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Ask an expert - neuro and psycho logical - stress

5 questions

Q:  I am having difficulty switching off and relaxing. This results in tension in my neck and other areas. I am interested in finding a "good" acupuncturist for, perhaps, treating stress. My stress isn't chronic but I'd like to try such therapy. Other than emailing each acupuncturist located in my area suggested by your site, is there any way of telling which ones are better experienced in certain treatments?

A:  The short answer is 'no'. From our perspective, all of our members are equally well qualified to treat all patients. The only areas where we are looking to develop standards which define expert practice, and which may have an impact on our recommendations, are obstetrics, paediatrics and mental health problems. In each of these areas, there is additional learning, often in conventional medicine but in the case of paediatrics in Chinese mediicne, which would mean that someone working primarily with each group maybe better qualified to deal with what they find.
 
In all other respects, the Chinese medicine which underpins the approach is known by all, and to a large measure is independent of the conventional disease labels which we all tend to use. Chinese medicine treats the person rather than the disease, and a label like 'stress' can mean as many different diagnoses in Chinese medicine as it can mean descriptions of stress in conventional medicine. The skilled practitioner will listen to what you tell them about how the stresses manifest in your system and from that, using Chinese diagnostic signs as well, determine areas of imbalance and poor flow which they need to correct.
 
Having said that, many patients like to be able to make a good rapport with their practitioner as a part of the process of improving their health, and phoning rather than simply e-mailing often gives a prospective patient a good idea of who they are going to be dealing with. In this respect we're just like any other business; the services are pretty standard but we use the ones which suit us as individuals.
 
Word of mouth referral still remains very important, though, and although you may not want to divulge your intention to anyone else you may well find that someone you know has had treatment and can give you a personal recommendation. This is the best guarantee of finding what you want and remains the most valued and effective source of referrals for most practitioners.
 

Q: I have a recurring problem with my shoulder and neck caused by stress and tension. I have received physiotherapy and osteopathy but I would now like to try something different. Is accupunture suitable for treating shoulder/neck complaints. I think the issue is mainly muscular but also affects the nerve in my arm.

A: There is no doubt that a great many people have acupuncture treatment for neck and shoulder problems, as well as coming along for stress and tension which they themselves recognise are the cause of neck and shoulder problems. On both fronts there is a gathering body of evidence which suggests that acupuncture may be of benefit, as our factsheets on stress
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/stress.html
 
and other factsheets on sports injuries and muscular problems show.

 

We are sure, then, that acupuncture may be a suitable treatment for your problems. You will find that many conventional medical doctors and physiotherapists also use acupuncture in the form of 'trigger point acupuncture' to unknot the muscles. Our concern, however, would be to discover what the causes of the tension were. For many people the modern workplace is a significant and unavoidable source of a great many neck and shoulder problems, and even your 'expert' is starting to suffer this afternoon, having spent the last couple of hours at a keyboard and screen without a break. If this is the case then while acupuncture may help to reduce the problems they will tend to recur. Adapting the workplace or looking at various postural techniques such as the Alexander Technique may offer a longer term solution.

 

In most cases, though, it is not simply the physical stress of work but the mental and often emotional stress which can be a large contributory factor. The systems of Chinese medicine were developed over two thousand years ago with the key word 'appropriate' underlying much of the understanding. All of us will, and perhaps should, experience some tension and stress in life, just as we should have our fair share of grief, anger, joy, and so on. The key thing is that there is an appropriate length of time to hang on to any emotion or mental response, and then we should be able tmove on. The stresses of modern life are relentless, however, and we find very often that they affect the system such that people get stuck. From a Chinese medicine perspective, where body mind and spirit are interlinked, a mental or physical blockage may impact the whole system in the same way, and there are means of treating both, wherever the body's reaction is no longer 'appropriate.'

The best advice we can give is that you visit a BAcC member local to you to ask if in their view your own case is suitable for treatment. We are confident that a brief face to face assessment will be far more informative that we can be here, and may offer you a better perspective on whether acupuncture or some other modality like massage or related techniques may be a better bet.      

