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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

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.

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:

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).

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

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5380320/

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.

 

Q. I'm looking at acupuncture courses, I'm currently studying an ITC in massage and anatomy, physiology and pathology. I have been looking at travelling to China to study but am finding info about transferable qualifications tricky to find. Is their a recognised international qualification for acupuncturists?

A. Sadly, there isn't an internationally recognised standard for acupuncture training, and what you may find is that there is an almost infinite variety of training courses in China which can range from 3 month intensive training to seven years full degree and beyond. A problem we have often had in the BAcC is finding out from Chinese practitioners who apply to join the BAcC exactly what their training entailed, so difficult can it be to get hold of course transcripts which map onto the requirements for entry into the BAcC.

The situation is certainly better than it used to be because of the standardisation of training around the style rather confusingly called TCM (Traditional Chinese Medicine) This become a kind of universally acknowledged system because there will always be TCM associations in every country, and most will operate some form of reciprocal recognition with courses in universities with which they have close ties. This doesn't apply to the BAcC which has always been a broad church and has people who practise all sorts of Traditional East Asian systems as well as TCM, but the ATCM, another major association, does have links with particular Chinese courses.

Generally speaking, though, most professional associations have accreditation processes which offer automatic entry to graduates whose teaching institutions they recognise, and then operate an individual application route for people who trained elsewhere. The BAcC, for example, set up the British Acupuncture Accreditation Board over twenty five years ago, an independent body which accredits courses, and the standards which it applies for courses in terms of content are used to assess the training of individual applicants. You can read about how we do this here

https://www.acupuncture.org.uk/public-content/join-the-bacc/3915-join-the-bacc.html

and you will find the Board's site https://baab.co.uk/ interesting, not least because it has useful information for prospective students and training standards but also because it lists accredited institutions, ones that have met its standards. It might be worth considering whether any of these might meet your needs. It's certainly cheaper than travelling to China, and has a level of quality assurance built into it. The worst outcome would be to find that after the expense and inconvenience your training wasn't adequate. This sounds improbable, but we have seen it happen, and it's heartbreaking to have to tell someone that after two or three years work they have to start again.

You may find, by the way, that some of your current A & P training may count towards the acupuncture training and reduce the

Of course, this is all predicated on the assumption that you want to join a professional body! There are almost no legal requirements for acupuncture treatment in the UK other than that the practitioner must be registered or licensed under local authority skin piercing laws. Some local authorities check whether their training is bona fide, but most don't, and if we find it difficult to assess the quality of someone's training it would be equally, if not more, hard for someone who hasn't any background in Chinese medicine. The only other requirement would be adequate insurance.

Anyway, we hope that this answers your question and gives you a little more background.

Q. My son has recently been diagnosed with stage 3b/4 chronic kidney disease. He would like to use acupuncture to help him through this challenging life changing period. Our insurance will cover the costs of this type of treatment.

However, he is unable to get a Doctors note to support this type of treatment either from his GP or from his kidney consultant. Therefore he cannot make a claim from our insurance.

How can I arrange a consultation with a doctor to support his acupuncture treatment?

A. We are very sorry to hear of your problem. We have seen this a number of times where the insurer is apparently happy to cover acupuncture as an option but requires the GP or consultant to act as a gatekeeper in providing a referral letter. We are not sure which scheme provides your cover, but we are aware that the scheme providers are wary of writing a blank cheque to scheme members for treatment where there isn't an agreed protocol which offers a realistic chance of success within a fixed number of treatments. Traditional acupuncture, which is as much about maintaining health as it is repairing damage and disease is potentially open ended and contextual, i.e. the same problem occurring in twenty people might arise from twenty different causes, some of which might respond quickly and some of which might not.

Since the schemes are created on an actuarial basis, where the provider has to have a realistic idea of what the commitment is, then the doctors and consultants are often instructed only to refer those patients with conditions for which there is a goof evidence base and standard treatment. This reduces the number of referable conditions dramatically.

It may be possible to locate a doctor who is prepared to refer your son; many private hospitals have GPs who are able to see patients at a price. Whether this would count as a referral is another matter; there's no point in spending £100 for a letter which your insurance company will repudiate anyway. We have seen patients whose companies have larger schemes which they control use this as a bargaining/blackmail chip by threatening to pull all their staff our of the scheme and go elsewhere, but this does have the disadvantage of a fresh start for people with pre-existing conditions whose cover lapses immediately.

We have found that talking directly to the insurance providers is often the best bet, both for throwing yourself on their mercy and also for finding opportunities within the system which you might be able to use to your advantage. Companies are run by human being who are often predisposed to help.

Another option is to use the PALS (Patient Advisory Liaison Service) which, in our experience, is pretty effective at fighting patient's corners. If you son is under hospital supervision, which we are sure he is, then this may well be worth a go. it won't be costing the hospital a bean, and consultants do not generally want the hassle of people nagging them when they might be shown to be unsympathetic. At very least it offers you something concrete about why they are refusing to sign, and that gives you are starting point for further negotiation.

There isn't a great deal of research we can point you to to support your case, and studies such as this

https://www.ncbi.nlm.nih.gov/pubmed/28422526

are few and far between. However, if you do get to a point where evidence might help to sway someone's mind then we will do what we can to help you.

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