dealing with a headache every day because of the stiffness.  

A: We are very sorry to hear of your problem. It is always very difficult to give a clear opinion without having sight of the problem itself. It is not unusual when treating people for a bad neck to find that for 24 - 48 hours after the treatment the problem can get a little worse. We, along with osteopaths and chiropractors, often counsel people that this may well happen so that they are prepared for a slight intensifying of symptoms. When this happens, though, invariably things then start to improve. It is most unusual for a treatment to cause a problem which continues for as long as the one you have has done.

The one possibility to consider is that the treatment may have caused a little subcutaneous bruising which is putting pressure on the cranial nerves and also on some of the muscles at the back of the neck. This might well cause some of the symptoms which you are experiencing. If this is the case then they will wear off within a week or so, and hopefully leave you with the overall improvement you were looking for.

We also have to alert to the possibility that the worsening of your problems might be a coincidence. This always sounds rather defensive but with close on 3 million treatments a year being given by our members there are bound to be occasions when something just happens at the same time as a treatment without necessarily being caused by it. The important thing to do is to establish what is going on rather than getting stuck into arguing about whether the acupuncture did or did not cause the problem to happen. In this situation it is important that you see your GP and get his or her advice about what is happening. This will undoubtedly lead to treatment options which will establish what caused the problem.

We often recommend that people keep the matter under discussion with their practitioner but recognise that sometimes people feel a little reluctant to have more treatment from someone who they feel has caused the problem. The reality is, though, that they are best placed to offer advice, knowing well what the initial presenting problem was as well as what they have done.

We can reassure you, however, that the number of cases in a year which result in anything serious happening are very few indeed, and we are confident that your symptoms will soon subside.

 

Q:  If I undertook training to be able to deliver ear acupuncture using the NADA protocol and then obtained NADA membership, would I be covered by my membership if anything went wrong?

A:This would depend entirely on the insurance arrangements in place. We have been searching the net for information about NADA-UK, but for reasons we do not quite understand their public website seems to have disappeared. We seem to recall that membership was only a matter of continuing competence and certification, and accountability together with an element of promotion, and did not include insurance.

Normally we would say that insurance is relatively straightforward. Most individual practitioners seem to get their insurance through the brokers Balens in Malvern who act for a master policy under Zurich. This is one of two main complementary medical insurers, the other being Royal Sun Alliance through whom we are insured. RSA don't deal with individuals as far as we know, and won't cover acupuncturists who do not belong to the BAcC. 

The confounding factor, though, on which you would have to seek advice is whether they would offer cover within the NHS. We suspect the answer may be 'yes' given the relatively safe nature of the intervention, but we would be a little cautious before saying this was certain. RSA, for example, won't cover any of our members who are practising GPs or working solely within the NHS. This has everything to do with the way that hospitals and surgeries deal with their own insurance and the fact that professional insurers might be an easier target than a health trust for what could be a very much wider range of potential claims. If Zurich won't pick up cover, be very careful of other offers. The cheaper the policy (and someone will always write cover) the greater the chance that the small print will apply.

If all else fails you would probably need to approach your practice heads or trust managers to get approval to offer your service within their overall offer. If, though, you are working independently of the NHS and can demonstrate this then it's probable that Zurich will pick up cover.

We are sure that NADA must have been asked this question thousands of times and almost certainly have a ready answer. 

 

Eight months pregnant and suffering back pain acupuncture has helped ...

Q: My son has kyphosis. He is due to see surgeons regarding  an op on his back, the pain he is in is terrible. He also suffers terrible pain in his ribs.  I am wondering if this is because he "stoops" over. He finds it difficult to work, although he has a part time job. He stays in most of the time because of the pain. Would  acupuncture help him either to get to his appointment or instead of surgery?

A: We are sorry to hear of your son's problems.

It would interesting to know whether the kyphosis was a congenital problem or whether something has happened throughout his life to make the problem develop, and where the main areas of 'bend' are. This would to some extent condition the advice we can offer.

Generally speaking, traditional acupuncture treatment is as much about treating the person as treating individual conditions on the simple but effective premise that a system in balance will maximise function across the body and help the body to repair itself. This is why we successfully treat a great many people with back and neck problems, not through manipulating the physical structure but through encouraging better and more correct function in the muscles which in turn pull the body back into shape. It may well be possible that treatment of this kind might benefit your son. There are also a great many ways of treating specific changes in structure by directly supporting the channels of energy which hold things in place, making good weaknesses which allow the shape to 'slip.'

There is also some hope that acupuncture might be able to address continuing pain. We invariably say that it is not a question of whether acupuncture treatment can treat pain as much as how much relief the treatment can give and how sustainable the relief is. This can sometimes, unfortunately, come down to finances. If treatment can buy a fortnight's relief and someone has deep pockets this might be a viable long term arrangement. Most of us are not so fortunate. After Nixon's visit to China in the 1970s made people in the West aware of the use of acupuncture for pain relief and anaesthesia there was a great deal of research which showed that treatment could have a tremendous effect, which is why some many pain clinics routinely offer acupuncture as a primary option.

We think that the best advice that we can give is to encourage your son to visit a BAcC member local to him for a brief face to face assessment of what might be possible. This will be a great deal more precise than anything we can offer here. He might also usefully consider cranial osteopathy as an alternative. This is a very gentle form of treatment which may be able to offer similar benefits.