Ask an expert - body - abdomen / gastro intestinal - pain

6 questions

Q: ]I have a permanent horrible acid taste in my mouth, morning to night. And pain in the mouth. > I take protopump inhibitors but they make no difference. > I also suffer from vasculitis affecting the nerves in arms and legs. > Fatigue, anxiety goes with this. > Could acupunture help?

A:  This sounds like a complicated mixture of symptoms, and we have to admit that we enjoy cases like yours because very often the diagnostic systems of Chinese medicine can put together all of the problems in a single overarching diagnosis. However, here we shall take them one at a time.

The acid taste in the mouth is probably just that, if you are taking proton pump inhibitors, stomach acids which are finding there way
upwards. This is immediately suggestive to us of a hiatus hernia, where the incompetence of the muscular ring in the diaphragm allows the top of the stomach to protrude through, and thereby opens up a permanent conduit for acids to rise up with any action which squeezes the stomach, like bending over, or where the person lies flat. This needs to be addressed because the acid will
eventually start to cause problems in the oesophagus which can be more difficult to treat.

From a Chinese medicine perspective the acid or bitter taste is a sign of excessive heat in the system, and the practitioner will be looking at why this heat is being generated. The 'pain in the mouth' doesn't quite give us enough to work on. It may be a part of the same problem - acid reflux sufferers often get a persistent cough or sore throat, and in some cases this can extend to pains in the mouth, but without more detail we can't really comment. Our factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/gastrointestinal-tract-disorders.html

gives a good indication of the kinds of research which have been done and how successful treatment may be.

As far as the vasculitis is concerned, again it is difficult to comment without greater detail. Vasculitis is a relatively rare condition
with many cases going into remission without needing treatment. There is nothing of consequence in the research databases about this specific manifestation, which is not surprising given the rarity of the condition.

Our advice to enquirers is very often to visit a local BAcC member for a brief face to face assessment, but in your case we believe that this is essential if you want the best possible advice. As we said at the top of the email Chinese medicine has complex diagnostic processes based on an entirely different understanding of how the body works, and it is often possible to make sense of symptoms which from a western perspective have no connection at all. Our first thought was to be intrigued and we suspect any colleague you visit will be too.

A: There is no absolute contraindication to acupuncture after a mastectomy. The advice we give to members in the Guide to Safe Practice, an internal document which contextualises the provisions of the Code of Safe Practice, is:

Most patients who have had lymph nodes removed (eg from the axilla after a radical mastectomy) are cautioned against being needled in the limb below the site of lymph node removal due to the increased risk of infection.

It is advisable to mark your treatment notes clearly and visibly to ensure that you do not overlook this in practice.

There have been some discussions about whether the entire quadrant of the body relating to the affected limb should be avoided. Most patients are, however, just advised by their consultants only to avoid having the affected limb needled.

We recommend that in each individual case you follow the individual guidelines the patient has been given by their consultant.

We would leave it to someone's professional judgement about when it would be appropriate to needle proximate to the scar tissue itself, but members are trained to err on the side of caution. Indeed, the nature of traditional acupuncture, where points can be used to act on areas of the body far removed from the needle site means that there are always ways of treating an affected area without going near it.

This is particularly apposite when the mastectomy has been accompanied by the stripping of lymph nodes in the axilla, after which many women experience some lymphoedema. Amplifying the advice we give in the Guide in a response to another enquirer, we said

As far as needling a lymphoedematous arm is concerned, our current recommendation to members is that this is not to be done. Although there is little or no evidence to support the almost universal prohibition of acupuncture by consultants, we have to acknowledge that there is an increased risk of cellulitis and other infection from needling a limb below where lymph nodes have been removed. However, there are many ways of using the interconnections within the system as a whole to treat successfully at a distance within the body, and a qualified practitioner will have many ways at their disposal to effect change and improvement.

Indeed, one of our members, Beverley de Valois, has published several landmark papers in this area

http://www.researchgate.net/profile/Beverley_De_Valois/publications

and has shown that treating constitutionally without needling an affected limb can be very beneficial.

We have heard of instances where the prohibition of acupuncture after mastectomy has been total, and we can only re-iterate what we said in this response, there is no evidence that acupuncture has elsewhere on the body has any adverse effects on a post-mastectomy patient.

Q:  My daughter has intermittently crippling trigger-point pain in the side of her abdomen. Is there any evidence that acupuncture can help? If so, which is the best kind? Massage will certainly be out of the question, she is too tender.

