Q. I had a shoulder replacement (just the ball of the joint) done one year ago. It has remained extremely painful, and I am unable to move my upper arm more than 30 degrees without pain. My surgeon says that I fall into the 5% of cases where there is no clear cause that can be rectified, and that I should consider having a full shoulder replacement. However I am reluctant to do this as there is a 30% chance of it failing within 10 years, and then there is very little they can do, as the bone around the socket will be too weak to take a further replacement. I am 62 and hope to have at least 20 year's active life ahead of me, if not more. Otherwise, I am healthy and fit.
Would acupuncture help with pain relief in this instance?
A. We have to be a little cautious about answers to questions about pain per se rather than named conditions in which pain is present. As you are probably aware healthcare professionals of all persuasions are governed by strict rules of what counts as good evidence in advertisng and marketing, and there is no specific evidence on which we could base an unqualified positive answer. However, much of the research into acupuncture in the early days was about its capacity to reduce pain, and the results, both on humans and animals, meant that it has continued to remain a worthy focus of attention for at least forty years.
From an eastern medical perspective pain and inflammation are usually described in terms of blockage or stagnation of energy, and the practitioner's task is simply to try to move the energy with needles and in some cases moxibustion to try to improve the flow. There are certainly a number of protocols used to free frozen shoulders which may have an impact on what you are dealing with, but in general the strategy is often the same as that used by western professionals in conventional healthcare, breaking the cycle of restriction, inflammation and pain which perpetuates itself. In your specific case there may also be issues with the way that the muscles are functioning around the new joint; the shoulder joint is much more heavily dependent on an exact balance of muscle than the more pronounced ball and socket of the hip, and it often takes an extended period of exercise and physiotherapy to regain full movement.
In Chinese medicine each case is regarded as unique, and a practitioner will always want to see the overall picture before making any projections about how effective treatment may be. Your best course of action would be to consult a BAcC member local to you to let them take a look at the problem to see whether in your case there is something which acupuncture might do. We are sure that if they feel that acupuncture would not be the best option they will have other positive suggestions about other forms of treatment that may be of benefit to you.
What counts as a good outcome may need to be carefully defined. For most people the outcome is fairly clear - 'I want the pain gone' - but in some cases it is a case of pain management, and the judgement has to be whether the extent and sustainability of relief after treatment warrants the time and expense. Regular reviews of what is happening are essential to ensure that everyone is clear about and happy with continuing treatment.