Ask an expert - muscles and bones - back / spine

66 questions

Q. I am contacting you on behalf of my mother who has experienced a loss of functionality and feeling in the lower body due to a suspected spinal cord inflammation; feeling/mobility has shown slow/small sign of returning.

Can acupuncture assist in reinvigorating nerve path ways and also address "pain"?

I would be interested in speaking to a specialist who could help discuss this and also understanding the possible help acupuncture could offer.

Thank you for your time and help with this matter.

A. We would be very reluctant to be too committal about the reinvigoration of nerve pathways. There is a small amount evidence for nerve regeneration through the use of acupuncture but this is mainly based on experiments with animals, what our colleagues sometimes refer to as 'ratpuncture' and usually only the peripheral nerves which even in western physiology can show signs of regeneration. Spinal nerves are another matter, and we suspect that a great deal depends on the extent of the impingement caused by the suspected inflammation.

The one hope would be that from a Chinese medicine perspective something has caused a blockage in the flow of energy, some of the more important channels run along the length of the spine, and that treatment might restore proper flow. It is a long shot, but that doesn't mean that it cannot work. What it does mean, though, is that if there is a blockage it will clear quickly, so we would be reluctant to see anyone commit to a long course of treatment.

When it comes to pain there are stronger grounds for believing that acupuncture might bring some relief. After Nixon's visit to China in the 1979s there was a great deal of research into acupuncture for pain relief and anaesthesia, and it was easy to demonstrate that treatment can cause the release of neurotransmitters. Many Pain Clinics now routinely offer acupuncture treatment. The main question is how much relief treatment gives and how sustainable the changes are. If the changes are short-lived then treatment may not be the answer unless it is precisely targeted at times when people need to be pain-free.

As far as specialists are concerned most traditional acupuncture practitioners are by the nature of the system of medicine generalists, and we have never heard of anyone specialising in this field. from our perspective we treat people, not conditions, and our understanding is based on looking at how the whole system functions. Your local BAcC member is perfectly well qualified to offer you a view of how much benefit your mother might derive from treatment. indeed,most of our colleagues are happy to give up a few minutes without charge to prospective patients so that they can make a properly informed choice about treatment.

We are delighted to say that there is some very good evidence  for the treatment of lower back pain with acupuncture. Indeed, until a recent reversal of policy based on what we believe was very unsound interpretation of research, NICE, the clinical guidelines body, was recommending ten sessions of acupuncture treatment as one of the basic offers for people with chronic back pain of over six months duration. You can see some of the evidence on which this decision was based on our factsheet which can be found here:

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html

Of course, from a Chinese medicine perspective treating back pain per se is not really how we work. It isn't just empty rhetoric that we treat the person, not the symptom, and although the symptom might be identical in twenty people they may well be treated in twenty different ways. Each symptom arises against a backdrop of imbalance, and it is by treating the imbalance as well as, and sometimes instead of, the symptoms real change can both be made and sustained. There are obviously specific points which can affect the lower back, but if these are treated alone and a deeper underlying problem is not addressed the pain will return.

The fact that pain can arise in many different ways means that sometimes the obvious diagnosis doesn't really work either. Most people over the age of 50 have some deterioration of the lower spine, but although it is often declared the cause, it may not be. We have certainly treated many people with serious deterioration of the lower spine whose pains have gone.

Acupuncture can also be used for straightforward pain relief, and here the main questions which we have are not whether it works but how much and how sustainable the results may be. There has been a great deal of high quality research into the use of acupuncture to release the body's own painkillers (easily measured and easy to assemble test groups), and it is largely on this basis that most Pain Clinics offer acupuncture.

The best advice that we can ever give, since each patient is unique and different, is to visit a local BAcC member for an informal assessment. Most are only too happy to give up a little time without charge to see whether acupuncture is the best option for your specific presentation. We are confident that you will get an honest appraisal and assessment.

A great deal depends on whether the damage to the nerve had become permanent before the operation successfully dealt with the disc herniation. It is unlikely that the continuing numbness is a consequence of the operation itself unless it was already impinged and then further damaged by the surgery. If this is the case then the evidence for nerve regeneration through acupuncture is not at all convincing and related mainly to experiments on animals. From a conventional medicine point of view unless there is an obvious site of inflammation, or the operation itself has left scar tissue which is impinging the nerve it is probable that this may be permanent.

However, from a Chinese medicine perspective it may just be possible that what you are experiencing as numbness may derive from changes in the flow of energy caused by first the herniation and then the operation itself. We are not in the business of giving people unrealistic expectations but we have come across situations, especially post-operatively, where changes in the flow of energy, called 'qi' in Chinese medicine, can manifest as a loss of sensation. Reinstating this flow can sometimes start to restore some of the sensitivity of the tissues.

This would be a bit of a long shot, but may nonetheless be worth trying. The best advice we can give, and which applies particularly in your case, is to visit a local BAcC member for an informal assessment of what may be possible based on physical sight of the problem. Most members offer some time without charge to prospective patients to check whether acupuncture is the best option, and if they find that there is a strong correlation between your areas of numbness and acupuncture channels it may convince them that treatment would be worth trying. 

Q: My partner has two slipped discs in her back. She been refused surgery due to her age and has now been refused injections.
Will acupuncture help her?

