Ask an expert - muscles and bones - neck

28 questions

 

There is certainly some good-ish evidence for the treatment of cervical spondylosis with acupuncture. As our factsheet shows

 

 

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

 

there are several good quality trials which suggest that acupuncture can reduce the neck pain with which it is associated. We have searched the databases for any further and more recent research, but while two studies are in development there is nothing else to report.

 

 

We always tread with caution when advising on the use of acupuncture, though. From a western medicine point of view this is a 'wear and tear' problem for the treatment of which the best that can be achieved is a reduction in the deterioration, getting worse slower, and some reduction in the pain caused by the inflammation. If the pain and discomfort is a recent phenomenon it suggest that the inflammation caused by the problem is not yet too severe, and that there may be some hope of significant reduction.

 

 

From a Chinese medicine perspective pain arises from blockage and stagnation in the flow of energy, and the use of needles is intended to restore normal flow and balance. Physical problems, changes in structure, can have an impact on the flows of energy, especially in the neck, and while acupuncture is never going to correct the changes in physical structure, it can often restore flow and remove pain.We see this quite often with lower back pain associated with crumbling of the lumbar spine, or shall we say attributed to the damage seen on X-ray. We have seen many cases where the X-ray remains unchanged but the pain has reduced.

 

 

As far as cost and frequency of treatment is concerned, that is almost impossible to say. In Greater London the cost of a first session is often in the £50-£70 range with follow up sessions perhaps £40-£60, where in the rest of the UK prices are likely to be £10 lower. There are a number of community based multi-bed clinics where treatment is offered in a group setting at much lower rates, and most members are prepared to discount treatment for those with financial issues. NHS treatment free at point of delivery has become a great deal more difficult to find, and it is a matter of luck whether you have a doctor near you who may be able to offer a number of sessions within GP practice.

 

 

Frequency of treatment is usually more predictable. Unless someone has acute pain treatment tends to be weekly, but with chronic conditions with an underlying physical change of structure you will find that most practitioners will review progress after four or five sessions to see what has happened. At this stage it is worth establishing clearly whether there has been a change and how sustainable any change has been. If the effect has been small and short-lived it may be worth exploring other treatment options.

 

 

The best advice is to contact a local BAcC member and see if they are happy to give up a little time without charge to have a face to face chat and look at the problem. Most do, and this will give you a very clear idea of what may be possible in your specific case. 

 


 

 

We have been asked this self same question this morning, and our response was:

 

 

We have been asked about it a number of times, and  we have factsheets about both facial pain and neuropathic pain

 

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

 

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

 

There evidence underpinning a recommendation for acupuncture treatment is limited, but as you can see from the evidence button on the neuropathic pain sheet acupuncture has on several occasions been shown to be superior to the standard drug treatment, which suggests that it is worth trying. 

 

In a previous response on the same question we said:

 

If you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.

 

We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, and subtle manipulation may offer possibilities.

 

We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficient to warrant making a recommendation to try to use acupuncture as a long-term pain relief option.

 

If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to establish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accurately bad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.

 

From our perspective it is always possible to achieve a certain amount of pain relief in almost any condition, whether this be because of the acupuncture treatment or as  our critics would have it some kind of placebo effect. The question is always how much pain relief and how sustainable this is. Clearly a treatment which works for twelve hours is not going to be very useful, although we have known cases where people have targeted treatment at times when they are going to need to be on top form for athletic events or important meetings. If the effects last longer but never quite increase in depth or duration then it may become a financial consideration, i.e. if someone can afford weekly treatment indefinitely because that is how long it lasts then having deep pockets is an advantage (although we have known members offer reductions for this kind of maintenance). Most of us, though, do not like to see someone remaining in pain for months, and we tend to look closely at other options if what we are doing isn't really taking off. Cranial osteopathy is one possibility, but practitioners will be aware of many other forms of treatment in their areas who might offer a useful solution.

 

 

If you want to trace a practitioner near you the simplest way is to use the postcode search facility on our home page www.acupuncture.org.uk 

 

 

 

 

There is certainly some good-ish evidence for the treatment of cervical spondylosis with acupuncture. As our factsheet shows

 

 

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

 

there are several good quality trials which suggest that acupuncture can reduce the neck pain with which it is associated. We have searched the databases for any further and more recent research, but while two studies are in development there is nothing else to report.

 

 

We always tread with caution when advising on the use of acupuncture, though. From a western medicine point of view this is a 'wear and tear' problem for the treatment of which the best that can be achieved is a reduction in the deterioration, getting worse slower, and some reduction in the pain caused by the inflammation. If the pain and discomfort is a recent phenomenon it suggest that the inflammation caused by the problem is not yet too severe, and that there may be some hope of significant reduction.

