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Q: Does acupuncture help in the treatment of tinnitus associated with severe Menieres Disease? It has left me totally deaf. I have had successful acupuncture before for arthritis and muscle strains.

A: We have been asked about Meniere's Disease on a number of occasions, and a typical answer has been:

There are a number of conditions like Meniere's disease, vertigo, labyrinthitis and so on, where changes in the structure or infections in the inner ear area can cause significant balance problems as well as generating other symptoms like nausea and headaches. Because there is no precise overlap between the classifications of conventional medicine and Chinese medicine, there may be many different ways of treating the same named condition depending on what else a practitioner finds to be out of kilter in a system. This means that it can be quite easy on occasion to identify a group of signs and symptoms which are likely to be amenable to treatment and which enable one to treat with confidence. On other occasions it can be very unclear, and when this happens we have to rely on the very basic premise of Chinese medicine, that if the energy ('qi') of the body is balanced and free-flowing, then symptoms will resolve through the body's capacity to heal itself.
 
There is a fair measure of evidence for a number of balance related problems, as our factsheet shows but we would have to admit that many of the trials which do report success are not conducted by using Chinese medicine as it is practised, and while we would contend that the personalisation of treatment to the unique individual is a far stronger treatment than a treatment repeated formulaically several times, this latter is the basis on which most research is conducted to meet the current 'gold standard.' One trial of this kind, for example,

 
http://www.ncbi.nlm.nih.gov/pubmed/19606509
 
generated some very interesting results, but the formula applied would not be appropriate for everyone.
 
For a generic problem such as this which might present against a vast range of contexts there is no substitute for visiting a BAcC member local to you to ask for a brief face to face assessment of the potential benefits of treatment. This will enable them to give you a far better informed view than we can do at a distance

We think this is about the best that we can say. When patients come to us the first thing we establish is what exactly is wrong with the inner ear. There are a number of physiological changes to the ear which can mean that conditions like this have to be regarded as permanent, so a practitioner will first want to assess whether this is something which is even amenable to treatment - there's no point in wasting time and money on something which isn't going to work.

As far as how long the treatment lasts is concerned, this is the proverbial piece of string. We always aim to treat the overall picture, not simply the symptom as it presents itself, because we believe that doing only symptomatic treatment is like turning off an alarm bell because you don't like the noise. If we treat the whole system, and the treatment is successful, there is no reason why someone who looks after themselves shouldn't remain relatively symptom free. In reality this tends to be a little less likely than a case where someone will experience some positive change which they have to 'top up' from time to time.

What we always aim to do, though, is to review progress after four or five sessions, and if there is no obvious sign of improvement to draw a sharp line in the sand before committing someone to what may turn out to be a long, fruitless and expensive process.

We believe that this still covers most of the ground pretty well. We have undertaken a survey of more recent research and there is a paper
https://www.ncbi.nlm.nih.gov/pubmed/26055400

which gives a guarded but generally positive view of the value of acupuncture treatment for these types of cases.

This doesn't mention tinnitus directly, although the studies often mention tinnitus and deafness as a part of the constellation of symptoms, and where the deafness accompanies balance problems there is often an all-round improvement.

We have had a further look at papers which directly refer to hearing loss and tinnitus, and we found this one

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980515/

which concludes that balance problems can be helped but not hearing problems. However, the selfsame reason why the authors qualify positive statements about balance - small trials, poor methodology - are the ones which they cite to not write off acupuncture for hearing problems too quickly.

We used to be quite downbeat about tinnitus treatment, but as a recent answer said:

Our experience in practice was that tinnitus could prove intractable to treatment. However, as our factsheet shows

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

and as some recent personal experience in clinic has shown too, there may be some hope.

The problem with measuring the success of treatment for tinnitus is that its appearance and disappearance can be entirely random. If you read the tinnitus association's magazine you will see stories along the lines of 'I tried everything and then x worked' and an equal number of stories which say 'I had tinnitus for five years and then one day it just went.'  Research trials tend to be quite reliable - it would be a remarkable coincidence if half the trial participants experienced a spontaneous improvement - but one-off cases could be a coincidence, with acupuncture just happening to be the therapy of choice when the change happened.

The available evidence, however, suggests that it might be worth a try with the proviso that progress is reviewed at regular intervals, and some kind of objective measure can be found, i.e. how much it interferes with a radio set at a particular level. It might also repay investigation of what makes it worse and what makes it better. A long n-1 case study this expert conducted had very little impact on the condition but did increase the sufferer's ability to deal with it.

