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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

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

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

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.

It is always rather difficult to provide the kinds of answer people might like for questions like this. From a Chinese medicine perspective metacarpal bursitis is the kind of problem which we all tend to feel confident that we can do something about, even if we cannot make the problem go away. With its central themes of removing blockage and stagnation moving stuck energy in the form of fluid filled sacs should be highly responsive to treatment.

However, just as there can be any one of a dozen reasons from a western medical viewpoint which someone might have as the underlying cause of the problem, so in Chinese medicine the symptoms might well arise from many different causes. It will depend a great deal on whether this is a purely local problem, brought on by accident or over-use, or whether it is the tip of a much larger iceberg. In this latter case clearing the symptom will only be effective to the extent that the conditions which created it are gone.

Although there is a fair bit of research into osteoarthritis as one of the predominant causes of bursitis there isn't a great deal specifically about the hands, and osteoarthritis is only one possible cause of the problem. The best and only advice we can give is that you visit a BAcC member local to you for an informal assessment of what may be possible. There is no substitute for a face to face look at a problem, one which also allows you a chance to explain in more detail how the problem has arisen, the precise nature of the pain it gives you and the what you have discovered for yourself makes it easier or worse. Most members are happy to give up a small amount of time without charge to prospective patients to make sure that everyone is very clear before committing to treatment what the propects for change are.  

Generally speaking most of us feel fairly confident that we can do something. The only question really is how much that something is and how sustainable the outcomes are.

We would advise you not to worry too much about short term adverse effects after a first treatment. The vast majority of these are short-lived, and we would not be at all surprised to hear that by the time you receive this reply they will have gone. Our experience is that this usually only happens after the first treatment, and you should have no reason to feel any trepidation about the next treatment.

There are a number of possible explanations for this. When someone has had Western medical acupuncture, which we suspect is the case, there may well be some sinus involvement in the pain and the treatment may well have provoked some clearing of the sinus which, in this particular expert's personal experience, can be a very painful business. In Chinese medicine terms we often describe this as the energy of the area being reinstated, but because we treat the person, not simply the condition or pain which they have, there can often be secondary consequences as the system as a whole rebalances. Pathogens are often seen by the Chinese are 'going into' the system, so the process of health can lead to a reverse of this which can cause ripples in the energy as they leave. This can leave the patient feeling a little unwell for a day or two.

It is very important to let the practitioner know exactly what has happened. There may be aspects of the treatment which he or she can adjust. Some people are highly sensitive to treatment, and using fewer needles with less manipulation can make a big difference to the experience of the treatment without lessening the effect.

At any rate we hope that you feel comfortable with continuing, and hope that the treatment deals with your pain

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