A: We have been asked surprisingly few times about slipped discs, and our answers to the questions have been relatively circumspect, as you can see from this example:

Slipped discs can take a long time to recover, even when using therapies which are known to help. Where the standard treatment in conventional medicine used to involve a great deal of bed rest, continual movement is now the order of the day to help the accumulated tissue to disperse. Our fact sheet on sciatica

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/sciatica.html

mentions a number of studies which show some encouraging results for the kinds of secondary problems which can arise from a slipped disc.

Sight unseen it is very difficult to offer a detailed opinion, but speaking in very general terms, there is often an accident or underlying pattern of weakness which predisposes someone to have a slipped disc, and there are often ways of understanding the disease process from a Chinese medicine point of view which offer treatment possibilities. This can often be the case when someone has reached a plateau in the conventional treatment they are having.

However, it is not uncommon for people to seem to plateau and then for the condition to resolve after 3-6 months, and you may well find that you suddenly begin to make progress again. Acupuncture treatment certainly won't do you any harm, and given that the area where you have been affected will have been quite immobile and 'stagnant' for a few months it is possible that from a Chinese medicine perspective there are significant blockages whose clearance may help to speed up your recovery.

At least a part of the reason for this circumspection is the fact that herniation usually resolves after about three to six months, and it can be difficult to assess in the circumstances whether the acupuncture treatment has added to the speed of recovery. The range of problems covered by the generic term 'slipped disc' is also quite extensive, and assembling a control and test group with identical problems may present problems in the current climate of minimal funding for acupuncture research in the West. We are confident that trials will have been conducted in China but most are never translated. Where there have been good results, though, they do tend to surface quickly, and the absence of research which meets western standards probably speaks volumes.

The fact that surgery has been considered probably points to some quite serious herniation, and we would probably surmise that the best we could achieve would be to lessen some of the pain and reduce some of the symptoms. The extent to which this worked, and how sustainable the change would be, is something only treatment itself would establish.

We always believe that the best option for cases like these is to visit a local BAcC member for an informal assessment of what may be possible. Most offer a small amount of time without charge to prospective patients to get a better idea of what benefit there may be in cases where it is not clear from the 'headlines', and if someone does commit to treatment there is usually a very clear agreement to assess progress after three or four sessions to see whether the progress warrants further time and expense.

Q: Can acupuncture help with polymyalgia? I have this fairly under control with steroids but have a very painful lower back pain.

A: Not surprisingly we have been asked many times about polymyalgia, and a typical response has been:

There are surprisingly few studies into the effects of acupuncture treatment on polymyalgia, and this does limit what we can say from a conventional medical perspective about the treatment of the condition. However, we suspect that this is a great deal to do with the diffuse ways in which the condition presents. In our experience the definition is imprecise, and we have seen patients with identical presentations diagnosed very differently.

From a Chinese medicine perspective, though, this doesn't really matter. For us the description of the patient's symptoms is seen against an entirely different theoretical framework. This involves an understanding of the body as a flow of energy whose rhythms, flow and balance can affect someone's health. When pain arises it is usually a sign of blockage in the system, or excesses and deficiencies which we can correct with the use of needles.

The real skill and art of the practitioner lies in identifying the true source of the problem. Such is the complex web of inter-relationships within the body a symptom will often not be the same as the cause of the problem. Finding out where the root cause is and addressing it is what differentiates a traditional practitioner from someone using simple all-purpose formula points. If the root is not addressed then the problem will come back. This also explains why a dozen people with the same symptom can be treated in a dozen different ways, with treating being individualised to each case.

The best advice that we can give is that you visit a BAcC member local to you so they can give you a brief face to face assessment of what could be possible. A skilled practitioner should be able to give you a rough idea quite quickly of how much change they think they might achieve and over what period of time. Most of our colleagues are happy to give up a few minutes without charge to enable the patient to make an informed choice, and will also be likely to offer good alternatives if they think these will address your problems better.

If asked by a patient what the evidence for the success of acupuncture for PMR is, though, we would have to be honest and say that not only does it not meet the gold standard of western research, the RCT, but often fails to meet any reasonable standard. We believe that this is partly to do with the difficulties of assembling a meaningful cohort for a trial, the diagnosis not always being precise, but partly to do with the fact that treating it as a purely physical condition may not be dealing with the underlying causes, some of which are often mental and emotional.

We believe that, downbeat as it may be, this is still a good answer. PMR is a condition which can on occasion be intractable, and it would be remiss of us to start making claims for treating all cases with great success. For many people the diagnosis is much broader than PMR itself, and there are often complex emotional problems which arise from having been incapacitated for a long time.

However, we are always careful when we see patients not to assume automatically that any pain which they experience is always a result of their 'headline' problem. There are often back pains which have an entirely different root cause, and if this is the case we usually feel pretty upbeat about our chances of achieving something with the patient. Until recently NICE recommended a course of ten treatments of acupuncture for chronic low back pain, and it is one of the commonest presentations in our clinics. The evidence for acupuncture treatment is good, as ourfact sheet shows:

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/back-pain.html

There's actually a short video on our home page of one patient's experience of treatment for back pain.

The advice we gave in the earlier reply still holds good. Find a local BAcC member and ask for a brief interview to discuss with them whether they think they can help. The fact that they can see what is going on and talk to your directly will give you a much more precise answer than we can offer here.

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