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Ask an expert - muscles and bones - neck

23 questions

Q: My sister lives in Malta. She has been suffering from debilitating pain from slipped disc at the top of her neck and the second disc is also damaged. Would acupuncture give any pain relief ?

A: As our factsheet on neck pain shows

 there is some evidence that acupuncture treatment can help neck pain. However, the kinds of pain which arise from loss or damage in the discs of the cervical spine are not always that amenable to treatment. There is no doubt that acupuncture treatment will generate some pain relief; this is, after all, what really brought it to the fore in the West after Nixon's visit to China in the 1970s and the picture of people having operations with acupuncture anaesthesia. Pain relief has been researched many thousands of times, and the best one can say is that there is no doubt that acupuncture can relieve pain, but what cannot be predicted is how much relief, and how sustainable the relief is.

 What this may unfortunately come down to is a financial question about how much relief someone can afford. We have seen patients with thriving businesses have treatment weekly for years because it enables them to carry on working and earn far more than the treatments cost, but we have seen many cases where someone does not get enough long term relief to justify the expense. The only way to establish this is to have a course of four or five sessions to see what benefit it can bring.

 What we can say, however, is that we have treated many cases where there has been significant deterioration in the cervical vertebrae where the patient has felt that things haven't got any worse for longer than they expected. Whether this means that the rate of deterioration has actually slowed down or whether it means that the patient is able to handle the pain better is difficult to say. We would rather hope it is both.

 It will certainly do no harm to try acupuncture treatment, however, and may have tangible benefits.

Q:  My GP is referring me to have acupuncture treatment for my neck.  I have a partial fear of needles and a low pain threshold . I am suffering with bad headaches and my GP  thinks it's coming from my neck.

A:  The GP may well be correct; a considerable number of headaches arise from problems in the neck, often to do with gradual changes in the vertebrae which can impinge nerves and affect blood flow. There is quite a great deal that acupuncture for both problems, as our factsheets show:

Obviously we have to qualify these kinds of sheet with the statement that traditional acupuncture treats the person, not the condition, so we treat a person with a headache, not just a headache. This can make a profound difference to the treatment. Twenty different patients with the same presenting symptom might be treated in twenty entirely different ways as the practitioner sought to balance their own specific patterns of energy. This is one reason why we believe that acupuncture can be more successful than some conventional treatment because it is tailored to the unique needs of the patient.

As far as needles are concerned, there is no reason to fear them. The majority of members use needles which are 0.18mm ot 0.25mm and usually only an inch long, of which the top 3mm-5mm is actually inserted. The use of guide tubes helps even more, the pressure of the tube deadening most of the sensation in the area. Most of us have treated people who are needle phobic, and the simple expedient of showing someone what is going on, perhaps on an area where they can see what's happening, and talking through the process is usually more than effective. There are very few cases where the needling itself has stopped people having treatment, and most of us know how to start as gently as possible in order to keep people happy! The best thing to do is to visit a local BAcC member for a pre-commitment chat to be reassured about them, where they work and what needles look like. You will also get the benefit of a straightforward assessment of how well acupuncture may be able to help you.

Q:  I've recently developed sensory nerve discomfort on my shoulder blades .I already have idiopathic peripheral neuropathy so I know what nerve pain is . This is touch related as there is no discomfort when there is no clothing touching my shoulder blades . I did a simple experiment with 3 shirts/t-shirts . The first had a rough/course texture , the second had a gripping texture , the latter was soft & smooth . The first two both caused discomfort , the latter virtually none , I had a friend present & we both agreed on the descriptions regarding the "shirts" .
I would also add that I use a thoracic brace for exercising & the pressure of the brace on the my shoulder blades seems to alleviate the discomfort .
I thus thought , albeit from a very limited understanding of acupuncture : its use of pressure points & the fact that a GP at  my practice has used acupuncture for many years for a variety of maladies for the benefit of practice patients is there any evidence of its efficacy in treating sensory nerve discomfort .

A:We do have a number of fact sheets on our website about neuropathic pain and also a number of answers to earlier queries about diabetic neuropathy, but none really quite addresses the problem which you describe.

We suspect that with your problem it really is a case where going back to first principles may offer the best chance of finding some relief from the problem you have. As you probably already know from background reading, the theories of traditional acupuncture are based on the flow of energy called 'qi' and its rhythms, flow and balance in the body. Understanding how problems occur means being able to identify and understand how the flow might have been disturbed where the problem is and also how this fits against the overall backdrop of someone's health. The practitioner invariably, as with any pain, asks questions about whether the problem area feels hot or cold, responds to hear or cold, responds to pressure, is better or worse at different times of day, and so on. The answers to these questions all point to specific disruptions in the flow of energy and hopefully towards solutions.

There are a number of formula points which can be used as short term palliatives, and on occasion these may provide a permanent solution. The majority of cases like this, though, where there is an area of skin and superficial muscular discomfort, require something more sophisticated by way of treatment. Of course, in saying this, we would ourselves be looking at the other possible environmental factors which might be causing the problem, but we assume that you have probably done an exhaustive check on things which might have affected the area.

