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Q. Can it help with tension headaches and TMJ?

A. These are both problems of which we see a great many cases in practice. There is a certain amount of research, as you can see from our two factsheets

but it has to be said that the quality of trials is not that great and as ever the conclusion from any trial will always be that more and better research is needed.

The predominant reason for this is that there are so many precipitating causes for both problems that even researchers fight shy of testing whether the symptom can be relieved by treatment. This is rather ironic, because this is precisely the way that Chinese medicine looks at every symptom, not as a problem in itself but as a problem which has emerged against a backdrop which is unique to each individual. That means that twenty people with the same problem may end up being treated twenty different ways because the underlying patterns were different.

Obviously there are going to be some cases where you can pinpoint the cause. We often come across TMJ syndrome which has been caused by rough dentistry when the jaw has been pushed wide for some time and slightly dislocated. It's not a fantastically stable joint, and once it is slightly out of alignment it can cause facial pain and sometimes headaches too. If we suspect that this is the case we sometimes refer people to cranial osteopaths who can go straight after the problem. This doesn't mean that we aren't interested in why this happened in this particular patient, but it could take a great deal longer to get the same change by restoring better function.

As far as headaches are concerned, though, there are literally dozens of differentiations in the more syndrome orientated acupuncture styles which can define precisely what kind of headache it is and alongside that several very long established styles of treatment aimed at restoring the overall balance. That is why we would never venture a view on a specific question because so much depends on the individual presentation. That is why we invariably say that a brief visit to a local BAcC member for a chat is a great idea. Most will offer a small amount of time without charge to prospective patients to give them a better view of what might be possible, and help them to make an informed choice. It has to be said, though, that headaches remain one of the more common presentations we see in clinic, and many are referrals from people who have been successfully treated themselves.

Q. I have been suffering from intense heel pain in both feet now for 6 years. I've been through years of physio/insoles/MRI/surgery etc in attempts to find the cause. Research now leads me to consider peripheral neuropathy. 15 years ago I suffered an almost terminating attack of Guillain-Barré Syndrome and I wonder whether this may be involved. I live on Hampshire/Surrey border. Could I get some recommendations for expert acupucture in this area, specialising in Peripheral Neuropathy.

A. The first thing to say is that there are only a couple of areas where we take specialism seriously - paediatrics and obstetrics - and where are are eventually likely to recognise expert training. Chinese medicine is by its very nature generalist because we treat people with conditions, not the condition itself. In that sense we are all qualified to treat everything, although we have to be very careful how we say this because treat implies cure, and treating people with, for example, cancer is not about curing so much as maximising the body's balance. It's an easy misunderstanding to foster.

That said, many problems present locally against a backdrop of systemic weakness, so some protocols emerge which can be applied within the overall context which we would primarily treat. We have been asked about peripheral neuropathy on a number of occasions, and a typical answer has been

There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet

shows but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.
Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achievement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.
The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.

From a conventional/western perspective it is quite possible that the Guillain Barre episode has resulted in nerve damage, and to that extent there may be a limit to what is achievable. We do come across cases, though, where the disruption in the flow of energy as we see it produces a pain which is assumed to arise from a broader condition someone has. Once people get a disease label it seems quite common to refer everything back to it. This is why we always recommend in cases like yours that a chat with a local BAcC member is always worthwhile. It is sometimes possible to see signs of blockage which would encourage the view that treatment may help.

We always have to be realistic, though, and after 15 years of unrelenting pain it would be a long shot for acupuncture to do the trick quickly. This does leave you open to the possibility of running up a large bill in the attempt which achieves nothing significant, so if you do decide after talking to someone to go ahead we would recommend that you try to find as objective as possible an outcome measure of progress and agree regular review periods before you start.

Good luck!

Q. Can acupuncture help with pain from post herpetic neuralgia?

A. We are frequently asked about post-herpetic neuralgia, and only a couple of weeks ago we wrote an immensely long answer as follows:

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

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.

to which we added

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

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).

and then added to the answer
We have undertaken further searches to see if the systematic review has been completed (no!), and to see if anything new has emerged. Nothing has, but we are always a little cautious about the results of trials because they rarely use acupuncture in the way that we would, rather instead they use the same points over and over again. This is not really a traditional way of treating but is unfortunately required to meet standard trial designs. From our perspective there are more variables which cannot be removed from the equation, the most significant of which is the individual patient. No two presentations are the same because no two contexts are the same.

This means that while there may be some similarities between aspects of a condition's appearance it will always be essential to look at them in the context of the patient's overall health, hence our recommendation to have a brief face to face chat with a local BAcC member to see what may be possible for your specific case.

