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As you might expect there is very little published research on the treatment of lichen planopilaris (LPP) with acupuncture. We are sure that there are many reasons for this, not least of which is that it is quite a rare condition and collecting enough cases for a study may prove difficult. There isn't even a great deal of published research on the commoner varieties of alopecia.

From a conventional medicine perspective treatment, usually heavily steroid led, is aimed at reducing or slowing down the spread of the condition by reducing the inflammatory responses which characterise its spread. We suspect that insofar as we use acupuncture to treat many forms of inflammation there may be some possibility of replicating or augmenting the effect of conventional treatment.

However, we are always keen to point out that the Chinese medicine perspective is a very different one from what most people think of as medicine. The idea of named conditions is not really at the heart of the system, and each patient is seen as a unique combination of energies whose patterns, rhythm and flow are the basis for understanding why symptoms appear. The blockages and changes of flow which create symptoms are sometimes local and directly related to the problem as it appears, but more often than not there are systemic problems which need to be addressed for local problems to have any chance of being properly removed.

The language of Chinese medicine is often quite literal, and will talk of Heat, Cold and Damp as factors within the system, so someone with an inflammatory response would be seen as manifesting Dry Heat or Damp Heat, and the treatment would be aimed at expelling this, and at the same time treating the system to ensure that it does not flare up again. This may all sound a little airy fairy but with 2500 years of history behind it Chinese medicine is a very sophisticated diagnostic and treatment tool.

We often find that with skin problems Chinese Herbal Medicine can be used to great effect, and BAcC members who are also members of the Register of Chinese Herbal Medicine may be the ones to approach for advice. Most RCHM members belong to the BAcC, so using their practitioner search function will almost certainly generate a hit near you. We always advise people to visit a practitioner for an informal chat because as is obvious from what we have said about individual treatment there really is no substitute for having a direct look at a problem. Most members are happy to give up a little time to prospective patients without charge to assess what the best treatment options may be.

We think, though, that you might have to accept that where hair has been lost the chances of regrowth are slim, and that the best treatment might be able to achieve would be a slowing down of the disease progress together with a lessening of some of the discomforts associated with it. 

We are sorry to hear that you are experiencing what sound like very unpleasant side-effects from a treatment.

We are not sure from your email what the provenance of your practitioner is. The technique you describe is called percutaneous posterior tibial nerve stimulation, about which you can read here:

https://www.nice.org.uk/guidance/ipg362/chapter/1-Guidance

It is not really an acupuncture technique as such, at least it certainly is not a part of the ancient traditional Chinese medicine which we all practise. It is a modern technique using needles as electrodes which, as is often the case in modern developments of acupuncture, is described as working 'by a mechanism which is not yet properly understood.' It may well be that a traditional acupuncturist has decided to add this to their repertoire, but it is not a part of our core training.

As far as your strange symptoms are concerned, in conventional medicine it might be possible to make a case for some of the local ones, i.e. pain or tingling in the immediate area of the electrodes, because there may have actually been irritation of the nerves or small bruises which have consolidated to generate the symptoms from which you suffer. However, there would be very little that western medicine could do to explain why that should be generating sensations in your left arm and in your head.

From a traditional acupuncture perspective it might just be possible that the stimulation has had an effect on the channels of energy, and there are certainly internal connections between hand, foot and head which might explain what is going on. However, the mystery here would be what was causing the connection to be made several days after the treatment. If there are after effects or adverse effects after treatment they are generally immediate and subside within the first 48 hours. It is rather unusual for something to kick in three or fours days after the event and then to generate something which we call propagated needle sensation at this stage. This kind of effect takes a great deal of work to generate, and it is difficult to see what could be replicating this so long after a session.

Of course, we do have to bear in mind that there are sometimes occasions when a new symptom arises after, but not because of, a treatment. With four million treatments a year this can always be a possibility. The first thing we always advise, and what applies especially in your case, is to seek medical advice to find out exactly what is happening. This may take a referral to a neurologist, but since it sounds like a neurological effect getting advice here may well establish causation, i.e. whether the treatment actually caused what it happening. In an event this will point the way towards making it go away.

It might also be worthwhile talking to the practitioner about what they have done. They will know better than anyone else what points and techniques they have used, and may be able to make sense of what has happened to you.

It may be comforting to be aware that very few serious adverse events take place each year, and where these do happen from acupuncture treatment it is usually from penetration of an organ or direct physical damage. The remainder tend to be short-lived and transient, and we are confident that if this is really an effect of treatment it will subside relatively quickly. 



File under neuro - neuralgia

We have been asked several times about TN, the most recent answer we gave to this question was:

Trigeminal neuralgia is a very painful and quite often intractable condition. We have been asked about it a number of times, and  we have factsheets about both facial pain and neuropathic pain

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

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

The evidence underpinning a recommendation for acupuncture treatment is limited, but as you can see from the evidence button on the neuropathic pain sheet acupuncture has on several occasions been shown to be superior to the standard drug treatment, which suggests that it is worth trying. 

In a previous response on the same question we said that if you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial, is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.

We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, and subtle manipulation may offer possibilities.

We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether, which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficient to warrant making a recommendation to try to use acupuncture as a long-term pain relief option.

If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to establish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accurately bad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.

