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Ask an expert - neuro and psycho logical - carpal tunnel syndrome

3 questions

A:  We note the question mark after the mention of carpal tunnel - has this been mentioned in passing or is this one of several possible diagnoses offered?
 
Generally speaking, the evidence for the treatment of carpal tunnel syndrome with acupuncture is a little patchy. Our factsheet
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/carpal-tunnel-syndrome.html
 
spells out the fact that the trials which have been held have been equivocal, although it does make the point that the use of 'sham' acupuncture as a control is always a problem. The idea that a needle inserted 'just anywhere' has no effect is wrong, and should be better understood as the contrast between needling at a classically known site against needling elsewhere at a site which may sometimes contingently have more effect than the classical point.
 
The symptoms of carpal tunnel are relatively distinct. The condition is believed to result from the impingement of the median nerve by the tendons of the inner arm as they narrow at the wrist, and symptoms will follow closely the distribution of the nerve itself. While this may cause pain and discomfort in the wrist itself, there are a number of other conditions which can also affect the wrist and which can be very painful. A neurological assessment should rapidly identify what is happening.
 
However, there is something of a risk in discussing named western conditions and their treatment with acupuncture. Although the ancient Chinese probably has some understanding of nerves, their system of medicine was built on an understanding of the flow of energy, called 'qi', in the body and the functional nature of the internal Organs in distributing and maintaining this flow. The manifestations of pain and the precise location often showed the nature and cause of the disturbance in energy flow, and the needles were used to correct the problem, along with any more general or lifestyle advice which the patient needed. The danger of 'mixing systems' is that it becomes more difficult to understand from the conventional medical perspective how the traditional acupuncture perspective can work. 
 
Our clinical experience is that the symptoms associated with carpal tunnel syndrome and other wrist pains can often be relieved with acupuncture treatment, but the critical questions are how much relief one can get and how sustainable it is. Clearly the evidence for the reduction of pain and inflammation by acupuncture treatment is good, but this is of no use to a patient if the relief only lasts for a day and costs a small fortune to maintain.
 
Our best advice is always in cases like yours to see a BAcC member local to you for a face to face assessment of whether acupuncture treatment may help, and also to ensure that you get a thorough neurological asessment too. There are some conditions where surgery or splinting is a serious option, and you need to be able to get yourself on this pathway in case other forms of treatment do not help.   
 
 

Q:  I have carpal tunnel in my right arm {mild}, gout in my right knee and both ball joints on my feet,{not too severe}

 

A:  As our factsheets show please click here
 
index.php?option=com_k2&view=item&id=2054:carpal-tunnel-syndrome

 

please click here
 
index.php?option=com_k2&view=item&id=2182:gout
 
there isn't a great deal of evidence in research studies for the use of acupuncture in the treatment of either of these conditions.
 
As far as both are concerned, however, it is important to recognise that Chinese medicine has existed as a system for over 2000 years and addressed problems like these long before there was the kind of knowledge of the internal workings of the body which we have today. The underlying theories of Chinese medicine are premised on the flow of energy, called 'qi', in the body whose balance, rhythms and smooth flow are integral to good health. Once this flow is interrupted by illness, lifestyle or accident/injury symptoms will develop.
 
In these terms the practitioner of Chinese medicine will often look at how a symptom presents in a very literal way. Carpal tunnel syndrome would be described as a blockage of flow in a channel leading to weakness and pain, and gout might be seen as a mixture of heat and consolidation in a joint. In either case treatment might be aimed both locally where the problem manifests, and systemically if the practitioner believes that there are more widespread imbalances in the system of which the specific problems are simply the first manifestation.
 
However, it is fair to say that trying to treat acute gout is not the easiest thing in the world to do, and by the time it has become a very acute and painful condition some form of anti-inflammatory medication may be essential alongside any attempts to use acupuncture as a treatment. For the more chronic cases management of diet and a regular dose of medication like allopurinol is an effective way of keeping the condition at bay, and treating with acupuncture alone does carry the risk that an acute episode may develop after it is too late to administer prophylactic medicine. However, this is something which a practitioner would ned to discuss with you face to face in order to assess your case in the round, including lifestyle factors.
 
Carpal tunnel syndrome is another matter, however. There are a number of short term treatments, like splints for sleeping, which can keep the condition at bay before surgery is the best and only option, and if you did decide to have acupuncture the condition does have very clear and measurable outcomes to enable you to assess whether the treatment is working.
 
In both cases, though, the presentations of the condition are so specific to the wider patterns of someone's health, heredity and lifestyle that it would be better to seek the advice of a BAcC member local to you face to face for them to be able to assess whether acupuncture treatment might offer you some relief, and the extent to which the problems might be amenable to treatment.     
 

Although a number of studies, such as

 

 

http://www.ncbi.nlm.nih.gov/pubmed/19590482

 

have shown some interesting and positive results for the treatment of carpal tunnel syndrome, the more recent systematic review

 

http://www.ncbi.nlm.nih.gov/pubmed/21093382

 

is not that encouraging. In many cases it is the methodological flaws in the studies themselves which mean that they cannot be taken as solid evidence. Anecdotally the BAcC is aware that some patients benefit considerably from their treatment, but there are just as many for whom the treatment does not appear to work and for whom steroid injections and/or an operation are the only options which offer some help.

 

The best advice, since from a Chinese medicine perspective all cases are unique and different, is to see if you can arrange a short consultation with a practitioner local to you to get their view on whether your particular case may be amenable to treatment. If you did so and opted to go ahead with treatment we would recommend that the outcomes are very clear, as well as the interim review periods. Obstinate conditions, of which this is one, sometimes lend themselves to the development of 'habit treatment' where progress is minimal but hope gets the better of experience.