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Q:  About 2 years ago I experienced sudden severe pain in my hip and thigh. this lasted for about 4 weeks and stopped suddenly.  A year later I experienced the same sudden pain. this time it did not stop. In an attempt to relieve the pain I  have used various pain relief medications.
I have had xrays and an  MRI scan which have failed to find the problem. I had a steroid injection into my hip bone and this relieved the pain for about a week. I have received treatment from an osteopath and physiotherapy.  I am in constant pain day and night and find it difficult to walk at time.  > My question is will acupuncture help in relieving the pain.

A:  There is no doubt that acupuncture can be used for pain relief, as our fact sheet on chronic pain shows:

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

and indeed, pain relief has been one of the most intensely researched areas of its use. The use of sophisticated assessment tools by patients to measure their experience of pain, and the fact that many of the neurotransmitters and natural painkillers can be precisely measured means that one can get meaningful results quite quickly.

However, the only two questions to ask if treatment is used in this way are 'is the effect reasonably sustainable?' and 'if it is, can I afford the treatment which maintains the level?'. We believe that this short-changes what we do to see it in this way. Chinese medicine is premised on the flow of energy in the body, called 'qi', and its proper balance and rhythms. Pain arise from blockage, excess or deficiency, and the skill and art of the practitioner lies in determining how the problem arises and whether local treatment or systemic treatment, or both, is required. The probability is that something has been brewing for quite a while, and there has been a tipping point which has meant a blockage or change has occurred. On the last occasion this has spontaneously reversed, but on this occasion it appears to be more tenacious, and a practitioner will want to assess whether the underlying tendency is going to keep on generating these pains unless corrected, or whether you have something specific which can be unblocked locally.

Our best advice with problems such as yours, which are always best advised on with the benefit of a face to face assessment, is that you visit a BAcC member local to you and see if they find anything on a brief, hopefully free, assessment which would encourage them to believe that acupuncture treatment would help you.

A:  We drew up a review paper some years ago

http://www.acupuncture.org.uk/arrc/public-review-papers/substance-abuse-and-acupuncture-the-evidence-for-effectiveness.html

which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.

However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK (www.nadauk.com) and SMART-UK (www.smart-uk.com) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.

There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).

This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.

We think this remains basically sound advice. There are a number of issues with which one has to be careful. There is certainly an argument which we have heard advanced by many colleagues that using five-point protocols is all very well, but going to a professionla acupuncturist who treats the person and not just the condition can offer some help in treating the causes of addiction as well as the addiction itself, and we have some sympathy for this view. In fact, we have had our own patients for whom the driver for their addiction problems was an imbalance which we were able to help resolve.

However, many of the problems which lead to someone becoming addicted to alcohol or any other substance are very complex, and being able to negotiate the difficulties is something for the expert, not the gifted amateur. We have seen colleagues get themselves into very uncomfortable situations by gettig out of their depth, and we always advise them that being part of a multi-disciplinary team is pretty much always the best way to help people come to terms with and control their addictions.

Q:  I am 37 weeks pregnant and was told this week my baby is in a breech position. I am rhesus negative. I've heard that it's not a good idea with my blood type. Surely this is a natural process as to whether the baby decides to move or not. It's not like the cpv procedure that forces the baby to move.  I'm booked into see an acupuncturist and she said she had not heard about this.

A:  As we are sure that you know from your own research, the use of acupuncture and moxibustion, mainly the latter, for breech presentation is well documented. The technique has been used in Chinese medicine for thousands of years, and involves the use of moxa, a smouldering herb, on a specific point on the foot. If the treatment is performed around the 33rd or 34th week of the pregnancy there is a significant amount of evidence which seems to show that the treatment works. Indeed, if you google acupuncture/moxibustion and breech presentation, you will find at least a dozen reasonably well constructed trials which appear to confirm this.
 
Of course, one of the factors which you have to take into account is that many babies spontaneously fall into the correct position after the 35th week anyway, so one has to take this into account in assessing the efficacy of the treatment. However, the technique is now being used by other healthcare professionals, and while we do not endorse the cherry-picking of our work, this is something of an empirical treatment, i.e. it works because it works, and this expert has never heard a conclusive argument for why this specific point should have this effect which would mean that its use was only legitimate in the hands of a professional acupuncturist.
 