We hope that this leviathan gives you an idea of what may be possible. We have addressed the problem of post-herpetic pain here, but in general acupuncture treatment has a reputation for pain management which dates back to the 1970s after Nixon's visit to China. When people saw operations performed with acupuncture anaesthesia it prompted a great many trials which showed the effects of acupuncture on the release of pain-killing neurotransmitters.

The question is not will it work, but usually how much will it work and for how long. What we try to avoid is a regular habit of treatment without much change, although some patients with deep pockets are happy to come very regularly for even a day or so of relief.

As above, though, talking to a local BAcC member about what may be possible is always the best step.

Q. Hi, I have had 3 courses of acupuncture for my tennis elbow. Each time the needles have been inserted around my elbow joint and on insertion and movement (the practitioner twisted the needles once after insertion) there was quite significant pain - I was whinceing. Once in situ there was no pain. Is this normal? Apparently the needles were tapped onto the bone in my elbow to stimulate the healing process. The treatment lasted about 20 minutes.

A. There are two elements to your question, one of which we find slightly puzzling.

It is not unusual for people to experience more sensation when a needle is being inserted than when it is in place. There are a variety of reasons for this. A needle is, after all, a sharp pointed object and fine as acupuncture needles are there are going to be small blood vessels and nerves which it touches on entry and which will cause a sensation, as will the breaking of the skin surface. After a needle has been inserted many practitioners use a quite vigorous action on the needle itself to elicit a sensation called 'deqi' which can vary from a dull ache to something a little more intense. This is particularly the case with Chinese techniques which tend to be a little more forceful than, say, Japanese techniques. Once the sensation has been elicited it tends to subside.

As far as we can tell this is probably what happened to you, and to that extent it is normal. Indeed, for conditions like tennis elbow where there is considerable stagnation of the tissue a more vigorous technique can be advantageous. Even the western versions of acupuncture which recognise what are called 'trigger points' can be a little bit challenging. However, we are a little puzzled by the claim that the needle is actually hitting the bone. This is something we would try to avoid because the tip of the needle might well be damaged by contacting more solid or dense tissue, and we don't really want to be drawing something shaped like a fish hook out of a patient. In the old days when people re-used needles after they had been sterilised this was something which could happen if a bent needle was re-inserted. Thankfully we now all use single use disposable needles, so this particular unpleasantness is a thing of the past.

So, we think there is nothing to worry about. If the practitioner is inserting the needle down to the level of the bone, which is what we suspect they mean rather than deliberately hitting the bone, then this simply means that they are using quite strong techniques which will probably serve you well in getting rid of this annoying problem.


Q. Is there any evidence that acupuncture can help with urology problems ie enlarged prostrate.. P s a 7.5 blood reading,am on wait and see for next 6 months advised.

A. There isn't a great deal of research evidence for the treatment of prostate problems, which we find rather surprising given that it is one of the more frequently occurring problems and more recently the most prevalent cancer in men.

There was a systematic review published exactly a year ago

which made encouraging noises but as usual said that more and better research was needed. Systematic reviews are the top of the pile in research terms. Because they accumulate the results of several trials they tend to iron our anomalies, and so random excessively good and bad results get evened out. If there is a general report of good results that is good news.

Of course, prostate problems are not a modern invention! That said, there is much about the modern lifestyle which predisposes men to issues in this area. The issues which men have in terms of discomfort, problems with passing water and occasional blood in the water have affected men since time began, and the diagnostic systems of Chinese medicine have ways of looking at the symptoms which are the same whatever the system of medicine in use and placing them within a framework which interprets them as blockages and changes in the flow of energy.

The great strength of Chinese medicine is that if places these disturbances in the context of the overall pattern of energy. This causes what many western physicians find problematic, the same disease being treated in as many different ways as there are patients. This means that the symptoms are seen as alarm bells that the whole system is out of balance, and rather than simply treat what appears to be wrong, Chinese medicine tries to address the underlying causes.

This means that in practice we find it quite difficult to say 'yes it will ' or 'no it won't' without seeing the patient in whom the condition manifests. We are not alone in this; the great Canadian physician William Osler often said 'The good physician treats the disease; the great physician treats the patient who has the disease'. This is, we believe, the way to achieve lasting change.

The best advice we can give, then, is that you visit a BAcC member local to you and see if they can offer you a brief chat about whether they think that acupuncture treatment would be beneficial for you. Most are happy to give up a little time without charge to prospective patients, and it means that someone can make a properly informed choice about what to do.


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