The best advice is to visit a BAcC member local to you  for an informal face to face assessment of what may be possible. There are one or two clearly recognisable syndromes within Chinese medicine which might offer considerable confidence that muting the problem may be possible, but even a general balancing of the system may bear fruit.


Invariably we check for more evidence when we are asked a question to which we have responded before, and the evidence trail for the fact sheet stops some time ago. We found a number of small studies like this one

https://www.ncbi.nlm.nih.gov/pubmed/26747258

which seem on the face of it to encourage the belief that there is a recognised connection between acupuncture treatment and symptom relief. There is also a systematic review, a 'trial of all trials' beloved of researchers because it aggregates to a much more powerful study than the individual ones.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3493359/

This draws the usual sorts of conclusion about the need for more and better trials, but the authors do conclude that acupuncture is worth trying as a safe alternative which seemed to have shown some success in addressing the problem.

The advice we gave before, though, holds good. Each case is unique and different, as is each treatment plan, and the best advice you can get will always come from someone who can see your problem in its overall context.

Q: What are the principles and practices of acupuncture?

A: We like a challenge but this is a little steep even for us. Not that we can't answer your question, but because the answer would run to several thousand words, which is a little beyond our remit.

Our website, www.acupuncture.org.uk, has a number of sections under the 'about us' and 'traditional acupuncture' buttons which provide a very brief and rudimentary explanation of what we do. For something more comprehensive, though, you would probably need to get hold of a book which explains in greater detail how the systems we use where and how they originated. The 'go to' text when we all trained in the latter part of the last century was Ted Kaptchuk's book 'The Web that has no Weaver' but since that time there have been a few more books by senior practitioners like John and Angela Hicks, or Peter Mole, which give thorough explanations of what we do and why we do it.

The challenge for any author in the West is how to present a 2500 year tradition in a comprehensible way when the very culture in which the original theories was embedded is vastly different from the western culture in which we live. Chinese language is able to express subtle shades between black and white in a way our language cannot, and the kind of internal logic of the language and concepts of yin and yang are embedded in the way that people actually think. Getting this across in a language and structure of thought which is very different can be a problem.

Not only this, whereas western medicine can be viewed as an expanding ball developing from a commonly agreed centre, Chinese medicine is inherently pluralistic. This arises in part from the fact that until the mid-1950s it was very much an apprentice trained tradition. There are many textbooks which have been handed on for thousands of years, but the basic principles have been applied in a myriad ways, some of which can actually be contradictory but nonetheless part of a practitioner's basic skill set. You can imagine the challenge that this represents even to learn the various systems, let alone try to explain the whole field thoroughly to an interested party.

If you are trying to get hold of a much briefer introduction there is a small pocket book which cnan be found here

https://www.amazon.co.uk/Understanding-Acupuncture-Joanna-Trevelyan/dp/1904439268/ref=sr_1_4?ie=UTF8&qid=1496646368&sr=8-4&keywords=understanding+acupuncture

We used to sell copies of this from the office to members who wanted something small to lend or sell to prospective patients. While it could do with a minor update it still offers a very simple but useful overview of what we do.

We are sorry that we can't go into much greater depth here, but the resources available online and in books are now so good that it wouldn't make sense to give a partial and over-short explanation here. We hope that you enjoy finding out about what we do.

Q: I went to see a physiotherapist after having severe spasms in my side from a pulled muscle.
He recommended acupuncture to "reset my nervous system" and put about 6 or 8 needles in my lower back. The first session was fine, I hardly felt anything. I went back a week later and my side was 90% better so he recommended more acupuncture. This second session was kind of uncomfortable and for hours afterward I had a feeling like a bee was stinging me in the lower back. The next day this was gone but I then I kept feeling like I had little electrical shocks in my lower back. The feeling lasted one day and then was gone, but I have had a throbbing ache in my lower back ever since. This is about 4 weeks now.
I went to see my family physician and she thinks he hit a nerve and I have inflammation and that this pain could be permanent.
I saw my physiotherapist last night. He thinks it is unlikely that he hit a nerve and said that some people just don't take to acupuncture well. He has given me some exercises to do.
I am really concerned that this pain won't go away......I am a self employed (female 56) house painter and have not worked in a month due to this pain.
Any suggestions?
Thank you.

