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Ask an expert - general - Mystery aches and pains

9 questions

Q:  I have had chronic pain in the testicle and area of repair following a mesh repair of an inguinal hernia 4 years ago.  9 weeks ago I had the mesh removed and a neurectomy of the illioinguinal nerve, which was supposed to sort the problem out but has not. Would acupuncture help and if so is there any particular type that would be best. Can you recommend anyone in the Leigh on Sea area who would be appropriate.

A: A great deal depends on what may be causing the pain. We are assuming that the neurectomy was selected after a very thorough neurological examination; it is not common practice to start cutting nerves unless there is a very good and clearly diagnosed reason. On the assumption that this nerve corresponded to the area in which you were and still are experiencing pain, then there may be a small chance that acupuncture treatment may be of benefit.

Acupuncture treatment does have a general pain-relieving effect which has been the object of a great deal of study over the years, as our factsheet on chronic pain shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

The chemical markers for pain relief, the neurotransmitters, are easily measured to provide an objective marker of whether something is happening. The main question with treating at this kind of generic level is how much relief the treatment may give and how sustainable the relief is. In many cases this comes down, unfortunately, to a financial question: is the treatment affordable and worthwhile when the cost is set against the relief.

However, the understanding of the body as a system of energy in flow which underpins traditional Chinese medicine does afford other possibilities for consideration. Like any enclosed and self-contained system, if there is damage then where the flow is impaired pain will arise, either from a deficiency or excess of energy in the area, or through the stagnation in the flow. Using needles this flow can be reinstated, and the pain reduced or removed. Sometimes the very fact of surgical incision can create a blockage, as can the formation of scar tissue. This can sometimes have effects some distance away from the scar tissue itself. Treatment is often a mixture of local treatment and treatment some distance away, although we can reassure you immediately by saying that there are no acupuncture points on the testicle or scrotum! There are, however, points on the lower leg a which refer directly to this area, and these may come into play.

The best advice that we can give is to visit a BAcC member local to you for an informal assessment of what may be possible. Although we can be quite confident about the treatment of conditions which we often see it is far more difficult to offer opinions on unique presentations like yours. However, a skilled practitioner may well be able to make a few diagnostic soundings which can tell them how likely it will be to help your problem.   

Q:  My farther has had his leg amputated 4 years ago and still has very painful phantom pains, can this be treated with acupuncture?

A:  Phantom limb pain can be a very distressing phenomenon.

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:

http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97

Hecker H. -U et al (2008) Color Atlas of Acupuncture 2nd Ed. Thieme, Stuttgart

Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142

Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112

Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213

Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in 'conventional' Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

The best advice we can give, especially when there is so little case evidence to point to, is to visit a BAcC member local to your father for advice on his specific circumstances. There may be a number of initial soundings which he or she could make to determine whether treatment may be of benefit.

The problem with conditions like this is that there are case studies which offer encouragement, but nobody publishes the results of case studies where things don't work, so for the small number which have been successful there may be ten times as many where treatment was tried and failed. It is best not to over-excited by the fact that some treatments work. Everything works for someone, but that doesn't mean that somehing works for everyone.

Q:  I am writing with a query regarding my husband. He had a vasectomy in August and unfortunately, due to complications during the procedure,  has suffered a trapped nerve on one side which is still painful at certain times. He has been referred to a consultant and been told there is no corrective procedure for this and he would just have to make use of long term pain relief, but he does not want to take long term medication. We are wondering if acupuncture would be able to relieve the pain from this trapped nerve and, if so, what would be involved?

Treatment would involve either needles and moxibustion, the use of a burning Chinese herb, and your husband can rest assured that needles do not have to ber applied locally to achieve an effect, or no-one would ever seek help with haemorrhoids ever again. The majority of points used in early sessions lie on the lower arm and lower leg, with a number of more powerful ones on the trunk and back.

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

shows. Indeed, much of the early research into acupuncture in the West was focused on this area after seeing some of the film of operations in the East performed under acupuncture and demonstrations of dramatic reductions in pain that people appeared to experience from a few needles. Of course, the main western preoccupation was to make sense of this in terms of neurotransmitter chemicals or natural painkillers like endorphins and enkephalins, rather than understanding it as a reinstatement of the proper flow of energy, or 'qi' in an area, but we were grateful anyway to see acupuncture being taken more seriously.

