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This is a very good question. It is the received wisdom inside the profession that treatment should be started as soon as possible after a stroke, and that the potential for change and improvement diminishes over time. This is driven in part by the fact that in China it is not at all unusual for someone to start having treatment on the day of a stroke, the logic being that the energy of the body has been disturbed and the sooner that it is corrected, the less likely the disturbance is to be 'set' in the system. 

We have some sympathy with this view. There have been several books published in the last couple of decades which have explored the possibility that once an energetic pattern has become established it is no longer seen as a pathological factor but becomes the essence of the person. This means that someone can in a rather peculiar way become invested in the post-illness state as their reality, with the attendant difficulty in getting things to change. If you talk to people who teach the Alexander Technique you find the same model; once the body has  a set pattern it takes a long time to re-train it.

However, our clinical experience with post-stroke patients is rather more mixed than this. Whilst we have always warned patients who come in many months or years after the initial stroke that progress may be slow or in some cases non-existent, we have found that some people do have a marked and immediate response to treatment, often in direct proportion to their underlying constitutional health. A person who was strong and energetically in good shape before the CVA often has a greater power to recover.

There has been a mountain of research into this area, as you can see from the rather long review paper which we have on our website

but which may be a little technical for many readers. It has long been our hope that the evidence will reach a critical mass where we can argue a case for early intervention within the NHS with acupuncture treatment, if for no other reason than the fact that increasing the speed of recovery would save the NHS millions of pounds in rehabilitation costs. We have some hope that familiarity with the Chinese system will encourage some trials in the UK.

As far as your brother is concerned, however, it is rather difficult to say what might be possible without a face to face assessment. What you and he will find, however, is that most of our members are very happy to give up a little time without charge to prospective patients to see whether acupuncture treatment would be a good option. Most of us are very frank about someone's chances because the disappointment of achieving nothing or very little is just as palpable by the practitioner as the patient. We get it wrong - some people we think we can't help recover amazingly and we think we can help don't. In the main, however, we tend to recognise those people for whom acupuncture is well worth a try.

The crucial thing is to try to set measurable outcomes so that improvements are not just a matter of feeling better in oneself, good as this is, but visible through verifiable markers - better range of movement, greater endurance in in walking, and so on. This avoids the problem of running up a large bill without really getting anything back. If it isn't working after five to ten sessions it is better to draw a line unless there are secondary improvements which render the treatment worthwhile.

We are really sorry to hear of your son's problem. These extremely uncomfortable but largely undiagnosable problems often create what the doctors call heartsink patients, the ones for whom they do not have an immediate answer and for whom they run out of options fairly quickly.

We were asked about a similar problem some years ago and our answer then encapsulates the general response to these sorts of problems:

We wish that we were able to say with confidence that acupuncture treatment would be of benefit. However, as far as the research goes, which is the only basis on which we are able to make claims to efficacy, there is very, very little. This probably has a great deal to do with the fact that conditions like tenesmus and anismus often spontaneously reverse, and are therefore quite difficult to research because gathering a trial and control group is hard. The other problem is that most people are trying just about everything at the same time, so a clear difference between acupuncture and acupuncture plus the normal treatment is not easy. Most people simply say 'throw everything at it.'

Clearly from a Chinese medicine perspective, based as it is on the underlying belief in an energy, called 'qi', and the understanding of its balance, flow and rhythm, there are ways of looking at conditions like this which are different from a conventional western medicine understanding. These could range from a simple consideration of what is flowing in the area, i.e. which channels might be affected, to a functional concern, i.e. which part of the system maintains good function in the end of the colon and rectum, and a broader look at what might have caused the problem to begin. The ancient Chinese, for example, had a very complex understanding of the effects of heat, cold and damp on the system, and very often attributed griping and spasmodic pain to the invasion of cold into a body orifice. For a race which was largely agricultural this kind of phenomenon was seen to be based on common sense. Although it is not as common in modern life to be exposed to extremes of climate in this way we have seen several cases where people have literally been exposed to cold breezes while inadequately dressed and suffered symptoms such as these.

From the Chinese medicine perspective, however, there would also be other signs and symptoms in the patient's presentation which would guide the practitioner's strategy, and these might just as easily point to a systemic problem of which your husband's symptom was a small manifestation.

Our only advice in cases like this is to visit a BAcC member local to you and seek their advice in person. This is the sort of case where there is no effective substitute for discussing with the patient what is happening, and offering a more rounded judgement on the potential benefit of acupuncture treatment.     

We have checked again for any research trials which might have surfaced since we gave this advice, but have found none. There are occasional sites like this one,

whose provenance we cannot check and which is riddled with advertisements and referrals on which we cannot comment, but what it does do is to offer some very real interpretations in Chinese medicines for what is happening and the relevant treatments. This kind of 'named condition - Chinese medicine treatment' is not how we believe we work, although it is becoming increasingly common in China, but it has to be said that for cases of acute pain it is often an approach that will bear fruit. 

The advice we gave in the earlier response holds good, though. If your son visits a BAcC member local to him for a brief chat about what may be possible we are confident that the practitioner will be able to make some sense in Chinese medicine terms of what is going on and give a balanced view of whether acupuncture treatment may be able to help him. 