The factsheet on our website  here outlines a number of systematic reviews and randomised control trials which show some positive evidence for the effect of acupuncture on hypertension/high blood pressure. Taken as a whole the evidence is not quite good enough for us to make unequivocal claims for the efficacy of treatment, but there are certainly a great many patients who, alongside their western medication, use acupuncture regularly to help to maintain a relaxed approach to life and to help to break the cycle of anxiety/tension leading to high BP leading to anxiety/tension into which people can become 'locked'.
 
Clearly the ancient Chinese did not have sphygmomanometers to measure blood pressure, and the diagnosis of the patient rested on the symptoms raising from the high BP which they experienced and some of the signs which a Chinese medicine practitioner looks for when taking the pulse at the wrist, looking at the tongue and a number of other indicators of imbalance. Not surprisingly the overlap between high BP and some of the syndromes into which the symptoms are grouped is very imprecise. This is one reason, for example, why research can prove problematic because the same reading of the BP in 20 patients can arise from 20 different diagnoses in Chinese medicine, which is not helpful if you're trying to standardise all the elements in a piece of research.
 
The best course of action, as we say in nearly every response, is to visit a local BAcC member and ask their advice face to face. There are no rules about how many sessions someone should have for a condition, and a great deal will depend on whether in the practitioner's view the problem is a part of a much deeper pattern of distress or whether there are simple problems like blockages in the energy flow which mght be the prime cause. All that we ask our members to do is to remember to set reasonable outcomes, to review treatment regularly and certainly to review progress after four or five sessions to ensure that it is worth continuing and to make sure that the patient is happy to keep coming in. 
 

Q. Hi, thank you for taking time to read and reply to my email. I am suffering from slight to mild anxiety (and OCD) and I'm currently going through a course of CBT with a therapist and he recommended acupuncture as a possible way to help relieve it. Will this help and where would you recommend I go for it in glasgow?

A. While the evidence (see our factsheet) for the use of acupuncture in the treatment of anxiety is not yet conclusive, there are promising signs in some trials, and certainly no evidence that any harm has befallen someone treated for this. From a Chinese medicine perspective, where many patterns of disharmony and imbalance are tied to the word 'appropriate', anxiety states which are reasonable to have in some circumstances become locked in a pattern which does not relent, and begin to manifest themselves at inappropriate times until they often become a way of living. Just as the CBT and conventional medicine aim to break the cycle which maintains this unwanted response to daily life, acupuncture treatment in Chinese medicine is aimed at re-establishing patterns of health on all levels - physical, mental, emotional. The simple underlying premise is that a system in balance corrects its own symptoms naturally, and leads to a set of more appropriate responses to the challenges of modern life. We do not give personal recommendations for specific members; in our view all of our members are trained to a standard which guarantees that your concerns will be addressed safely, competently and ethically. It may be worth contacting one or two members in the area if you decide to go ahead with treatment, because a good rapport with the practitioner can sometimes enhance the outcomes of treatment.

The BAcC home page section marked Research has a sub-heading 'fact sheets' in which you can find an assessment of the value of acupuncture for treating stress in general and anxiety as one of its most common manifestations.

 

 

Factsheet on stress is viewable here

 

Factsheet on anxiety is viewable here

 

Acupuncture used to be very widely regarded as no more than a technique for reducing stress and pain, but opinion was sharply divided between those who thought the benefits were largely non-specific - being given time and attention, being listened to, lying down relaxing for half an hour - as much as the needles themselves. This is still the case now, and the words 'placebo effect' are used somewhat disparagingly about apparent successes of acupuncture. As one of the senior medical acupuncturists in the UK said, however, if both acupuncture and the 'sham' acupuncture used in a major trial outperform conventional treatment, that has got to be worth investigating.

Stress is such a wide-ranging and inclusive term that it is very difficult to give a blanket answer. In most cases we advise people to seek advice locally and in person for their specific needs, except in those cases where we are sure that acupuncture will not help or may even be contra-indicated, but in this case that is the only answer we can give. How stress presents in your life and what the main presenting causes are can have a huge bearing on how well it can be treated. If someone is trapped in a job they hate with an unpleasant boss whom they have to put up with to pay a large mortgage, there is nothing that treatment can do to change the material circumstances and possibly the best it can manage is to reduce the impact of these day to day vexations. Where the causes are more internal it may be possible to achieve more. Speaking directly to one of our members is the best course of action.