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Ask an expert - body - cancer

9 questions

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.

Q:  Can acupuncture be used to treat cancer of the pancreas? If not, are there any other alternative remedies which would help?

A: We have to be as careful as we can in answering questions like these. Our view of traditional acupuncture is that it treats the person, not the named condition, and this has been the basis on which it has been practised for over 2000 years. This means that we believe that treating the system as a whole corrects imbalances in the system which generate symptoms, and successful treatment can reverse symptoms.

However, and this is a really big however, it is really easy for people to mis-hear this as a claim to treat anything and everything, and the word 'treat' is then misunderstood as 'cure', in the way that a doctor might say that he can treat headaches, i.e. you hear 'can help to get rid of them.' Cancers are not usually thought of as treatable by acupuncture practitioners in this sense. Once the system has gone this far into disrepair, there is not much that any practitioner can offer except some relief from the worst symptoms and also some help in dealing with the side-effects of the medications on which people become more reliant as the disease progresses.

As you are probably well aware, pancreatic cancer is one of the less treatable cancers within conventional medicine, and the most that doctors will offer is the possibility of slowing down the progress of the disease and dealing with symptom relief. To that extent we would say that our experience of acupuncture treatment as a part of this process of relief has been good, and that the control of symptoms in the palliative care stage has helped many patients lead a generally less pained life. 

There have been a number of studies published in the last two or three years which offer some support for the use of acupuncture treatment. Three such are:

http://www.ncbi.nlm.nih.gov/pubmed/24280575

http://www.ncbi.nlm.nih.gov/pubmed/20683216

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3734160/

and there are a number of other studies about the use of acupuncture in palliative care

http://www.ncbi.nlm.nih.gov/pubmed/24338183

http://www.ncbi.nlm.nih.gov/pubmed/23868190

which also offer encouragement for experimenting with treatment.

You will find that many of the other complementary therapies to which people turn, like herbal medicine or homeopathy, take the same stance, steering well away from any misunderstanding about possible cure and focusing instead on the control of symptoms and pain reduction. Our view is that as with all forms of complementary medicine it is worth trying a variety, perhaps one at a time, to see which seems to have the greatest effect on you, or which combination seems to work best.

This is an area where you need to exercise great caution. Anyone who makes excessive promises for what might be possible needs to be avoided, in our view. If you visit a BAcC member local to you for a brief face to face assessment we are confident that they will be able to give you an honest and realistic assessment of what may be possible. 

Q:] I have peripherial neuropathy in hands and feet for almost a year caused by chemotherapy for breast cancer. I also have lymphodema in my arm. How many acupuncture treatments before I should notice benefit or when should I consider stopping. Is  it safe to have acupuncture in lymphodema arm?

A:  The first question is difficult to answer, and is usually described as a 'how long is a piece of string' question. Our usual recommendation to patients in giving answers here is to review progress every four or five sessions, and to try to establish clear and measurable outcomes so that there is some objective evidence of whether the treatment is taking effect. We are really concerned that our colleagues avoid situations developing where a treatment 'habit' can run to fifteen or twenty sessions without discernible change - it's just very easy to book week after week with no sense of time passing. This tends to lead to discontent and occasionally complaints.
 
In this expert's view, there has to be some evidence of progress, however limited, after the first five sessions to have a good sense that it's worth continuing. This need not necessarily be in the main symptom; in Chinese medicine we treat the person, not the condition, and there can sometimes be good evidence from other systems of beneficial change which means the main problem will also be likely to move. This does not always mean drawing a line, but it does mean that if someone does decide to carry on it is with clear understanding of what is happening.
 
As far as needling a lymphoedematous arm is concerned, our current recommendation to members is that this is not to be done. Although there is little or no evidence to support the almost universal prohibition of acupuncture by consultants, we have to acknowledge that there is an increased risk of cellulitis and other infection from needling a limb below where lymph nodes have been removed. However, there are many ways of using the interconnections within the system as a whole to treat successfully at a distance within the body, and a qualified practitioner will have many ways at their disposal to effect change and improvement.
 