However, when we look at your question small but significant alarm bells ring. 37 weeks is at the very end of the range of possibilities for this treatment working. At this point the baby is usually too large to encourage this movement. That said, many women, with the approval and encouragement of their midwives and obstetricians, try the treatment in order to head off a C-section. In your case, however, the Rhesus negative factor becomes slightly more crucial. We always advise members to speak to the medical team in charge of the pregnancy if someone is Rhesus negative. This is one of a number of conditions which we believe warrant additional care. In this case, if the treatment does encourage vigorous movement and a minor bleed, there could be serious consequences for the baby. A practitioner needs to know whether the woman has been given anti-D treatment, less likely on a first pregnancy but still possible, and also whether the risk assessment made by the obstetric team favours the use of the technique. If the midwife or consultant advises against it, that's the end of the discussion.
 
We are a little surprised that this is news to the practitioner. If she is a BAcC member, not only is the advice printed in or Guide to Safe Practice and also on our members' website, but it also forms a part of the training which all entrants have. If she is not a BAcC member, we are sure that most of the reputable professional associations take the same view. The increase in risk is sufficient to warrant conversation with the obstetric team.
 
We have had some lively and vigorous debates inside the profession about some aspects of treating late stage pregnancy, and the question of whether we are intervening to make something happen that otherwise would not or whether we are simply encouraging a natural process is a vexed one. Sometimes it is important to be clear what one is actually trying to achieve, and many practitioners regard themselves as simply trying to encourage a natural process, which is generally how we perceive what we are doing. This line can get a little blurry when people start to talk about induction by acupuncture because the very use of an imported conventional term implies a level of direct causation, not simply a speeding up of a 'stuck' rhythm. There are also a number of points whose use is expressly forbidden during pregnancy because they can cause serious problems, so not all treatment can be perceived as 'helping nature along'.
 
We would put this treatment in that same category, as something which is done with a specific and predictable effect in mind, this time for the benefit of the patient. If doing 'x' causes 'y', then it is crucial to ask oneself what might go wrong if the desired effect takes place. We would be reassured to know that either you or the acupuncturist has contacted your midwife or obstetrician to get advice and clearance for the use of this treatment, and if they say 'go ahead' we wish you every success and in any event, a trouble-free delivery!  
 

A:  In the case of treatment for tinnitus, we have expressed some reservations about how responsive to acupuncture the condition can be, and we have reproduced below our last answer which addressed this problem:

Can acupuncture help with severe tinnitus?

As you can imagine, we have been asked this question on several occasions, and our replies have not been that encouraging. The fact sheet which we have on the website
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html
 
is quite upbeat about a number of small studies, but our clinical experience is not as good, with tinnitus among the more intractable conditions with which patients present. In a recent answer, to which we can probably not add a great deal more, we said:


 A. Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet, found at lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. It is also fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. It is quite easy to spend considerable time and money and be no better off than when you started, and the individual case reports in the tinnitus sufferers' magazines often have the same shape.

However, what many practitioners do find when treating people with tinnitus is that while the noise remains largely unchanged their ability to cope with it seems to improve. Evidence for this is largely anecdotal, though, and it would be wise to discuss carefully with any future practitioner whether they think that they might be able to help. In all events we would recommend that frequent and regular reviews of outcomes and progress are essential.

We don't think you can say more than this. There are two or three clearly identifiable patterns in Chinese medicine, described as syndromes, where tinnitus is a specific named symptom which frequently appears, and it is possible, if your tinnitus has arisen as a part of the syndrome, that there may be some help which acupuncture treatment may offer. An experienced practitioner should be able to make a very straightforward determination on whether this is the case. Overall, however, there is not a great deal of cause for optimism about getting rid of the unwanted

A: We are happy to say that the majority of health insurers are now happy to fund acupuncture treatment. The fact that NICE (the National Institute for Clinical Excellence) has now included acupuncture as a treatment of choice for chronic low back pain has also meant that some policies which were more restricted in cover have now accepted acupuncture treatment as an option.

We are still mid-negotiation with BUPA and AXA/PPP, the two major insurers who have until now not accepted BAcC members as traditional acupuncture providers, but restricted their cover to acupuncture provided by members of the British Medical Acupuncture Society or statutorily regulated healthcare professionals. Their criteria for acceptance even of these are quite strict, and many doctors do not meet them. However, BUPA are on the verge of accepting BAcC members as eligible providers, and we are hoping that where they lead, AXA/PPP will follow.

The majority of insurance providers, as we said, are more than happy to cover acupuncture treatment to a certain limit. Where there has been any reluctance we have known patients to win ad hominem concessions with the threat of taking their business elsewhere, but we always counsel caution to our patients considering this as an option, because if the company calls their bluff and they have to find a new insurer, many policy providers will not take on pre-existing conditions. If someone has a long history of claims for a chronic problem, the last thing they want to do is undermine their cover by going elsewhere. 

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