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Q:  My sister has a long standing back injury, she fell on a concrete surface and injured her lower back in 1997. She has been in tremendous pain over the years, chiropractors, physios, pain killers the lot. Recently someone advised acupuncture, and we all recommended she go. After this length of time she'd try anything for relief. The acupuncturist told her she needed at least 6 sessions, then they could decide further. My sister managed 3 sessions. All 3 were very painful, and the pain lasted for days mostly at the points where the needles were inserted, mostly her left shoulder. After the last session, she was very dizzy, lightheaded, started experiencing blackouts and fainting, unable to stand, unable to get up and down stairs we took her into hospital because she'd hurt herself when she fainted. Her MRI is clear, 2nd one also clear. All results clear. They are now focussing on getting her mobile, saying its like her brain has forgotten the function of her legs and that is  why she isn't walking. My sister has a 5 year  and has now been in hospital a week. Any advice  would be greatly appreciated.

A:   This is certainly a very strange outcome after acupuncture treatment. Generally speaking, acupuncture is an extremely safe treatment, and such few adverse effects as there are tend to be short-term and transient. Of course, one can never rule out a causal connection, but at this stage what really matters is finding a solution to your sister's problems.

The practitioner has certainly taken an approach we favour, which is to set a target of four to six sessions and then review progress. The placing of needles in the shoulder is something on which we could not comment without detailed access to the notes. Chinese medicine treats the person as much as it treats the condition, so needles are inserted where they need to be for achieving balance across the whole system, and this may be far away from the site of the problem. Even symptomatic treatments can be a long way from the problem; a standard first-aid point for frozen shoulder is on the shin.

What would interest us most is the fact that the treatment itself was painful. We are assuming that your sister made her feelings known to the practitioner about how painful it was. In this situation a responsible and caring practitioner will inevitably look to use even shallower needle insertion with less 'action' on the needle (less needle rotation), and in some cases to move to other areas of the body where the patient experiences less pain. We find quite often that with backs in spasm treating directly in the area of the pain can appear to aggravate the sensations, and we often work at a distance, making use of the channel connections to affect the painful area.

On the assumption that the practitioner did respond positively to your sister's distress, it may simply be that acupuncture is not the best treatment for your sister. We have come across a handful of patients in our time who are too sensitive for needles and for whom treatment is a form of torture, even when they are committed to it and really want it to work. If this is the case, it may also rule out some of the hands-on therapies which may also feel highly uncomfortable.

We still believe that acupuncture may have a role to play in helping your sister, although we would not be surprised if she decided that this was a bad option. If she does go ahead, it will be important to establish with the practitioner that the treatment has to be extremely gentle and involve as few needles as possible. If the practitioner will not agree to this, find another practitioner. Other than that, we wonder whether cranial osteopathy might offer a possibility. This is an extremely gentle form of treatment with profound effects, and a growing number of osteopaths now offer this as their primary technique. If the problem may be more neurological, and on the assumption there is no actual physical damage to her system, there may be some mileage in looking at hypnotherapy as an option. This is a highly problematic area, though; there is no statutory regulation of hypnotherapy, and the range of training levels for people to be able to call themselves hypnotherapists is vast. At one end you have degree level practitioners, especially those using Ericksonian hypnotherapy in which this expert has great faith, and there are weekend trained 'look into my eyes' people whose standards may not be as good. However, where learned patterns are forgotten, this is something to bear in mind.

We hope that your sister does improve and hope that she is able to try acupuncture again on the basis we have suggested. If not, we hope that the two pointers we have given may be useful.  

Q:  I am an acupuncturist & possibly moving to Bali. Just wondered if you know what the rules are re practising there ... Or who could I contact to find out how you can practice while I'm there ...?

A:  Well, to be honest we were a bit stumped and started doing the same sorts of internet searches which you have probably already done, and found the following information (in rotten English!) about the history of acupuncture regulation in Indonesia  

http://www.wfas.org.cn/en/show.asp?men=10&liststate=0&id=1925&Position=members%20%3E

http://translate.google.co.uk/translate?hl=en&sl=id&u=http://www.infokursus.net/ormit/ormitdetil.php%3Fid%3D19&prev=search

Then, of course, we did what we should have done from the off to see if any existing BAcC Oversease members are working there, and amazingly Day Post, who used to be involved with the BAcC Research Committee is working in Bali. His details, which we took from the BAcC website are

Address:

Jalan Sri Rama 63

Villa 3

Legian, Seminyak

Bali

80118

Indonesia

Mobile:

+62 822 91183911

Email:

This email address is being protected from spambots. You need JavaScript enabled to view it.

