Ask an expert - muscles and bones - back / spine

66 questions

A:  It is tempting to trot out the usual information about how successful acupuncture is at treating back pain to the extent that it is one of the treatments recommended in the NICE guidelines. However, your brief e-mail hints at a very complex history, and any good practitioner would want to know a great deal more detail about the operations you have had, and also the injections, before offering a balanced view of what might be possible.

The usual operations in this sort of area, like laminectomies and fusions, always have an effect on the flow of energies in an area, and sometimes from a Chinese medicine perspective create long term blockages which are very difficult to correct. In these circumstances there is often something to be done to reduce the long term pains from which people suffer, and make them more manageable, but getting rid of the pain altogether may be a much longer shot.

That said, we have all seen patients with very long histories of back pain and often with a history of operations and all sorts of invasive treatment who have experienced great improvements. It is, though, impossible to predict which ones will benefit best, and that is why the good practitioner will be cautious and recommend that no more than four or five sessions are worth trying to see if the treatment has an effect. After that there is a second issue: the treatment may have an effect but how much and how
sustainable. This can often become a matter of cost; if a treatment gives a week's relief then unfortunately it is a matter of deciding whether the cost of achieving this much change is warranted by the opportunities it offers. If someone can remain in full time employment as a consequence the trade off is obvious. If, however, they are on a pension or reduced income, it may become more of an issue.

Treating to maintain an even keel with some pain is a legitimate way of operating. It is sometimes sensible to recognise the limits of what is possible and work within them rather than chase rainbows in the hope that a therapy will suddenly transform a long standing condition where everything else has failed.

The best advice we can give, and which we often give but which particularly in your case, is to visit a BAcC member local to you for an informal chat and brief face to face assessment of what they think they might be able to achieve. If they think that acupuncture treatment may offer some real benefits they will say so but we also trust that they will tell you if there are alternatives. like cranial osteopathy for example, which may work better or work allngside the acupuncture to give you the best shot at getting
some improvements.

Q:  My mother of 80 years has many problems.  She has chronic arthritis and osteoporosis her spine is crumbling and she suffers terrible back pain.  For the past 2 years she has developed tremors which are in her hands and legs now.  Doctors diagnosed her as having Parkinson's but they feel after no success with drugs to treat the tremor they think she has something different but don't know what . she has bowel problems nausea and no appetite and us tiredcall the time.  She has poor concentration now and can't follow a TV programme read a story or knit , as she can't follow the sequence.  Her memory is pretty good though and she will remember many things going on in my life when I call her on the phone.   I am wondering if there could be some blockage in her spine to her brain that is causing the latter problems and could acupuncture help ? She awaits a brain scan on.   She is pretty much at the end of her tether and seems to be barely coping with all that is going on for her .  I would appreciate your thoughts.

A:  This is such a complex presentation we would be very reluctant to give a definitive view of whether acupuncture treatment may be helpful. We do believe that we are treating the person, not simply the condition, and the diagnostic skills in which we are trained very carefully will identify the balances and blockages. These are not always identical to the symptoms which someone has, the view being that symptoms are mainly alarm bells which point to fundamental imbalances in the system. However, over the centuries specific symptoms, when view together, do point to areas of weakness, and the practitioner's skill and art lies in tracing how they have developed and
which ones are primary. 

This is all a very roundabout way of saying that an experienced practitioner will almost certainly be able to find something which can treated in Chinese medicine terms , but whether this will then reduce the symptoms from which your mother is suffering will only become clear after a number of sessions. She certainly won't be risking any more disturbances by having treatment. We tend to say to people that it may be worth having a short course of treatment, perhaps four or five sessions, and then assessing
carefully what improvements there may have been and how sustainable they are.

There are a number of BAcC members in Aberdeenshire, and we are absolutely sure that any of them will be more than happy to see your mother for a short assessment visit without charge to let her know whether they think acupuncture may be a good option for her. Some of the symptoms from which she is suffering are suggestive of a need for other types of treatment, possibly cranial osteopathy or dietary adjustments, and it is highly likely that an experienced practitioner will know other professionals with whom they cross refer on a regular basis to ensure that patients get what they need.

The one thing we would say, though, is that your mother's age is no reason to believe that acupuncture will not have a good effect. This expert has treated ninety year old patients, and been pleasantly surprised by how well they respond. If her spirit is strong, there is potentially much to be done. We hope that you and she manage to locate the help that she needs.

Q:  I have had recurring back pain problems for about 10 years.  I have had various physiotherpists give me exercise but I am still have back pain.  Would acupuncture help?

A: For back problems we can make a positive recommendation of acupuncture treatment. The evidence which has accumulated over the years has been sufficient to convince NICE, the body which defines suitable treatments within the NHS, that a course of up to ten treatments should be available within the NHS for chronic back pain. Unfortunately acupuncture is just one of a number of options for treatment, and we have seen very little evidence of anyone contracting with our members to provide treatment which is free at point of delivery, but in time we hope this begin to happen.

