Ask an expert - muscles and bones - back / spine

66 questions

Q:  I had decompression surgery July 2015 to relieve l5 nerve. I reherniated within 3 months and again have lower back pain and nerve pain. Could acupuncture help deal with pain/inflammation?

A:  There is certainly a considerable amount of evidence for the use of acupuncture in the treatment of low back pain, as our factsheet shows

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

The evidence is sufficiently robust that NICE make acupuncture one of its recommendations for treatment of chronic back pain lasting more than six months.

However, when there is a specific cause like a herniated disc, we tend to be just a little cautious about what may be possible, especially when we are not entirely sure of the nature of the surgery (fusion, laminectomy, discectomy, and so on). Where there are specific physical changes in the body that can limit what we are able to achieve. This may mean, for example, that treatment might be aimed at pain relief and reduction of inflammation but only with the expectation that this will eventually return. The equation then is between how much relief and how sustainable, and the cost of maintaining an 'acceptable' level of discomfort.

It is best not to be too negative, however.Our clinical experience is that when there is disc protrusion which will probably resolve of its own accord within six to twelve months treatment may be able to speed up that process, and may well be able to reduce some of the inflammation which it causes. There is a spiral of discontent where a problem causes inflammation which exacerbates the initial problem, and conventional medicine is often aimed at the same thing, to break the cycle and let things stabilise.

In summary, we suspect that treatment may well be able to help with the pain and inflammation, but we think that the best option is for you to visit a BAcC member local to you for a slightly better assessment than we can offer here. Most are willing to give up a some time for prospective patients without charge and this sort of face to face assessment would in our view be essential to give you the best possible information. We treat people, not conditions, and the great Canadian physician William Osler summed this up well; 'tell me not about the disease the patient has, tell me about the patient who has the disease.' The wider context within which the symptom sits can have a huge impact on what can be done, and with problems like yours really does need to be taken into account. 

Q:  Recently I had a broken t7 in my spine.  This has left me with bad pains around my ribs which I am told is nerve damage and could last longer than 12 months, Would acupuncture help and can I get this on nhs or if not can you recoimmend anyone  in my area, kt152fd Addlestone surrey? 

  

A:  A great deal depends on the way in which the nerve damage has occurred and whether there is any residual impingement which will keep generating pain. If the damage has caused long term inflammation which in turn presses on nerves and creates a cycle of further pain and inflammation, then the acupuncture treatment may well help to break this cycle and allow the area to settle down. This is essentially what conventional medicine does with the prescription of painkillers and anti-inflammatories.

Acupuncture treatment first found greater prominence in the West after Nixon's visit to China and the extraordinary scenes of people having surgery without anaesthesia while under acupuncture treatment. This led to a focus on researching on the painkilling effects of acupuncture, and there is considerable research on this which shows convincingly that it works. The question is really not whether it does or not, but how long the pain can be controlled and to what extent. If acupuncture is like a short term medication which wears off then unless someone has really deep pockets and the trade-off is that they get a reasonable amount of pain free time, it's not really a viable option.

Chinese medicine, though, is all about restoring balance in the system in the simple belief that a system in balance will heal itself better and quicker. On that basis we would have to say that traditional acupuncture is geared to helping the person as a whole to recover, and our clinical experience of treating people after injuries or operations is that they do appear to heal more quickly than their counterparts  If you google 'ncbi acupuncture post-operative recovery' you will see a number of studies which seem to show that there are some very good reasons to think that treatment may be of benefit.

Since each case is unique and different, however, your best bet is to seek a brief face to face assessment with a BAcC member close to where you are. Most are happy to give up a little time without charge, and can advise you far better by actually seeing what is going on. Using the postcode function on our home page www.acupuncture.org.uk will identify several practitioners near where you live. We can't recommend individual practitioners, but we can assure you that all our members are trained to degree level and work to high standards of safety and conduct.

As far as getting acupuncture treatment on the NHS is concerned perhaps your only hope would be your local Pain Management Clinic where acupuncture is quite often a part of the offer they make. Otherwise there is very little prospect of getting treatment free at point of delivery; NHS funds are very tight at the moment and even where there is a proven evidence base and a NICE recommendation there are very few of our members who have managed to find funding.

A:  Acupuncture has traditionally been used for chronic pain, often because the first major publicity event for acupuncture in the West, Nixon's visit to China in the 1970s, saw operations carried out without anaesthetic under acupuncture, and a great deal of research was stimulated into the pain relieving and anaesthetising effect of treatment. Many pain management clinics now feature acupuncture as a part of their offer. The main question is not whether the treatment will relieve the pain as much as how much relief it will give and hows sustainable its effects are. Used in this way it can sometimes, if affordable, be enough to keep someone going.

However. from a Chinese medicine perspective pain only arises where the flow of energy, called 'qi', has been affected, either from a blockage, or from a deficiency or excess in the channels through which it is said to flow. Knowing where pain appears is less important than understanding how this sits against the backdrop of the whole system. On many occasions the pain is local and to do with specific local issues, but even here the question is how the system has lost its ability to repair. More often than not, however, the pain appears as evidence of a deeper functional disturbance, and the skill of the practitioner lies in making sense of the local manifestation of discontent in the context of someone's overall balance.