Indeed, one of our members, Beverley de Valois, has published several landmark papers in this area
 
http://www.researchgate.net/profile/Beverley_De_Valois/publications
 
and has shown that treating constitutionally without needling an affected limb can be very beneficial. 
 

Q:  My husband has had chemo and radiotherapy to treat throat cancer. Treatment finished 12 weeks ago and he is suffering with severe pain in his throat following the radiotherapy. Can acupuncture help?

A:  This is a very difficult question to answer. While acupuncture has always been used for pain relief, as our factsheet shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html
 
there is a considerable difference between a chronic back pain or chronic headache and the sorts of tissue damage which radiotherapy can create. We do have a factsheet on postoperative pain,
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/post-operative-pain.html
 
but this does not have anything specific to say about radiotherapy.
 
As far as other research is concerned, there is a systematic review
 
http://www.ncbi.nlm.nih.gov/pubmed/23341529
 
which summarises the results from all studies in this area, and seems to show a number of potential positive outcomes. These reviews will always conclude, however, that 'more work needs to be done' because the sample sizes are usually too small to generalise from - acupuncture research is not high on the agenda of mainstream medicine. There are a number of encouraging studies for the treatment of xerostomoa (dry mouth) resulting from radiotherapy in throat cancer, and insofar as these point to a return to normal function, there may be some hope that acupuncture might work with servere pain in the same area.
 
Each case is individual, however, and we would recommend that your husband would be best advised to visit a BAcC member local to you (you can find one by using the search function on our home page) and see if they will offer a face to face assessment of what may be possible. Most practitioners, if they took on a patient with a problem such as yours, would set some fairly tight review periods to make sure that treatment did not continue if there were no tangible benefit; it is very easy for the patient to want to keep going when there has been no discernible improvement.
 
We hope that your husband does find a way to reduce the pain. We know from our own experience of treating similar cases just how debilitating it can be.  
 

Q:  Can acupuncture help pain caused by scar adhesions resulting from raditation treatment for cancer? Is there any suggestion that after the lymp nodes have been removed that acupuncture treatment should not be done?

A:  Acupuncture has a considerable history of use for pain relief, as our factsheet shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html
 
The treatment of pain, and trying to understand the relationship between eastern treatment and western recognised effects in terms of endorphins and enkephalins, was one of the most commonly researched areas of acupuncture treatment, especially because the measurement of chemicals gives nice crisp data. 
 
However, as with any pain relief, the question is never as simple as 'does it work?' but is usually 'how much does it work and for how long?' In the case of scarring and adhesions inside the body we have no evidence to which we can point. Scarring on the surface of the body can occasionally block or prevent the free flow of energy in the channels, and there is some anecdotal evidence that treating local blockages caused by scarring can have considerable impact. However, although the same must apply to a degree internally, we have no anecdotal accounts to draw on. Indeed, it is fair to say that physical damage and irreversible change are just as much an impediment to health in eastern as in western medicine.
 
One could argue that the essential premise of Chinese medicine, that in restoring the balance of the whole system recovery of all kinds becomes improved, may have some impact, and there are certaonly styles of acupuncture premised entirely on restoring balance, treating the patient and not the condition, which can have profound results. We think that in this case this would be a very long shot. Most of the best results we have heard of involve a variety of physical therapies aimed at stretching out or releasing the adhesions and freeing up the internal tissues the movement of which they restrict.
 
The treatment of someone whose lymph nodes have been removed has been the subject of great discussion in the profession for years. Although acupuncture is routinely used in China for the accumulation of fluids, called lymphoedema, which can happen after lymph nodes have been removed, in this country the position is that people are told not to have acupuncture treatment in the affected limb because of the increased risk of infection, especially cellulitis. The advice we give to members is to take care not to needle the affected area, and to use alternative point combinations to achieve the desired aims. However, if treatment of the affected limb is avoided, acupuncture treatment performed according to the proper guidelines is perfectly safe.
 

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