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Q: For over a year now I've been suffering with a frozen shoulder. I went to see a specialist who said I had a nerve problem because the pain moves around my neck, arm and shoulder. The pain was really bad and I couldn't move my arm. I was given Morphine for the pain and a steroid injection into a different part of my shoulder. I also have Type 1 diabetes and thyroid problems. After the injections the pain went but after a few months it's back but not as bad as the first time. The doctor has now told me that because I have Type 1 diabetes I cannot have any more steroid injections, so has prescribed me ibuprofen and advised me to go back and see a physio. But the physio said he can't treat me if I'm in pain and the ibuprofen doesn't work, so I was wondering if I could have acupuncture?

A: The very simple answer is that there is no reason why you cannot have acupuncture as a Type 1 diabetic. The only caution which a practitioner will have is that with Type 1 diabetes there can sometimes be reduced sensitivity to the extremities. In our Guide, which we publish for our members, we say:

Diabetes mellitus It is recommended to ask diabetic patients about neuropathies they may have developed. In severe neuropathies the patient may experience loss of sensation. Due to impaired blood circulation to the affected area the patient may also be at a greater risk of developing a localised infection.  

Needling into the affected area should be done with particular care and strong manipulation of the needle avoided. Patients with poorly controlled diabetes, especially if insulin-dependent, may experience greater than normal fluctuations in blood sugar levels.

As strong acupuncture treatment can lower the blood sugar levels and occasionally induce some drowsiness, it is recommended that you treat such patients with particular care, especially on their first acupuncture treatment, and ensure that they have had something to eat before the treatment.

This just about says it all, really. We have come across the very occasional patient in whom the treatment triggers a release of additional insulin and can steer them towards a hypo, but most long term diabetes patients are usually very much on top of maintaining their sugar balance.

The reason for stopping steroid injections may also be that there is an upper limit beyond which most doctors will not go anyway. Three or perhaps four usually represents the safe number, after which there is an increasing risk of local damage to tissue in the area.

As far as frozen shoulder itself is concerned, as our factsheet shows https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1133-frozen-shoulder.html there is some fairly good evidence that acupuncture can be helpful. This is far from conclusive, so we can't make specific claims, but the evidence does suggest some benefit as well as some reduction in pain. The only problem is that it is difficult to stop someone using the shoulder while it improves, so progress can often be hampered by unintended setbacks when people reach out automatically and trigger pain and discomfort.

The best advice that we can give is for you to visit a local BAcC member for an informal chat. Most are more than happy to give prospective patients some time without charge to take a look at what is going on and will be able to give a better informed answer than we can about what prospects there are for benefit from treatment.

Q: I've read that acupuncture raises blood pressure in individuals with normal blood pressure. Does this always happen and if so, after treatment, does the blood pressure go back to normal?

A: We have looked carefully through all of the research databases and checked for anecdotal accounts on the web, but apart from people who have experienced a raised blood pressure as a nervous response to having treatment itself, there is no evidence to suggest that acupuncture would raise blood pressure in someone with a normal blood pressure. Clearly if someone has low blood pressure, treatment might have the effect of normalising it, but the primary effect of acupuncture on blood pressure is to lower it. This is a well attested outcome, and we have have seen thousands of patients over the years who have hypertension as a primary or secondary problem, many of whom have seen considerable improvements after treatment.

That is not to say that it cannot happen, and if you have come across some research which we have missed we would be very grateful for the reference. Things do change, and surprising results do emerge, but something as important as this would generally bubble to the surface quite quickly.

Our own fact sheet on hypertension is not as informative as some others we produce, and the evidence is not to the standard where we would be making specific claims for the benefits to be derived from treatment. Most of the studies, however, fail on methodological grounds, but all report a lowering of blood pressure with treatment.

Q: Can acupuncture help with post herpetic neuralgia?

A: As you might imagine we have been asked about this many times over the years, and a recent answer was:

Shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/herpes.html says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

We have had a good look through the research databases to see what further evidence is available (the fact sheet seems to stop around 2008) and we have found a few which are positively encouraging, such as:

https://www.ncbi.nlm.nih.gov/pubmed/21639941

https://www.ncbi.nlm.nih.gov/pubmed/22502623

but the systematic review proposed in 2014 has still to be completed (at least we can find no trace of a publication by the principal author).

The advice we gave earlier holds good, and that is to visit a local BAcC member for an informal chat about what may be possible. This is by far the best way to get a clear idea of your prospects, and most members are only too happy to see prospective patients in this way.

Q: My doctor advised me to contact a physio as I was experiencing joint pain in my knees. I had acupuncture on my first visit and after three days my shoulder blades and upper neck are in excruciating pain. Painkillers are not even helping and I don't know what to do. I can't deal with this any longer. Why Am I experiencing this and will it ever stop?

A: We would probably need a little more information before we could give a definitive view. The first question we would ask would be where the needles were inserted. Acupuncture is a very safe treatment with very few serious adverse effects, and most, when they do rarely occur, are the result of damage caused by the needles themselves, hitting nerves, causing deep bruising, etc etc. If someone throws a very specific pain then the first thing to check is whether the treatment as a physical act of needle insertion could have caused it.

