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Ask an expert - body - cancer

13 questions

Q:  We have a family friend who is suffering from severe pain in his knees as a result of advanced cancer. The hosiptal has stopped treatment as there is
nothing they can do as a result he is just on medication from the local GP to reduce the pain, which  doesn't seem to be that effective. Would acupuncture be
something that could help, block / reduce this pain?

A:  Acupuncture for the treatment of chronic pain has a long history, and also some reasonably good evidence of success, as our factsheet shows http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html  After Nixon's visit to China in the 1970s a great deal of
research was done into acupuncture and pain control after the sight of people having surgery without anasethetic. The measurements of the neurotransmitters
involved in normal pain relief are easily measured, and this fitted well with the standard research models. Much of the evidence showed that acupuncture
treatment in addition to conventional treatment had a significant impact.

From a Chinese medicine point of view, pain arises from the blockage or weakness in the flow of energy, or 'qi' as it is called. The skill of the practitioner lies in knowing precisely why the blockages or weaknesses are occurring, and treating to ensure that the problem is addressed at source. If the local problem has a systemic source, then treatment needs to be addressed at the system as a whole, which is why a similar pain in twenty patients can be treated in twenty different ways according to their individual
needs.

As far as your family friend's case is concerned, we are confident that acupuncture treatment would have some effect, and our main concern would be exactly how much effect and how sustainable that effect is. All forms of acupuncture, both traditional and western medical, would expect to be able to provide temporary relief, but it would then be a balance between the extent and duration of the effect and the cost of achieving it. Acupuncture treatment would certainly do no harm, and since we treat the person as much as the pain itself there may even be some secondary benefits to the system as a whole.

The best advice we can give, and which we do almost every time, is that a visit to a BAcC member local to you will undoubtedly give you/them a much better indication of what may be possible. What we do not know, and which limits our comments, is the kind of cancer from which he is suffering and how much the pain is a reflection of metastases in the area. If the cancer lies in the bone itself that may have a significant impact on the efficacy of treatment, and may also restrict to a degree where needles can be placed. A skilled practitioner will be able to give you a much better assessment by looking at what is happening, and by asking a few more direct questions.

Q: I am trying to find an acupuncturist familiar with treating chemo induced peripheral neuropathy.

A:  We are happy to say that almost all of our members are likely to be familiar with treating the effects of chemotherapy, so prevalent is the treatment and so survivable many of the conditions for which it is the primary treatment option. If you enter the terms 'ncbi acupuncture chemotherapy induced neuropathy' in google , you will generate a number of results which show studies supporting the use of acupuncture treatment in helping this problem. Most of the studies conclude that further and better studies are necessary, but the general tone is one of encouragement.

From a Chinese medicine perspective, of course, neuropathy is understood rather differently and treated not simply as a result of the effects of chemical damage but as this against the backdrop of the patient's health. This is one of the greatest strengths of traditional acupuncture, that it aims to understand the presentation of symptoms in each individual patient rather than simply applying a general formula treatment. All of our members are trained in this approach, and our growing popularity over the years is testament to how well this approach works.

As far as finding a practitioner is concerned, using the practitioner search function on our home page will generate a number of people within easy reach. We typed 'Beckenham' in the search function and were given six options within a short walk from the town centre. You also have a greater number of options in nearby boroughs or at the end of the train line  - we have nearly 600 members working within Greater London. 

Q: Could you please give me details of acupuncturists practicing in Central London who have experience in treating cancer patients. My husband has throat cancer and is receiving radiotherapy. i would very much like him to be treated for pain relief by an acupuncturist.

A:  Our stock response to these sorts of requests is that as well-trained generalists working within a Chinese medicine tradition which treats the patient, not the condition, any of our members should be able to offer you the same exemplary standards of care and treatment. The only areas where we have spent time investigating standards for expert practice are obstetrics, paediatrics and mental health issues. In all three there is a strong argument for recognising the additional training which members undertake, often in conventional medicine but also drawing on the experience of practitioners who have made these areas their entire practice focus for twenty years or more.