A: First, let us say that we are sorry to hear of your experience. Adverse events after acupuncture treatment are relatively rare, and the vast majority of them are transient, wearing off after a day or two at most.

From what you report we would be very surprised if the practitioner had hit a nerve. This is a generally unmistakable sensation (this expert has been on the receiving end!), and there is absolutely no doubt when it happens. What can happen, though, is that a needle inserted deeply into the tissue of the back or elsewhere can cause a small internal bruise which forms beneath the skin and then becomes more condensed. If this sits near a nerve then every time you move it is going to impinge the nerve and cause pain or discomfort. That certainly sounds like what the 'little electric shocks' could be.

However, these would, or should, have subsided well before four weeks have passed, and certainly would not account for a pain of sufficient intensity to stop you working for this time. There are two possibilities. The first is that the treatment has been a little too successful. The physios'professional association warns its members that occasionally deep needling can relax muscles which, while tense, are actually guarding the back. When these stop doing this job it can mean a back problem which has been under control can suddenly cease to be so. This is quite rare; the BAcC keeps records of reported adverse events and insurance claims, and there have only been a couple of instances over the last twenty years where this may have been the case.

The other possibility is that this problem is unconnected with the treatment, and has just happened coincidentally. This is not so odd as it sounds; with over four million treatments being administered every year there are going to be a few cases where something happens after a treatment which has nothing to do with it. The problem is that patient and practitioner can get then get into debate about whether the treatment caused the problem while it goes undealt with. We always advise members to get their patients checked by the GP and referred on if need be, because eventually the diagnosis will point clearly to the probable cause.

The fact that you may have told the GP that the pain was caused by the treatment may have discouraged them from further investigation. We tend to think that if something is bad enough to keep you off work for a month it needs to be checked out immediately.

We have to say that you physio may be right insofar as acupunbcture isn't always the best treatment for someone, and we have seen several patients for whom it was too powerful an intervention. Where this has happened, though, we have never seen an adverse event lasting this long. The most that we have seen hs been a couple of days.

Hopefully your pains do derive from an accidental nerve impingement, and will subside soon. If they don't, though, we would be pushing for an X-ray or scan to find out what is going on.

Q: My son who is 14 has had Labyrinthitis for two weeks and slowly recovering. His dizzy spells are reducing but he still haves some vertigo.
Is it possible that Acupuncture could help?.
He is one of the countrys top bmx racers in his age group and due to race in the World championships
in the USE at the end of July. At the moment we are very worried he may not be able to compete.
Your early reply would be most appreciated.

A: We are sorry to hear of your son's predicament. We have a factsheet on our website

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/2599-vertigo.html

which gives a fair bit of evidence for trials which are very encouraging about the use of acupuncture for a variety of balance problems. We quoted this some time ago in an answer about the generic problems of the inner ear, in which we said:

There are a number of conditions like Meniere's disease, vertigo, labyrinthitis and so on, where changes in the structure or infections in the inner ear area can cause significant balance problems as well as generating other symptoms like nausea and headaches. Because there is no precise overlap between the classifications of conventional medicine and Chinese medicine, there may be many different ways of treating the same named condition depending on what else a practitioner finds to be out of kilter in a system. This means that it can be quite easy on occasion to identify a group of signs and symptoms which are likely to be amenable to treatment and which enable one to treat with confidence. On other occasions it can be very unclear, and when this happens we have to rely on the very basic premise of Chinese medicine, that if the energy ('qi') of the body is balanced and free-flowing, then symptoms will resolve through the body's capacity to heal itself.
 
There is a fair measure of evidence for a number of balance related problems, as our factsheet shows but we would have to admit that many of the trials which do report success are not conducted by using Chinese medicine as it is practised, and while we would contend that the personalisation of treatment to the unique individual is a far stronger treatment than a treatment repeated formulaically several times, this latter is the basis on which most research is conducted to meet the current 'gold standard.' One trial of this kind, for example,

http://www.ncbi.nlm.nih.gov/pubmed/19606509
 
generated some very interesting results, but the formula applied would not be appropriate for everyone.
 
