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Q:  I have suffered from pudendal neuralgia for 2 years. I would like to know if acunpuncture can be used to treat this condition? Also, details of practices that can treat this condition. I live in Newcastle-upon-Tyne

A:  Pudendal nerve problems can be a source of immense discomfort and can often lead to severe depression, especially if entrapment of the nerve not only causes the neuralgia but also affects functions in the lower abdomen.

We would first want to ask a great many questions about what brought the problem on, or if there was no obvious cause what was happening at the time of onset. We would also probably want to know whether the onset was sudden or gradual, whether you had found anything which seemed to relieve the problem, and what tended to exacerbate it. These questions would be standard fare for any doctor, but the underlying theory of Chinese medicine can often make sense of symptoms and how they present within an entirely different framework.

The bottom line, though, is that quite often pudendal nerve problems result from physical changes in the lower spine or in the internal musculature, and these can often be difficult to reverse. Occasionally there is a level of entrapment brought on by a hobby like cycling or working for long hours in a fixed position, but these are easily identified and easily remedied. The majority of cases are more treatment resistant, and it would be unfair to give you unrealistic expectations of what was possible. We have trawled through the research databases and found very few studies which even look at the problem, let alone indicate that it might be amenable to treatment.

However we must not sell ourselves short! Acupuncture treatment is often the last resort for intractable problems, and occasionally generates results in the most unexpected cases. If a practitioner can make sense of the presentation you have from a Chinese medicine perspective then there may be some cause for hope that the symptom can be reduced in severity or even removed. The best way to establish this would be to see a BAcC member local to you for a chat and brief face to face assessment.  The only caution we ever offer is that where we are not sure whether treatment will work it makes sense to try to find measurable outcomes and to review progress regularly, and certainly after the first four or five sessions. If there has been no change of any kind then it may be wise to call it a day early rather than run up a large bill going nowhere.

As generalists all of our members are capable of treating this problem, and using the postcode search facility on our home page www.acupuncture.org.uk will generate a list of members geographically closest to you. 

 

Q:  I have alodinya feels like permanent sunburnt but also results in pain in different areas. I have had an MRI scan and the  results they don't think are anything to do with spine damage. They think it is difficult to associate it with sensory symptoms.  Would acupuncture help?

A:  We are very sorry to hear that you have this problem; it can be very disheartening to have something for which no clear-cut cause can be found.

We have searched the literature for any evidence of acupuncture being used to treat this, but weren't at all surprised to find nothing of significance. The condition usually presents itself as a feature or symptom of something which is already named and classified, and treatment usually focuses on that specific problem.

However, the great strength of Chinese medicine is that it has a 2500 year history of treating problems not by name but by how things appear, and understanding them within a system which is based on energy flow. This has evolved to use a great many classifications based on observation and lived experience, like feelings of heat and cold in the body, and also a complex understanding of the inter-connectedness of parts of the system. Once one steps aside from the disease label and asks more specific questions about where the sensations are, how they feel, and what makes them change this can often point to a series of possible causes, many of which are treatable.

It has long been received wisdom in the acupuncture and Chinese medicine world that skin problems are often best treated with a combination of acupuncture and Chinese herbal medicine. Since most of the practitioners on the Register of Chinese Herbal Medicine are also BAcC members too this may be the best option to pursue. However, herbs are to everyone's taste, and we are pretty confident that acupuncture alone could be just as effective.

The best advice that we can give, and often do give, is that seeing a problem face to face is always the best way to establish whether something is treatable. Most BAcC members are more than happy to give up a few minutes without charge to have a look at the problem and give more specific advice, and this also gives you a chance to meet them and see where they work before committing to treatment.

 

Q:  I have suffered heel pain for 3 years.  I have plantar fascitis in  both feet after running on a trend mill in flat shoes.  Now  my right foot is very troubling,  I  stopped having cortisone injections about a year ago,  I have tried all types of gel pads which have made no  difference.  The pain is crippling like having a nail inserted through the heel, does anyone have answers regarding acupuncture, 

A:  We were surprised to find that we had been asked a similar question some time ago and managed to trace some research; we didn't think that this would have been chosen as a research topic. The answer we gave then was:

There are a small number of encouraging studies, summarised in this systematic review:


http://www.ncbi.nlm.nih.gov/pubmed/23099290

We use the word 'encouraging' because the researchers used a protocol for gathering data which was partly devised by acupuncturists themselves within the framework often used to gather material, and the results reflect far more accurately than usual the probable benefits of acupuncture.

However, all reviews of this kind will conclude that more and better studies are needed. This is just a reflection of the fact that while acupuncture is regarded as a fringe activity it will never attract the levels of funding which are required for studies of sufficient size, and we shall be continually reporting that there are encouraging but inconclusive signs!

We would really like to know a little more about how the condition which you have developed. This is quite often associated with exercising or jogging, and this impacts on the possible solutions. What we can say is thatwe would want to know what had been ruled out by conventional tests before we gave a professional view of whether we could help. There are some forms of damage in this area which would not be amenable to acupuncture treatment, and might only be corrected by surgery.

However, the majority of cases involve inflammation and tightening of the tendon, and from a Chinese medicine perspective this points either to local blockage and stagnation through over-use or accident, which might be amenable to local treatment, or a much more wide-ranging systemic condition of which this is the earliest manifestation. The skill and art of the practitioner is what enables them to determine the extent to which the problem is a reflection of a wider pattern of imbalance, and this in turn ensures that the treatment is not applied just locally as a quick fix which may not last that long.