In your own case the backdrop of MS would appear to make the situation a little more complex, but it is important to recognise that the diagnostic categories of Chinese medicine are entirely different from the conventional medicine paradigm. From this perspective how a patient presents is far more important than the disease labels which they carry. That is not to say that Chinese medicine offers a chance of change where conventional medicine doesn't; in the modern parlance of sales, once it's gone it's gone. If a nerve is demyelinated there is no evidence to suggest that acupuncture treatment can reverse the damage. 

However, MS, as you know very well, can sometimes plateau and often have periods of remission, and our general sense is that treatments like acupuncture which are aimed at maintaining balance in the system may well be a contributory factor in staying well. This was, after all, the basis of ancient Chinese medicine,, helping people to stay well rather trying to get them better after they got ill, which was said to b e 'like forging a spear after the battle had started or digging a well when you were already thirsty.'

There is no reason not to have acupuncture when suffering from diabetes.  There are no absolute contraindications of which we are aware, and we have seen no case reports of adverse events where acupuncture treatment has affected someone's diabetic control.

We do, however, issue a couple of cautions to members. The first is that if you see a traditional acupuncturist you are very likely to have treatment for the constitution as well as local treatment for the elbow. There is a small but mentionworthy risk that the treatment may stimulate the residual pancreatic function and cause an increase in body insulin. If this happens and someone has a balanced intake of medications it can force a slight hypo. This is more of a risk with insulin, where the effect is more rapid and a hypo really can cause serious problems. On the meds which people usually have for Type 2 diabetes this is less likely to occur.

The second issue is that long term diabetes can begin to impact on circulation and wound healing, and if the practitioner make a  judgement that this is beginning to be the case he or she may well choose to swab all of the points they use to protect against infection from the needle insertion. This is pretty much only a theoretical risk at best - in the UK there are almost no reports of infections from needle insertion - but where a theoretical risk exists modern best practice is to address it by swabbing. Otherwise we follow generally accepted practice in the NHS for not swabbing unless there is an identifiable risk where a patient might be more vulnerable.

We hope that this reassures you and that the treatment of your elbow is successful.

We are not quite sure from your question whether you mean atrial flutter or atrial fibrillation. The difference between them is not substantial - in fibrillation the increased atrial beat is irregular whereas in flutter the increase tends to be regular - but the impact of both is much the same: faintness, tiredness, palpitations, shortness of breath and dizziness.

We have answered questions on atrial fibrillation before, a typical answer being:

There are some early indications that acupuncture may have an anti-arrhythmic effect in patients with atrial fibrillation. A study published earlier this year

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3312232/

concluded that there appeared to be benefits and that further large scale trials would be valuable to test the hypothesis more carefully.

However, it is only fair to say that needling a single point such as Neiguan repeatedly is not a fair representation of what a traditional acupuncturist does in practice. Although there is considerable overlap between eastern and western systems the arrhythmia typical of AF could be classified in several different ways within Chinese medicine, and the practitioner would be guided by evidence other than simply a reading of the rate of the pulse. That in turn would mean that ten people with AF might receive ten different treatments. To that extent, it is not that straightforward to extrapolate from research studies like this and conclude that 'acupuncture works'. 

The skill of the practitioner lies in making sense of the symptom of AF within an entirely different theoretical framework, and understanding each presentation in each individual patient as unique. The best advice we can give any prosepctive patient is to contact a BAcC member local to them to seek a short face to face consultation at which they can be given a better assessment of whether acupuncture might benefit them.

The one caution with AF is that most patients are taking some form of medication to control the problem, and the cessation of medication can quickly provoke a return of the symptoms. For people involved in highly technical or responsible work this might represent a serious risk. We would always recommend that any member contemplating treating someone with a condition like AF should talk to the patient's GP to ensure that nothing they do will undermine the current treatment regime. 

We have undertaken some further searches of the literature and these two articles

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4321072/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673375/

say much the same as the earlier articles and indeed cite them frequently.

Most of us have treated AF cases, and they do represent something of a challenge because of the management of the case alongside western treatment and medication. Even where we manage to bring the episodes under control to a greater degree than the medication most medical practitioners are reluctant to stop the meds in case the patient has a serious recurrence when they are doing something which could have dangerous consequences (driving a car, etc etc). However, good dialogue can address these kinds of problems, and a patient with their symptoms under control is likely to be happy to facilitate good communication anyway.

The other slight issue is with the setting of outcome measures. AF can come and go, and a problem-free period can happen anyway, so a practitioner has to be careful to discuss with the patient what would count as evidence from the patient's perspective that there had been some progress.

This represents probably the best that we can still say. There is no evidence of research into atrial flutter as such, and we suspect that for the purposes of the trials which have taken place the distinction has not been drawn.

What we did not say in our earlier reply is that most of our members are only too happy to give up a little time to prospective patients, usually without charge, to give them a better idea of what may be possible. Most conditions like this do not occur in isolation from a Chinese medicine perspective, and there are often other signs and symptoms which together make more sense of what is happening. From a Chinese medicine perspective each person is unique and different, and although a dozen patients share the same named condition there may be a dozen different ways of looking at it and treating it. Having a  word with a skilled and experienced practitioner might make more sense of what is going on and give a better idea of how treatable it may be.

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