For a generic problem such as this which might present against a vast range of contexts there is no substitute for visiting a BAcC member local to you to ask for a brief face to face assessment of the potential benefits of treatment. This will enable them to give you a far better informed view than we can do at a distance

We think this is about the best that we can say. When patients come to us the first thing we establish is what exactly is wrong with the inner ear. There are a number of physiological changes to the ear which can mean that conditions like this have to be regarded as permanent, so a practitioner will first want to assess whether this is something which is even amenable to treatment - there's no point in wasting time and money on something which isn't going to work.

As far as how long the treatment lasts is concerned, this is the proverbial piece of string. We always aim to treat the overall picture, not simply the symptom as it presents itself, because we believe that doing only symptomatic treatment is like turning off an alarm bell because you don't like the noise. If we treat the whole system, and the treatment is successful, there is no reason why someone who looks after themselves shouldn't remain relatively symptom free. In reality this tends to be a little less likely than a case where someone will experience some positive change which they have to 'top up' from time to time.

What we always aim to do, though, is to review progress after four or five sessions, and if there is no obvious sign of improvement to draw a sharp line in the sand before committing someone to what may turn out to be a long, fruitless and expensive process.

We believe that this still covers most of the ground pretty well. We have undertaken a survey of more recent research and there are a couple of papers

https://www.ncbi.nlm.nih.gov/pubmed/26055400

https://www.ncbi.nlm.nih.gov/pubmed/26055400

which give a guarded but generally positive view of the value of acupuncture treatment for these types of cases.

There is plenty of time between now and your son's championship for acupuncture to take effect, if it is going to work. Even if it didn't do as much as we expect it could, there are other options which you might want to explore. Amongst the more promising is cranial osteopathy, which can often offer help for problems where a small but significant shift in the subtle structure of the skull could have an impact on balance. We would assume that as a serious BMXer your son is used to the odd tumble, and it may well be that a succession of these have contributed to the problem.

Whatever option you choose to pursue we are confident that the network of practitioners in your area will be able to point you towards whatever help will best suit your son.

And if he/you do choose acupuncture and he wins, we'd love a namecheck!

 

 

Q: I am trying to find out if I can have acupuncture as an anaesthetic for a knee operation in the UK. Is this possible in a hospital and are there any practitioners in the UK please?

A: We have been asked about the use of acupuncture anaesthesia a number of times, and a typical answer has been:

The answer to your question is that in theory acupuncture can be used as an anaesthetic, but we suspect that you will find it very difficult to locate a practitioner prepared to do it.

After Nixon's visit to China in the 1970s, and the remarkable pictures of people having some very serious operations using acupuncture anaesthesia (AA) , there was something of a surge of interest in the West in researching the use of acupuncture for pain relief and even trying to use AA. However, what the images from China did not show was that in every case there was a bank of conventional anaesthetic equipment ready for immediate use in case the AA wore off. The effects were not always guaranteed and reliable, and in the past two decades its use has now diminished to being an occasional novelty rather than mainstream practice.

We did have a colleague who agreed with great reluctance to use AA for a rhinoplasty in a patient who could not have a general anaesthetic, but he did have to study books to work out what to do. The fact that the operation went well, there was less bleeding and the patient recovered much faster was not enough to make him succumb to the blandishments of the consultant who wanted to offer him a permanent slot. He found the whole business far too stressful.

If you can find someone willing to do this your best bet may be someone who regularly uses electro-acupuncture (EA). This has the advantage of being consistent over time, and can also be ramped up if the effect starts to diminish. You might well find that some of the medical acupuncturists are more conversant with this than traditional acupuncturists, and indeed some of the physios who use acupuncture may also use EA more. Both of their registers ( http://www.medical-acupuncture.co.uk/ and https://www.aacp.org.uk/) may offer search options, as well as our own. We think you may just have to ring around until someone points you towards a practitioner they know of who regularly uses EA and may be prepared to do AA.

We are not sure that we can say any more or better than this. The only times we have come across someone having AA in the West are when an operation is necessary but for some reason the patient cannot tolerate either general anaesthetics or epidural injections. There would have to be a very strong reason for doing it, we suspect, for a consultant to be able to take what may be an enhanced risk in working in this way.

That said, a great deal depends on the operation for which you are lined up. If we are talking serious surgery like knee replacement or similar then we think it is highly unlikely. However, for arthroscopy and a number of much simpler procedures you may be able to make a case. You would probably have to sign some very serious disclaimers and make a very robust case for sidestepping the usual procedures, but nothing ventured, nothing gained.

We wish you luck, and hope that you do manage to find someone who can help you.

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