Although there is an increasing amount of research into the use of acupuncture treatment after radiotherapy the majority of studies are aimed at specific symptoms which often accompany treatment - nausea, dry mouth, fatigue etc. Unfortunately nerve pain or generalised pain in the pelvic region is not amongst them, and we suspect that this is because the generality of the symptoms makes it difficult to assemble meaningful trial groups. The results of the research show some quite positive outcomes for dry mouth and nausea, but as always is the case with acupuncture research the conclusion is that larger and better designed trials are needed. Even if someone had researched nerve pain specifically, the chances are that this is what the conclusion would be. The bar is set very high, and not always appropriately, for the work we do.

That said, there is a substantial and growing body of evidence for the treatment of neuralgia with acupuncture, even in the strange limiting cases like phantom limb pain, so it would not be a bad idea to see if treatment could alleviate some of the discomfort. The effects of radiotherapy in terms of the heat and scarring of tissue are outcomes which can clearly be translated into the diagnostic systems of Chinese medicine, and a practitioner can hope to address some of these within the overall constitutional setting within which they have had an effect.

The idea of context is central to Chinese medicine. Every is a unique blend of energies, so even when two people have the same symptoms they might arise from different internal disturbances. The skill of the practitioner of traditional acupuncture lies in treating not the symptom but the person as a whole. This means that the kinds of damage which radiotherapy can do will differ from person to person, both in terms of severity and in terms of potential for recovery.

The best advice that we can give is that you visit a local BAcC member for an informal chat about what may be possible. Most of our colleagues are happy to give up a little time without charge to establish whether acupuncture treatment might be worthwhile, and this gives you a chance to meet them and see where they work before committing to treatment. There is nothing to lose from trying treatment. Not only is acupuncture a very safe therapy but it does not have any major side effects. Even if the treatment managed to help you to deal with the discomfort it may be worthwhile.

The key thing is to set measurable outcomes from the beginning so that you can judge how well the treatment is working. Amounts of painkillers, sleep disturbance and general energy levels are the usual markers, and using them sidesteps the problem that people can feel good on some days, bad on others, and are not always able to say on any given day whether they are feeling better overall. 

If we took your question as face value as one about peripheral neuropathy then we might be tempted to use an answer we gave quite recently:

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.

This is quite a useful start because it sets out some basic principles and also emphasises that for conditions like diabetic neuropathy in the language of modern sales talk, 'once it's gone, it's gone.'

However, without any further elaboration of the health condition which may be the root cause of your symptoms we would be looking at them as they were in  themselves and trying to make sense of them within the framework of Chinese medicine. As our factsheet on vertigo shows

there is a growing body of evidence which suggests that acupuncture might be of benefit, but even here we would say that vertigo is simply a label for someone's experience, and that once it is put in the context of someone's overall balance it can be the result of any number of possible imbalances from a Chinese medicine perspective. That is why we invariably recommend that someone sees a BAcC member for an informal chat. Most are happy to give up a little time without charge to discuss based on a first hand view whether acupuncture treatment might the best option for you. We have confidence that if it isn't they will say so. There are alternatives if this seemed to be the case.

It does illustrate very well for us, though, how working backwards from symptoms to a disease label can make a huge difference to how one perceives a problem. The great strength of Chinese medicine is that it see symptoms in their wider context as manifestations of the disease, not necessarily the disease itself.

We're not quite sure whether you are asking about having sessions of acupuncture with your GP or whether you are considering asking your GP whether it is OK to have acupuncture.

If it is the former, then we suspect you may not get very far. There are quite a few doctors who now incorporate acupuncture within their day to day practice, but generally speaking they are normally only allowed to do so when there is an evidence base for the condition which they are trying to treat. For a variety of complex reasons most of the research into acupuncture doesn't pass muster with the UK regulatory agencies, and chronic lower back pain is one of the few that does. Unfortunately NICE, which used to recommend ten sessions of acupuncture for chronic lower back pain, has recently reversed its ruling, so it is now unlikely that your GP will take advantage of this to refer you on or to treat you themselves.

There is nothing to stop you asking your GP if he or she is happy to give you acupuncture treatment, and most GP practices have at least one partner who uses acupuncture regularly. In terms of getting treatment free at point of delivery, this is perhaps your one and only option.

In terms of safety with the problems which you have, there is nothing in the literature to suggest that any of your health issues might make acupuncture a bad idea. We have experience of treating people with all of these problems. We are always careful with epileptic patients, but that is mainly because many want to get off their medications and we would never make that recommendation, however successful treatment may appear to be. When a condition is well controlled even GPs are reluctant to interfere with the treatment plan. As far as mental health issues are concerned we advise members to be aware of their limitations. Although we take detailed case histories and explore many problems with patients there are some areas where a practitioner needs specific skills in addition to acupuncture training to be able to understand the kinds of problems with which they are dealing. We regard mental health issues as one such area, and we are in the process of exploring standards for expert practice which would define what additional training a practitioner should have.

As far as the back problems are concerned, we feel confident that acupuncture treatment may well be able to help, but you may find it worthwhile to discuss your complex health background with a local practitioner before committing to treatment. Most acupuncturists are happy to give up a little time without charge to discuss with prospective patients whether acupuncture is the best option for them.

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