Our fact sheet on back pain

provides references to some of the research, but such is the prevalence of the problem there have been many more studies of varying degrees of rigour which all seem to point to positive outcomes.

The two factors which will be of interest to a practitioner will be the way that the problem developed and how it relates to the overall functioning of the body, and how entrenched some of the coping patterns have become. As far as the former is concerned, unless the pain has arisen as a consequence of an injury it is usually a part of the much larger picture of what is happening in the body, and this is the great strength of Chinese medicine, understanding this back pain in this person rather than simply applying formula treatments for everyone. The latter issue can sometimes be important. People learn a number of coping mechanisms to deal with the pain, such as holding their bodies in different ways, and it can sometimes take a while to encourage the muscles to revert to natural positions when they have been trained over time to hold the body in a position which avoids pain. Many of our members often work closely with osteopaths in a  two-pronged strategy to encourage the body back into its correct shape.

The best advice always, though, is to visit a BAcC member local to you for advice on whether acupuncture can help your specific problem. Although the evidence is good, most of us can tell quickly what the best options for a patient are, and are always happy to refer on to other healthcare professionals if we think that they are the best line of attack.


Q: ] I have been diagnosed with Spondylolisthesis (slipped disc).  I have spent  approximately £600 on chiropracty and podiatry and  would like to know if acupuncture would be effective. 

A:  We are always a little reluctant to make claims for the potential success of acupuncture treatment when there has been structural change in the body that is unlikely to reverse. In some cases, for example, the use of acupuncture treatment to strengthen muscles which then cause someone's posture to revert to its normal position is well-documented, and many practitioners work alongside osteopaths to off a two-pronged approach to treatment. If the spondylolisthesis you have involves a relatively short forward displacement, there may be some possibility that this may be of considerable benefit. In this case, however, we would usually be guided by the osteopath's view of what is happening; they are, after all, the experts in bone and structure.

Conventional treatment is generally about pain management through anti-inflammatories, steroids and some physiotherapy. Acupuncture treatment has a long history of being used for chronic pain; indeed, this is one of the more frequently researched areas, mainly because the markers of pain and pain relief in body chemistry are easily measured and mean that research can be quantified easily. Our factsheet on chronic pain

is generally pretty upbeat about what can be achieved. In clinical practice most of us do not find the reduction of pain difficult to achieve. What really matters is the extent to which the pain is relieved and how sustainable the relief is. In the end it may come down to a financial equation - if someone needs weekly treatment almost indefinitely but as a result can function nearly normally, that hay be the equation they have to deal with. We know that some practitioners are not happy to work indefinitely without making long-term improvements, but occasionally treatment can be about stability or ever getting worse slower, so if a patient is happy to be kept going in this way, so be it.

Since each case of a condition like this is likely to be unique, we think that the only realistic advice is to visit a BAcC practitioner near and ask for a brief face to face assessment of what they think they might be able to achieve. Most practitioners review progress after the first four or five sessions when dealing with chronic conditions, and if there is no improvement consider the benefit of continuing while the bill has only reached the £200 mark. If the practitioner can sense changes in some of the diagnostic signs which make them believe that change is on the way, then the patient can make an informed decision about whether to continue rather than simply run up a large treatment bill without tangible results.

Q:  How do I find an acupuncturist who specialises in chronic pain (resulting from a car accident - spine and shoulder injuries). The only treatment offered are morphine based pain killers, which is not very appealing as it impedes ability to work and drive.

A:The important point to make is that from our perspective all of our members are equally well equipped to treat chronic pain. The nature of Chinese medicine is that it treats the person, not the condition, and although as in your case the problems do not arise from within the system itself, the ability to maximise your system's ability to heal itself would in our view be an important factor in your recovery. All of our members are trained to the same high standard, and there are oly a very few areas of work where we are beginning to recognise that there may be scope for postgraduate training to underpin expert practice, such as paediatrics or obstetrics.

As far as chronic pain is concerned, there is a substantial amount of evidence that acupuncture can be beneficial in providing pain relief. This rests largely on the fact that acupuncture became more popular in the West research into its effects focussed on pain relief because the outcome measures were relatively easy to assess, both the chemical ones such as neurotransmitters and also the patient assessment of their own levels of pain. We have produced a factsheet

which highlights some of this research, but while the experimental, i.e lab, results have been good, the more elaborate trials have been more equivocal. We believe that this owes a great deal to the trial designs, though; using formula treatments to achieve results is far removed from traditional practice.

However, as we said earlier, traditional acupuncture treats the person, not the condition, and this means that the best advice we can give you is to visit a BAcC member local to you to seek a brief face to face assessment of how they think treatment might be of benefit to you.

Our feeling about this is that acupuncture treatment will always bring you some relief from chronic pain. The only question is how much relief it provides and how sustainable the changes are. Although it might be positive boon to be pain free for a couple of days, if this is all that treatment can manage it is probably not financially sustainable, unless the patient has very deep pockets. BAcC members will always maintain a rolling review of chronic cases to ensure that their treatment remains focussed and that a treatment 'habit' doesn't lead people into expenditure beyond what they had intended or expected.

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