The best advice we can offer, since it is an unusual and specific presentation, is to visit a BAcC member local to you for a brief assessment of whether acupuncture might be of benefit. A skilled practitioner could usually elicit in a very few minutes how treatable something is, and most of our colleagues are happy to give up a short amount of time to make this determination

Q:  My dad had a heart attack in  2005 and he has an stent in his heart. He has recently had a lot of pains in the  back of his shoulder going to his neck and his left arm.  Do you know if acupuncture is the solution for it or if it's good for him or not please.

A:  We think we can safely say based on what you have told us that there is no reason not to have acupuncture. There are very few contraindications for acupuncture, reasons why we could not treat someone, and having had a heart attack and stent fitted does not pose a problem.

Whether acupuncture could help or not depends a great deal on what the cause of the pains is. For the kinds of pains which your father is getting, and taken together with his medical history, I think most of us would probably want to refer him back to his GP or cardiologist for further testing and an all clear for all involvement of the heart or other internal organs. Some of the aches and pains which people have are what is known as referred pain, where the pain is actually starting in an internal organ but is perceived by the body as a muscular problem on the surface. The classic example is angina pectoris which can present as a pain the left shoulder and arm. Given that your father has had a stent fitted it implies that there has been some atheroma/plaque-like material in the arteries and this may have caused another artery to be sounding warning bells.

However, if the pains are simply muscular, there is a good chance that acupuncture treatment may be of benefit. As we point out in our factsheet

there is some reasonable evidence for the successful use of acupuncture as a means of relieving this kind of pain.

We always advise people to see a BAcC member for a brief face to face assessment; this is by far the best way to establish just how much benefit acupuncture may be able to offer. In your father's case this is doubly so, just to make sure that these are not pains which we would do better to heed as a warning sign than simply treat and try to disperse.

Q:  I suffer from cervical spondylosis with radiculopathy in my upper right quadrant and wear and tear in my thoracic and lumbar spine. Suffered badly for years up to this past year finally getting best nerve pain med. Female aged 62, take pregablin Lyrica 100mg x 2 for past 4 months. I was paying for private physio for past year which was working well. Was offered a plate and pins to stabilise neck last year but have defferred as I'm still at work.  I begged for and am getting a nhs course of acupuncture - just a few pins in the  top of head, neck, right thumb and shoulder. Hoped to get off meds which have side effects. 3rd session of acupuncture and I now feel like the pain has come back and the pregablin not working. Is it normal for this reversal to happen or should I cancel? Would you recommend I ask for a new scan of my neck to see if it has got worse?

A: Based on what you have told us we think that it is very unlikely that the acupuncture has caused the reversal of progress which you describe. In traditional acupuncture we do warn people that there can be situations where a chronic condition can sometimes sign off with a flourish, and it is not unknown for a migraine sufferer to have a really bad migraine after a first or second session. However, this tends to be a very good sign that a pattern has been broken and a pathogen expelled, so the effect is short lived. Occasionally after treatment for musculo-skeletal problems the same can occur, and along with osteopaths and chiropractors we do tend to warn people to expect a day or so of disruption. The effect, however, is invariably transient.

There are two possibilities which we can think of. The first is that something has in fact really changed, and that your intuition that a new scan may be appropriate is a good one. We always express this with great care, but it is possible that changes have absolutely no causal relationship with the acupuncture treatment but just happened at the same time. This can sound like evasion of responsibility if not spoken with care, but what we worry about is that people can get distracted into arguments about causation while the problem goes unattended. 

The second is that the treatment itself has not exacerbated the existing problem but generated a few new symptoms in similar areas. Most of the practitioners working in pain clinics are safe and well trained, but they do tend to use what we would call formula acupuncture on the basis of western medical theory. This variant, called western medical acupuncture, can often be applied a little more vigorously and with slightly thicker needles than most traditional acupuncturists would use. This can sometimes generate problems of its own, but we have to say that if this was the case they would start pretty much as soon as the needles had been inserted, not appear gradually over time.

A third possibility is that the acupuncture treatment us having a rather good effect in terms of helping to relieve some of the tension in the muscles of the shoulder and neck, but this has had the unfortunate consequence of allowing slightly greater flexibility in the neck itself which in turn generates a little more pain. We do see this on occasion with backs, where a kind of unhealthy stability is achieved where a lesser problem, chronic muscle ache, is traded off against a more sharp pain like sciatica. It is rare but there are times when succeeding in helping the lesser pain can bring on the worse pain.

We think the best thing to do is to discuss this with the person giving you treatment. This is not a case of wasting anyone's time; this is all about ensuring that you get the best possible treatment for a really unpleasant chronic condition. If there are over-shoots or under-shoots in the treatment, then that is simply a useful guide to getting the balance absolutely right, and your healthcare professionals will welcome the feedback to be able to make the appropriate adjustments or, if need be, decide that another scan may be appropriate.

We hope that you manage to find a good balance of treatment to help you to continue without a plate for as long as possible.   

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