 

A:  It is interesting to us that you use the term 'trigger point' pain, since trigger points themselves belong to the vocabulary of systems of western medical acupuncture and refer to knots in muscle which often cause symptoms, often quite severe, to occur elsewhere along the fibres of the muscle and the structures to which they attach. The location of the trigger points, and their treatment with acupuncture, is a system which many doctors use, and is replicated in Chinese medicine where the knots and the pain consequent upon their palpation are referred to as 'ah shi' (literally, 'yes, that's it') points, and often treated with a similar direct needling. The main difference in treatment will probably be that the Chinese medicine practitioner will also be looking at the overall picture to see whether the knots form a part of a broader pattern of imbalance within the patient's system. This can ensure that any underlying conditions which may cause recurrences of the problem are dealt with.
 
We are sure that you have already had all of the routine western medical examinations, but if this is not the case then this would be our initial and fairly urgent recommendation. Pains of this nature in a child usually have a specific cause, and the obvious ones should be eliminated by investigation first. If she is too tender for massage, this would indicate a more generalised discomfort which may point to an underlying pathology. If there are no obvious pathologies, then the choice of practitioner is really up to you, since the treatment approach may be very similar. Your doctor may even be able to offer this as a part of their service.
 
However, although we do not as yet recognise specialisms in acupuncture (our view is that we are committed to generalism - every practitioner is capable of treating any patient within the limits of their competence), there are many BAcC members who undertake specific postgraduate training in treating children, and they are very used to dealing with children. We cannot make individual referrals for obvious reasons, but it should be relatively easy to track down someone local to you who has undertaken such training and with whom in the first instance you can discuss whether treatment may be of benefit. We are sure that they will offer you an independent and impartial assessment of the best course of action.
 

Q:  I am a 34 yr old female. I have experienced rectum pain for the past 3-4 yrs. It is sharp and feels like muscle spasms. Lately I seem to get it every day. Nurofen seems to be the only tablets that work effectively and quickly. My doctor has done some tests and can't see anything obvious. She has suggested sending me to a dietician though I am not convinced. Can acupuncture help?

A:  It is extremely difficult to say whether acupuncture treatment would be of benefit in a case like yours. There is very little evidence that we can find, and such as there is is normally a feature of case histories of ulcerative colitis and very clearly diagnosable gastro-intestinal conditions which would be instantly recognisable to your GP. The fact that the tests have come back without any obvious signs does make recommendations more difficult. The referral to a dietician may be based on some aspects of the case of which we are not aware, such as the timing and nature of the food you eat, and if this is the case you may well find that the referral is a good one. Many people have diets which, though well intentioned and often recommended as natural or healthy, are not at all good for their systems.
 
From a Chinese medicine perspective, a practitioner would probably want to talk about the way the condition developed in the first place, the sort of general health background against which it developed, the longer term context of your overall health and family's health, and the speed with which it became a problem. Chinese medicine in this respect is no different from western medicine; the patient is like a puzzle which the practitioner detective-like tries to unravel. The entirely different conceptual and theoretical basis on which Chinese medicine works may offer solutions which would not be apparent to the western practitioner, and there may be aspects of your overall functioning which point to specific treatment possibilities.
 
Generally speaking, however, the best that one can do in these cases is to treat the person according to the principles of Chinese medicine and see whetherre-establishing balance overall helps the specific symptom to reduce or cease. This can sometimes lead to the odd situation where a symptom goes without anyone being clear about what caused it, but the patient is usually not too troubled by this.
 
If you did decide to try acupuncture we would advise that you set a very clear limit to how many sessions you try initially so that you can assess whether it is helping. We do not like to see situations develop wherer someone has ten or fifteen sessions without discernible change and feels cheated. If the process is agreed from the start, such as a review at five sessions, then the room for misunderstandings is reduced.
 

 

Q: My wife has severe rectal pain,she has had haemorroids removed,had mri scan been to see various specialists,but they cannot find cause,do you think acupuncture could help to ease the pain.

 

A: This is a very difficult question to answer. Acupuncture has a long history of being used for chronic pain and for post-operative pain, as our factsheets

 

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describe. However, in a case such as you wife's, with a very specific and acute pain in an area which is not available for direct needling, we have to be a little cautious in whay we can say.
 
There is no doubt that the diagnostic techniques of Chinese medicine might give an insight into what is happening within the system from an eastern perspective, and there are both systemic problems and local blockages which might cause an acute symptom such as this. There is also the general premise on which eastern medicine is based that when a system is fully in balance everything functions as it should and symptoms tend to resolve. When someone has had local and specialised surgery, however, there may also be local neurological damage which could cause a severe symptom which might not manifest symptomatically.
 
Our best advice is to see if you can arrange a visit to a BAcC member local to you so that they can assess whether there is anything which presents itself as an obvious intervention which might help. There may well be tender or sore reflex points, for example, which present treatment options. Treatment certainly wouldn't do any harm, but we would advise that if you do decide to go ahead you should be very clear about measurable outcomes and frequent reviews. If there is no sign of progress after three or four sessions it may be worth exploring with the practitioner what other treatment options there may be.
  
 
 

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