The second thing to check is whether the treatment has caused a change in your posture, especially if needles have been applied to the lower back as well as the knees. The physios pay particular attention to this, often because they use slightly more vigorous techniques than we do as traditional acupuncturists. Occasionally a muscle might be tense and 'guarding' because it is supporting an inherently unstable spine. If this relaxes then it can generate problems locally or even higher up. It can even be the case that the correction of gait problems can affect the spine which in turn can make a change higher up for which the muscles are not yet prepared. The physio may well be able to recommend some exercises if this is the case.

Of course, a third possibility is that by using  acupuncture from a physical/medical perspective only the treatment has caused systemic effects in a wider way of which the practitioner may be unaware. It has been one of our constant themes with western medical acupuncturists that using points within a medical context does not mean that you can switch off the effects they have from our perspective in Chinese medicine. Why this might have resulted in neck and shoulder pain would very much depend on the nature of your energetic balances from a Chinese medicine perspective.

What we think is very likely, however, is that unless a needle has caused physical damage in the area where your pains are they are very likely to subside within the next few days. You would be well advised to contact the physio anyway to ask what it going on, and any of our members would in the same circumstances be only too happy to discuss the problem and perhaps invite you back to take a look at what is happening. Nobody wants a patient to be in pain after treatment. It may well be that further discussion reveals why this is happening and also go a long way to ensuring that the same thing does not re-occur.

The other thing we should say, though, is that although it looks fairly likely that the treatment was causally implicated in the pains it may not be the case. If by the time you get this response the pains continue and are beyond simple pain control you would be well advised to see your GP in case this is something different which has by pure coincidence happened at the same time. With over four million treatments in the UK each year there are bound to be occasional coincidences, and the key thing is to get problems checked out first before getting engaged in discussions about what caused what.

Q: Can acupuncture help with polymyalgia? I have this fairly under control with steroids but have a very painful lower back pain.

A: Not surprisingly we have been asked many times about polymyalgia, and a typical response has been:

There are surprisingly few studies into the effects of acupuncture treatment on polymyalgia, and this does limit what we can say from a conventional medical perspective about the treatment of the condition. However, we suspect that this is a great deal to do with the diffuse ways in which the condition presents. In our experience the definition is imprecise, and we have seen patients with identical presentations diagnosed very differently.

From a Chinese medicine perspective, though, this doesn't really matter. For us the description of the patient's symptoms is seen against an entirely different theoretical framework. This involves an understanding of the body as a flow of energy whose rhythms, flow and balance can affect someone's health. When pain arises it is usually a sign of blockage in the system, or excesses and deficiencies which we can correct with the use of needles.

The real skill and art of the practitioner lies in identifying the true source of the problem. Such is the complex web of inter-relationships within the body a symptom will often not be the same as the cause of the problem. Finding out where the root cause is and addressing it is what differentiates a traditional practitioner from someone using simple all-purpose formula points. If the root is not addressed then the problem will come back. This also explains why a dozen people with the same symptom can be treated in a dozen different ways, with treating being individualised to each case.

The best advice that we can give is that you visit a BAcC member local to you so they can give you a brief face to face assessment of what could be possible. A skilled practitioner should be able to give you a rough idea quite quickly of how much change they think they might achieve and over what period of time. Most of our colleagues are happy to give up a few minutes without charge to enable the patient to make an informed choice, and will also be likely to offer good alternatives if they think these will address your problems better.

If asked by a patient what the evidence for the success of acupuncture for PMR is, though, we would have to be honest and say that not only does it not meet the gold standard of western research, the RCT, but often fails to meet any reasonable standard. We believe that this is partly to do with the difficulties of assembling a meaningful cohort for a trial, the diagnosis not always being precise, but partly to do with the fact that treating it as a purely physical condition may not be dealing with the underlying causes, some of which are often mental and emotional.

We believe that, downbeat as it may be, this is still a good answer. PMR is a condition which can on occasion be intractable, and it would be remiss of us to start making claims for treating all cases with great success. For many people the diagnosis is much broader than PMR itself, and there are often complex emotional problems which arise from having been incapacitated for a long time.

However, we are always careful when we see patients not to assume automatically that any pain which they experience is always a result of their 'headline' problem. There are often back pains which have an entirely different root cause, and if this is the case we usually feel pretty upbeat about our chances of achieving something with the patient. Until recently NICE recommended a course of ten treatments of acupuncture for chronic low back pain, and it is one of the commonest presentations in our clinics. The evidence for acupuncture treatment is good, as ourfact sheet shows:

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html

There's actually a short video on our home page of one patient's experience of treatment for back pain.

The advice we gave in the earlier reply still holds good. Find a local BAcC member and ask for a brief interview to discuss with them whether they think they can help. The fact that they can see what is going on and talk to your directly will give you a much more precise answer than we can offer here.

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