The advice in all of these cases, where we lack the specifics of the problem and cannot make a face to face assessment is to visit a BAcC member local to you and see if they are happy to give up a short amount of time without charge to give you a more balanced view of what acupuncture treatment may be able to achieve. If they think there are other and more effective options, they are likely to say so.      

This probably remains the best that one can say. We are assuming that the various investigations have ruled out a calcaneal spur, which if it were the case is not really going to shift without surgery. If it does arise from tendon problems, however, then there may well be some hope that acupuncture may be able to offer something. Even as pain relief treatment can be very beneficial, but the question then becomes how much relief and how sustainable it is. This can sometimes become a financial equation - is the expense worth the extent of relief - but for some people it is important to buy some pain-free time when they need it.

Our advice always remains the same in these cases: visit a BAcC member local to you for an informal assessment, hopefully without charge, of what acupuncture treatment may be able to offer.

 

A:  There are no rules as such about anyone attending a clinic with a patient. We do have a provision in the BAcC Code of Professional Conduct which says

You are allowed to have acupuncture students, potential acupuncture students, or other individuals present as observers in your practice.  An observer may only be present with the explicit permission of the patient and may not carry out any part of the treatment. You must take care to avoid ‘coercive consent’ where a patient feels that they are under pressure to allow an observer to be present.but this is primarily intended to address the situation where a practitioner wants to have other people in attendance.

Most of us are more than happy to oblige if someone wants to bring a friend or relative along. In the case of children under the age of 16 or adults lacking capacity this is not a choice for the practitioner but mandatory. The only problems which we encounter are where the friend or relative interferes with the normal process of treatment. This 'expert' had one occasion where a husband booked his wife in for treatment and then answered all the questions on her behalf, including how she experienced her menstrual cycle! She happily acquiesced in this, and diagnostically it was interesting and valuable but after a while I had to explain that it really was for the patient to answer questions. 

We have heard of a very small number of occasions when a practitioner has refused to let this happen, and the only advice we can then offer is 'find someone else who does'. Acupuncture is something which many of us have done for thirty years or more, and this shouldn't make us blase about the fact that for many people it will be a novel and potentially scary situation. It would also not be common to have a chaperone in place at all times, and having a friend or relative in situ can make the difference between attending and not attending a clinic. 

If the question is based on a less than positive experience and you have been treated with less than appropriate sensitivity when making such a request we have procedures for people to follow this up and can advise you accordingly.


A:  We are always cautious about answering questions about conditions for which there has been little research evidence. The one summary of trials on the use of acupuncture for glaucoma really does not say very much

http://www.ncbi.nlm.nih.gov/pubmed/23728656

A part of the problem here, as the author of the review says, is that the standard method of testing procedures in the West, the randomised double blind control trial, involves one group getting a real treatment and the other group getting a sham treatment, to test the difference in outcome. No physician, however, would leave a condition like glaucoma untreated because of the potential for serious sight loss, so until someone tests the effects of standard treatment against standard treatment plus acupuncture there will be nothing definitive to point to.

All of us have treated people with glaucoma, either as a primary condition or as a secondary condition after a patient has presented with another problem, and I'm sure all of us can report some success. As the author of the review says, blockages in the flow of energy which prevent the free flow of fluids sums up what glaucoma is, and it would seem intuitively possible that acupuncture would have an effect. This expert's experience, though, has been that it takes a long time to achieve sustained and sustainable results, and the medications remain a part of the picture throughout. What acupuncture seems to do well is to prevent uncontrollable variations in pressure, but there is no statistical evidence to which we can point.

We have searched the internet and found surprisingly little patient feedback about the treatment of glaucoma with acupuncture. Most of the official charities and organisations do not have a great deal of feedback from patients on their websites, and we have not been able to trace many forums of sufferers. That these exist is not in doubt; the internet has created thousands of forums across the globe. The best that we can say is that if you search, you will find quite a few, and our experience is that they tend to be  a great deal more measured than used to be the case. Where it used to be 'it works, oh no it doesn't' the entries now tend to reflect the wider range of outcomes and views.

We do not ourselves 'bank' feedback on specific conditions, primarily because we take the generalist view that we treat the person as much as or more than we treat the condition. However, our best advice as always is to go to see a BAcC member local to you for a brief face to face assessment. This will enable someone to see your problem not simply as it is but against the backdrop of your overall health. This will enable them to offer a much better view of what might be possible and also enrich any basic understanding of how your problem may have arisen from a Chinese medicine perspective.  

On this basis we would always recommend that someone should visit a local BAcC member to seek a face to face assessment and also to try to understand the problem in its overall context in the body, not just as a specific manifestation. This is how Chinese medicine works, treating people not conditions.

What we would say, however, is that occasionally you come across websites for people treating eye conditions, especially two clinics in the USA and one clinic in India, which claim amazing success rates for these kinds of conditions. Our view is that if something was that effective we would all be doing it, so there may be something unique to the character of these set-ups which is driving such spectacular improvements. We tend to agree with the last answer; success can take a while, is always relative, and often reduces the impact of the condition more than totally removing it.

However, acupuncture will certainly not do any harm, and may well do some good.

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