Website:

www.acupost.com

and we are absolutely sure that he would be delighted to fill you in on the background to working there. The fact that he is means that our own level of qualification more than meets the requirement for registration, as far as one can be certain from the documentation above.

We are just the tiniest bit envious of someone thinking of working in such a beautiful location, and if you do decide to move, we hope it is as good as it sounds like it could be.

Q: I have had urticaria for almost 2 years now and I have been on antihistamines for a year. Traditional medicine does not offer any solution in my case - none of the doctors can establish what causes it and no one knows how to get rid of it. My only hope at the moment is alternative medicine and I have heard that acupuncture could offer a solution. Do you have any record of it helping with my condition ?

A:   We were asked about the treatment of urticaria with acupuncture a little while ago, and our response then was:

Can acupuncture treat urticaria with any level of success?

Success is a very loaded word in the context of what one can now claim in marketing and advertising. The standard of proof in all healthcare advertising is the randomised, double blind control trial, the model most often used for testing drugs, and it has to be said that it is not very well suited to assessing whether acupuncture 'works' or not. Reducing variables is the last thing a practitioner would try to do in Chinese medicine; understanding and interpreting their variations is integral to the way that the system works. Hence a paper such as this one from 1998
 
http://www.ncbi.nlm.nih.gov/pubmed/9828874
 
is a great example of the problems we face when asked questions such as this. The manifestations of urticaria, understood in Chinese medicine terms as a description of the specific symptoms, have always been around and like any complete system of medicine, Chinese acupuncture has ways of understanding how the heat and swelling develop, and within the system has developed clear protocols to deal with the problem.
 
However, as the paper acknowledges, getting precise enough definitions if urticaria itself to assemble a trial is a problem, as indeed would be the next stage, ensuring that the test and control groups had the same western and eastern conditions to guarantee objectivity. However, when one takes into account that in Chinese medicine the person with the disease is as important, if not more so, than the disease which the person has, it becomes rather difficult to talk meaningfully of treating a named condition.
 
That said, there are papers which examine the presentations and treatments of urticaria such as this one
 
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3276885/
 
where there is a very positive reference (60) to a paper which on the surface appears to meet the criteria for inclusion in a growing body of good evidence.
 
We prefer to hold to the view that each patient is individual, and that it is the unique assessment of their energy by a skilled practitioner which is the best judgement of whether treatment may be beneficial. It is true that many patients present themselves for treatment with urticaria-like symptoms, and anecdotally we here of success in both acute and chronic cases. However, if you wanted to establish whether acupuncture treatment was a good option for yourself or someone on whose behalf you are asking, then a brief face to face assessment by a BAcC member local to you is your best way of establishing this. 
 

We think that this still represents the best advice we can give. Anecdotally we have all had some very positive experiences of treating people with urticaria. Of all the skin conditions this appears to be the most amenable to acupuncture. For many other conditions, like psoriasis or eczema, we have often recommended the use of Chinese herbal medicine alongside acupuncture treatment. There are a considerable number of BAcC members who are also members of the Register of Chinese Herbal Medicine, and there may be some advantage on seeing someone who uses both, although as we have said, you may well find that acupuncture treatment by itself can offer a solution.

If you do go ahead, it is very important to set measurable outcomes and to ensure that your review the treatment at regular intervals. It is quite easy to run up a large bill in pursuit of success without realising, and the responsible practitioner will always check on a regular basis that there are enough signs of improvement to warrant carrying on. 

 

Q: My daughter is in Anerqerque where her little boy with cerebral palsy is being treated with scalp acupuncture by Dr Jaso Hao. Daniel is 3 yrs 5months old. Intensive physio both on and off horses has had a monumental effect in getting him to walk, albeit still unsteady.However, after only 3 sessions of treatment with Dr Hao he is walking with confidence and speed. I have seen the video she sent me and it phenominal what this has done for him. Her story may of great interest to you. We need this here in the UK

A:  Many thanks for getting in touch with us about your grandson. We are very heartened to hear of his progress.

We have been aware of Dr Hao for some time since the publication of his book by Blue Poppy Press in the States, and also of Dr Yamamoto and his system of scalp acupuncture. This is fairly cutting edge material; although it has its roots in the classical traditions it is a modern development. This means that at the moment it does not form a part of the mainstream training in Chinese medicine, and slightly more problematically for us, does not yet have recognised training standards which have been accredited. When something is being offered, often as a last resort for people with desperate needs, it is crucial that there are some forms of standard and accepted evidence to support the claims which practitioners make and to underpin any training they offer.

That said, we note with interest that a number of UK practitioners have undertaken postgraduate work in scalp acupuncture and are quite quickly and easily traced. When stories such as your about your grandson start to circulate it will be relatively straightforward for prospective patients to track down a local practitioner.