The way in which energy flows in the body, and the various functions which are grouped together under the heading of an Organ (capitalised because the meaning is far broader in Chinese medicine) often show greater connections than are apparent from a conventional medical point of view. If the symptoms, for example, tended all to lie on the same channel, and this channel happened to be associated with an Organ generating other symptoms of functional disorder, this would immediately inform the practitioner and point to various treatment possibilities.

The best advice for concerns like yours is to visit a BAcC member local to you and seek a brief face to face assessment to see what they think may be possible. We would be very surprised if they did not immediately make some connections which informed their view, and if so, we think they will probably advise you that four or five sessions may be a worthwhile investment to see how well your system reacts.

 

Q:  I had accupuncture for longstanding low back pain radiating down the right leg. It helped considerably. I had 5 sessions, each time it helped more. On the 6th and last session the needles hurt more when inserted and I was very achey. A month later all my symptoms have returned and I am in considerable pain. The only difference I can think of is that before the last session I did some exercise in the gym about an hour before and my muscles were more taut. What can I do?

A:  On reading your account we doubt very much that there was anything about the final session or what you did thereafter which has led to the return of your symptoms. If there has been a severe reaction to treatment, or if something a patient has done like over-eat or over-exercise immediately before or after a treatment, then the reaction is usually pretty immediate. However, as quickly as the reaction comes it usually goes; most adverse effects after treatment wear off after about 48 hours.

It is more likely that the treatment provided some pain relief without actually changing the underlying pattern of discontent in the system. We often give advice to people with chronic back pain along the lines of assessing how much pain relief the treatment offers and how sustainable the change is. We find sometimes that the underlying problem doesn't really shift, but acupuncture treatment can push it into the background for a while as long as it is continued. The question then is whether it is practical and cost-effective to keep on with treatment, and this can take into account all sorts of factors.

The other possibility, and we say this with great caution not knowing what kind of treatment has been offered, is that the treatment did not really focus on the system as a whole but was aimed primarily at the back itself as a symptom. There are a considerable number of physiotherapists and doctors offering acupuncture treatment, and generally speaking we are not too concerned. Many use acupuncture to great effect, and our view is that the more people who have successful treatment, the better for all of us. However, they tend to take a much more symptomatic approach with formula treatments, and our view is that for many people the symptoms which they have have to be understood in the context of how the energy of the whole body is flowing. The symptom is merely an alarm bell, and turning it off doesn't change the underlying pattern. If that is what the treatment did, then the symptom will return.

As we said, though, we can't really be more specific than that without knowing exactly what has been done and with what intent. If acupuncture treatment worked before it will certainly work again, but it would be useful to discuss with the practitioner what continuing treatment may be necessary to sustain the improvements you make. Our experience is that people with chronic back pain tend to develop all sorts of changes to the way that they hold themselves which over time become their familiar 'shape', and it can often take quite a while to encourage this shape to soften and allow the body to regain and maintain the better posture which treatment can encourage. Osteopaths and Alexander teachers often find the same problem; getting someone back into the correct shape is not as much a problem as keeping them there.

Q:  Posterior rami syndrome neck to shoulder blade to lower rib to lower right side abdomen pain,idiopathic sensory nerve syndrome.  Could acupuncture help .Maybe sacra joint dysfunction..

A:  Posterior ramus syndrome is an unusual problem which was not really precisely defined until the latter part of the last century, although its appearance had been described for at least a century before that. The key factor in the description is that its appearance is unexplained, often described in medical literature as idiopathic, which is a smart way of saying 'it just happens.' There are a few examples where there has been a pre-disposing cause from accident or injury, but the majority of cases arise without obvious reason.

Whether acupuncture could help with suppressing the activation of the nerve roots which causes the problem is a moot point. There is no research that we have been able to locate which suggests that it can. Although there are certain to have been some studies in China, very few Chinese studies are translated and many are methodologically weak, especially from a western research perspective where the randomised double blind control trial is the standard for measuring both efficacy and effectiveness.

However, we have on several occasions been asked about phantom limb pains and whether acupuncture can de-activate the nerve signals which caused referred pain from non-existent limbs, and there are a number of reasonably good quality papers which provide evidence that this can be done. On that principle there may be some hope that treatment might be able to achieve something similar.

Of course, this is to look at treatment from a very western perspective, where needles treat specific conditions. This is far from the basis of Chinese medicine, based as it is on the concept of energy 'qi' and its rhythms, flow and balance in the body. From this perspective the interpretation of the symptoms from which someone suffers is made against a complex understanding of the patterns of flow and how the symptoms sit within these patterns. This is why a number of symptoms in different parts of the body can make sense from a Chinese medicine perspective because they all lie along a channel or meridian which can link head to toe, and all points in between. Nerve pains and pain in general often have specific areas of appearance which associate with the flow of channels and the use of acupuncture treatment to restore the flow where it has become blocked can often have a beneficial effect.

Your case, however, while not unique, is specific enough not to be able to trade in generalities in a written answer on web helpline. The best advice that we can give is that you visit one of our members local to you and seek a brief face to face assessment of what benefit acupuncture treatment might bring. It may well be that they see something in your presentation or in the diagnostic signs which will give them a much clearer idea of what may be possible than we can give here. It may also suggest to them other therapeutic possibilities.

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