Ask an expert - muscles and bones - hips

2 questions

Q:  I have nerve damage after a hip replacement where my sciatic nerve got nipped with wire.  It was then released with more surgery.  I  now have a lot of nerve end pain -  do you know if accupuntre might help? 

A: This sounds highly unpleasant, but although hip replacement surgery is now pretty commonplace, it remains a complex and relatively dangerous procedure, and there are bound to be occasional accidents, as appears to be the case here.

A great deal depends on the extent to which the nerve was damaged. It sounds as though there has been a quite serious impingement of the nerve, and in most cases this can recover over time if the pressure is released and the nerve has not been damaged structurally. If there has been structural damage to some of the nerve fibres, then it is possible that they are sending out pain signals and will carry on so doing almost indefinitely.

However, a strange parallel with this is phantom limb syndrome, where people who have lost a limb through amputation or injury continue to receive signals from the missing limb, sometimes very painful ones too. There is a growing body of evidence for the successful use of acupuncture to address this problem, and in an answer about this phenomenon we quoted a number of studies which support the possible effect of acupuncture:

  

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:


http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97
Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142
Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112
Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213
Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

We always tread a little cautiously when we discuss things like this, though. As practitioners of Chinese medicine we use a very different approach to understanding the body, mind and spirit as a complex flow of energy, called 'qi', the rhythms, patterns and flow of which determine someone's health. From this perspective operations in particular can be seen as responsible for creating blockages or breaks in the flow, and this alone could cause pain symptoms alongside any actually physical damage which people may suffer. This is often the case in injuries like fractures where the bone heals but the pain remains. This could mean that from a Chinese medicine perspective that the energy flow has been compromised even though the physical structure has repaired.

Chinese medicine is based on treating the individual, not simply the condition. Each case will be unique and different, just as each person is unique and different, and for a really clear assessment of whether acupuncture can help you you might meed to pop in to see a BAcC member local to you. This will enable them to have a good look at what is going on and offer you a much better idea of what acupuncture might be able to do for you.  

Q:  About 2 years ago I experienced sudden severe pain in my hip and thigh. this lasted for about 4 weeks and stopped suddenly.  A year later I experienced the same sudden pain. this time it did not stop. In an attempt to relieve the pain I  have used various pain relief medications.
I have had xrays and an  MRI scan which have failed to find the problem. I had a steroid injection into my hip bone and this relieved the pain for about a week. I have received treatment from an osteopath and physiotherapy.  I am in constant pain day and night and find it difficult to walk at time.  > My question is will acupuncture help in relieving the pain.

A:  There is no doubt that acupuncture can be used for pain relief, as our fact sheet on chronic pain shows:

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

and indeed, pain relief has been one of the most intensely researched areas of its use. The use of sophisticated assessment tools by patients to measure their experience of pain, and the fact that many of the neurotransmitters and natural painkillers can be precisely measured means that one can get meaningful results quite quickly.

However, the only two questions to ask if treatment is used in this way are 'is the effect reasonably sustainable?' and 'if it is, can I afford the treatment which maintains the level?'. We believe that this short-changes what we do to see it in this way. Chinese medicine is premised on the flow of energy in the body, called 'qi', and its proper balance and rhythms. Pain arise from blockage, excess or deficiency, and the skill and art of the practitioner lies in determining how the problem arises and whether local treatment or systemic treatment, or both, is required. The probability is that something has been brewing for quite a while, and there has been a tipping point which has meant a blockage or change has occurred. On the last occasion this has spontaneously reversed, but on this occasion it appears to be more tenacious, and a practitioner will want to assess whether the underlying tendency is going to keep on generating these pains unless corrected, or whether you have something specific which can be unblocked locally.

Our best advice with problems such as yours, which are always best advised on with the benefit of a face to face assessment, is that you visit a BAcC member local to you and see if they find anything on a brief, hopefully free, assessment which would encourage them to believe that acupuncture treatment would help you.

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