A great deal depends on how your husband's nerve is trapped. If there is impingement of the nerve a great deal depends on whether there is post-operative inflammation in the surrounding tissue which treatment may be able to help to reduce, thus breaking the cycle of pain, or whether the operation has simply caused the nerve to be jammed between physical structures where change is less likely. There is no doubt that acupuncture treatment may well be able to achieve some pain relief, and the main issue is usually how much and how sustainable that change is.

Usually there is no way of predicting how someone will respond in circumstances like this, and most practitioners will probably say that the best way is to have a couple of sessions to allow them to assess the viability of treatment, based both on feedback from the patient and from signs and symptoms which they themselves interpret. In any event there should be some reaction within three to four sessions, and a responsible practitioner will draw a line in the sand then if the patient is not making progress, however pleasant the actual experience of treatment may be.

The best advice we can give is that you visit a BAcC member local to you and seek a face to face assessment of whether they think acupuncture treatment may be beneficial. There are a number of ways in which they cam make this assessment and we are confident that they will give you an honest view.

A:  If you use the power of google to see whether acupuncture can help with anosmia you may find a number of references but they will all lead back to a single paper:
 
http://aim.bmj.com/content/21/4/153.full.pdf+html
 
which is an N=1 case study, i.e. a practitioner writing up a note of treating a single patient, and very successfully too. However, that is all that there is, although there are a number of Chinese studies which have not been translated which appear to suggest that something can be done.
 
We would be very reluctant to give a positive recommendation on this basis alone, however. Evidence has to be a great deal more robust even from an Eastern perspective which is not bound by the so called 'gold standard' of the randomised double blind control trial before we would start to make claims for success.
 
The one thing which may have a bearing on your problem and which we cannot assess at a distance is the virus. Chinese medicine has an entirely different way of assessing viral infections, based as it is on an entirely different understanding of the physiology of the body. This rests on a fundamental belief on an energy called 'qi' whose flow, balance and rhythms are essential for good health and which can be compromised by all sorts of external and internal factors which manifest as disease. The skill of the practitioner lies in seeing what has happened and correcting it. There may an underlying connection between the virus you had and the olfactory function, and a practitioner may just believe that correcting blockages and flow may help. It may be worth visiting a BAcC member local to you for a face to face assessment.
 
However, our experience of trying to treat this condition has not been that good that we would regard acupuncture as first choice for its treatment.
 
 
 
 

Q:  My first visit for acupuncture was nearly 2 weeks ago. I wanted to try it for my hot flushes, itching skin(due to a medication I am on) and arthritis. Unfortunately that evening I realized I had a heavy ache in the whole length of my left arm. I can use the arm as usual but I am aware of the dull ache, at nightime it seems to trouble me so much more and I have to take painkillers or use ibroprufen gel.

On my 2nd visit 3 days ago the acupuncturist was obviously concerned that I was still suffering this ache, I did not have needles on that occasion in the arm, but she tried massage etc all to no avail. She said she had never heard of anybody having this ache for this long before.

I did have a fracture of the wrist on this arm before, but this was about 9 years ago; no pins or anything so she presumed it was nothing to do with this.

I would be glad if you could be of any help as this ache is now causing me sleepness nights, (it wakes me when the medication has worn off).

A: This is a most unusual outcome. There are a number of rare short term adverse effects associated with treatment, but most disappear after 24 to 48 hours. There are also a number of normal treatment effects, and a dull aching sensation where the needle has been inserted is relatively frequent, but this again disappears within minutes of treatment, although occasionally lasting a little longer.
 
The only thing we can think may have happened is that there has been a slight bruise created by the treatment adjacent to a nerve, and the impingement is causing the sensation you are experiencing. In any event we think that it would be best to visit your GP and ask for a neurological assessment to see whether there is a specific nerve which is being affected.
 
We also need to emphasise that all of our practitioners are fully insured so that if this problem continues and is a direct result of treatment you would be entitled to make a claim for any disturbance or distress this may have caused.
 
However, we hope that it proves to be a consequence of minor bruising within the underlying tissue, and in our experience where this kind of problem does occur it does resolve within a week or two, gradually diminishing in intensity and discomfort. We are sorry that you have had this happen, and hope that it does not deter you from having further treatment. 
 

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