We hope that your grandson continues to improve and that his success is an inspiration to others.    

 

Q: Nearly 6 years ago I had a cancerous tumour removed from my mouth , following the successful operation I then had radiotherapy treatment. In a nutshell since the operation I have been suffering with chronic pain in my mouth which makes life unbearable I am taking up to 16 strong painkillers everyday.  My surgeon referred me to A  pain relief specialist,  but the tablets he prescribed me sent me crazy.   Someone has mentioned today I should consider acupuncture.  I would be greatly obliged if you could give your thoughts and if you have had previous success with acupuncture treatment for this problem

A:  There is no doubt that acupuncture has been used successfully in treating some of the consequences of radiotherapy treatment in the mouth. Most notably we were asked not long ago about a condition called xerostomia (dry mouth) which is quite common after radiotherapy in the area, and our answer was:

We were asked this question once in relation to xerostomia induced by radiotherapy, and our answer was, taken from our factsheet on palliative care and further supplemented:

Dry mouth (xerostomia)

A systematic review found possible benefits with acupuncture for radiotherapy-induced xerostomia (O'Sullivan 2010). Not all the inter-group differences were significant but this is typical in trials comparing acupuncture with sham acupuncture, for the latter is commonly viewed as being an active treatment itself, not a placebo, and hence may underestimate the effects of the therapy (Lundeberg 2011; Sherman 2009; Paterson 2005).The RCTs to date are few in number and small in size. Although they have produced encouraging results, and are supported by observational studies (for example, Meidell 2009), larger trials are required to achieve more robust evidence. Acupuncture may also help with xerostomia dysphagia (swallowing difficulty) in late-stage palliative care (Filshie 2003).

There is some evidence for the value of acupuncture treatment for dry mouth after radiotherapy, and the two studies below certainly seem very positive.
 
http://www.ncbi.nlm.nih.gov/pubmed/23104718
 
http://www.ncbi.nlm.nih.gov/pubmed/22072272
 
Clearly there is a considerable difference between the kinds of functional disturbances caused by disruption of the balance of the body's energies through normal wear and tear and the kinds of damaged brought on by injury or accident. This does mean that it is more difficult to predict whether acupuncture treatment might be of benefit. Treatment of the kind used in the studies tends to be localised or precisely targeted, and this can mean that it does not really conform to the patterns of treatment which a Chinese medicine practitioner would employ. In broad terms, however, acupuncture treatment is aimed at putting the whole system back in balance with the underlying belief that a body in balance tends to deal with symptoms itsef, and on this basis it may well be worth talking to a BAcC member local to you to see if a combination of systemic and local treatment may, in their view, be of benefit. Most BAcC members are more than happy to give up a little time without charge to give a face to face assessment of whether treatment would help.
 

There is a chance, of course, that the xerostomia which you are asking about is not related to cancer treatment. From a Chinese medicine perspective this makes no difference. The understanding of the mechanics of the disruption of the physiology of salivation from within the Chinese medicine paradigm will be the same whatever the cause, although the cause, again seen from this perspective, may have a considerable impact on the treatment. By this we mean that radiotherapy might be seen as a cause of great heat and dryness within the system as a whole or locally, and this would almost certainly feed into the treatment strategy.
 
As we said above, speaking to a BAcC member local to you who can assess the problem face to face may well be the best option for you before committing to treatment.  

The reason we quote this at length, although it is not the identical problem to that from which you suffer, is that if we start to trawl research databases for the treatment of specific problems, we always run up against the problem that the treatment offered is rarely good quality traditional acupuncture and most often uses a very reduced palette to meet the dictates of the trial design which seeks to reduce the number of variables. The huge strength of Chinese medicine is that it treats the person, not simply the condition, and the this is even reflected in the wisdom of the great Canadian physician William Osler who said 'it is more important to find out about the person who has the disease than the disease the person has.'

The confounding factor in your case is that six years of powerful medication are going to have generated secondary problems which someone will have to take into account, and therefore any assessment of what may be possible will have to look at this as a part of the overall picture. We are sure that if you contact a BAcC member local to you they will be only too happy to spare some time to discuss whether acupuncture treatment is a good option.

We have to say, though, that when we researched the treatment of another cancer recently we were very pleasantly surprised at the number of recent studies which show that acupuncture is used increasingly often for palliative care and for the reduction of post-treatment pain, a pattern which seems to be reflected across a number of different areas. Radiotherapy is a necessary but brutal treatment which causes massive disturbance of the energies of the body, and there is a growing body of evidence which suggests that acupuncture treatment, even some time after the treatment, can have a significant impact in restoring proper flow. Hopefully you will find that there is still good reason to hope for improvement even after this length of time.

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