However, our own view is that the treatment of patients during cancer treatment is a strong candidate for the next round of expert practice investigations. Our experience in working with chemotherapy and radiotherapy patients is that both treatments have a substantial number of energetic as well as physical effects, and treating the person constitutionally is not always sufficient to offer the greatest benefit, good but not necessarily optimal.

Our hands are tied a little insofar as we cannot recommend individual practitioners, even though we know of several members who work within major cancer care establishments. Our advice to you would be to contact some of the more well-known treatment centres like the Royal Marsden or UCH and see if they offer acupuncture services within their brief and if so whether your husband can attend any of the clinics which they offer. If not, they may be able to recommend acupuncturists with whom they are associated.

Some of the leading experts in the field are not BAcC members but medical acupuncturists, but we are aware from their publications over the years that their expertise is considerable, and as we intimated above, traditional treatment may not always be sufficient in itself for dealing with the after-effects of radiotherapy. Chemotherapy is more commonplace, and most members will have a least a handful of patients at any one time following chemo regimes. Radiotherapy is less common.

Whichever route you follow, we would advise you to be a little cautious. There are a number of acupuncture facilities in the private cancer care field which offer acupuncture but there is no way online to check the bona fides of the practitioners. we believe that for your husband's optimal care you need to be looking at a properly trained traditional acupuncturist or a practitioner with several years of demonstrable experience working in this sector.  

Q: I'm wondering if acupuncture with eg Allegra Wynt, Oxford who is experienced with cancer patients, could help with peripheral neuropathy in hands and feet: side effects from my chemotherapy (incl Cisplatin). This finished in January, but side effects persist. May disappear within  6 months. Can acupuncture help? Would it interfere with ongoing Herceptin (I/V) 3 weekly, which will hopefully keep cancer cells at bay ? Don't want to jeopardise my treatment. I have cancer of unknown primary (? upper GI tract) with secondary in lymphatic system. Chemo is successful.

A:  We have been asked a number of times about peripheral neuropathy, but this has mainly been where the problem has arisen of its own accord or where it forms part of a broader medical condition like diabetes or Charcot Marie Tooth disease. Clearly this places limitations on the potential outcome, since these conditions are not usually reversible, and the practitioner is usually limited to 'things getting worse slower'.

However, there is a growing body of evidence which suggests that acupuncture can be very effective in helping to reduce the severity of peripheral neuropathy (PN) induced by chemotherapy and to speed up the rate of recovery. If you search on google using the terms ' ncbi acupuncture neuropathy chemotherapy' you will access a major American research database gathering studies from all of the established online collections like PubMed and Medline. The first half dozen results point to a number of recent studies which show very encouraging results, but most of which conclude that a much larger study is warranted before any definite conclusions can be reached. This is not uncommon; research funding for acupuncture is not that freely available in the West, and Chinese studies are often regarded as methodologically unreliable. There is certainly enough to say that acupuncture treatment will probably help.

As for interfering with your current treatment, there is no evidence of any kind that acupuncture treatment can interfere with the function of medications which people are prescribed for cancer treatment. Indeed, there is no evidence from outside the acupuncture profession that treatment can interfere with any drug regimes, although we are understandably careful where we use points which are said in Chinese medicine to affect the blood flow, blood pressure and the like when someone is on medication to try to achieve the same result. Our usual response, however, is that the treatments are apples and oranges, two entirely different ways of treating the person which do not interfere with each other. There are even advantages to acupuncture treatment alongside western medication routines where unwanted side effects, like PN or nausea, can make a patient's life difficult, and treatment can make the regimen more bearable.

We tend to avoid comment on individual practitioners, but we are happy to say that Allegra is a vastly experienced practitioner, and you could not wish to be in safer or more experienced hands.

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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