 

 

From a Chinese medicine perspective pain arises from blockage and stagnation in the flow of energy, and the use of needles is intended to restore normal flow and balance. Physical problems, changes in structure, can have an impact on the flows of energy, especially in the neck, and while acupuncture is never going to correct the changes in physical structure, it can often restore flow and remove pain.We see this quite often with lower back pain associated with crumbling of the lumbar spine, or shall we say attributed to the damage seen on X-ray. We have seen many cases where the X-ray remains unchanged but the pain has reduced.

 

 

As far as cost and frequency of treatment is concerned, that is almost impossible to say. In Greater London the cost of a first session is often in the £50-£70 range with follow up sessions perhaps £40-£60, where in the rest of the UK prices are likely to be £10 lower. There are a number of community based multi-bed clinics where treatment is offered in a group setting at much lower rates, and most members are prepared to discount treatment for those with financial issues. NHS treatment free at point of delivery has become a great deal more difficult to find, and it is a matter of luck whether you have a doctor near you who may be able to offer a number of sessions within GP practice.

 

 

Frequency of treatment is usually more predictable. Unless someone has acute pain treatment tends to be weekly, but with chronic conditions with an underlying physical change of structure you will find that most practitioners will review progress after four or five sessions to see what has happened. At this stage it is worth establishing clearly whether there has been a change and how sustainable any change has been. If the effect has been small and short-lived it may be worth exploring other treatment options.

 

 

The best advice is to contact a local BAcC member and see if they are happy to give up a little time without charge to have a face to face chat and look at the problem. Most do, and this will give you a very clear idea of what may be possible in your specific case. 

 


 

Q: I have struggled with my neck and shoulders for years and have recently started to get tension head aches. Massages have helped in the past but not so much anymore. My posture isn't great so I know this is the main trigger and I also work in an office so sit at a desk for 8 plus hours a day. Would acupuncture help me?   Thanks in advance

A: We often come across people who are pretty much spot on about the causes of their problems - posture, work-related stress and sedentary nature - but are not in a very good position to do much about it. This is a problem for us as acupuncturists in terms of the ''two steps forward, one and half steps backward' of a great deal of the treatment we do. We obviously believe that we can help problems like neck pain and headache, and the evidence supporting this is pretty good, as our factsheets show:

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

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

It falls a little short of an absolute recommendation but this is more to do with the vagaries of methodological requirements than the treatment itself. These remain some of the more common conditions for which people seek our help.

We suspect that the real issue here is how a practitioner might work with you to manage the causes of your problems. There are a number of exercises and self-help routines which people can use, both within acupuncture and within associated disciplines, and many of our patients find these very beneficial, although we have to be honest and say that it takes a bit of nagging on occasion. We know that employers have statutory duties to offer staff members breaks when they are machine or desk bound, but we know equally well that it is a brave employee these days who insists on this. There are a number of meditation and mindfulness programmes which can be of great help, and other people use NLP as a means of anchoring relaxed states and breaking the cycle of tension.

We think the best thing to do, though, would be to visit a local BAcC member, possibly for a chat or even for a couple of sessions to explore how much change the acupuncture treatment seems able to achieve. If this can be targeted for a time when you have some R and R ahead, like a Bank Holiday weekend or holiday, so much the better. This will give a very clear indication of the possible benefits.

Much of the problem stems from blockage and stagnation of the energy, and acupuncture treatment can be hugely effective in relaxing people. The point, though, is to stop them tensing up again while they do what they have always done.

Q:  My father is 87 and suffered unstable c1c2 neck fracture 8 months ago due to falling. He has no paralysis and has refused most medical interventions (including wearing a collar which he finds too painful) as his desire to live was reduced by recent bereavement. He has severe chronic neck and head pain ever since, with little or no relief even on opiate medicines. Please could l ask if acupuncture might perhaps give him any relief or reduction of pain if it is safe for cc2 fracture?

A: There is no reason of which we are aware why acupuncture would be absolutely contra-indicated for your father's problems. However, there are degrees of relative contraindication, but these depend on the professional judgement of the practitioner and the specific circumstances of the case.

 The one caution of which we are aware is one which mainly appears in the literature of physios who perform acupuncture. We have seen them say that there are rare occasions where the muscles of the back or neck brace themselves to maintain stability, and any treatment which relaxes muscle, even unwittingly, might make the joints of the spine more mobile and thence cause pain. However, we recently put together an acupuncture safety website with the main physio and doctor acupuncture associations www.acupuncturesafety.org.uk and this was 

not thought to be significant enough to warrant mention. Indeed, the fact that your father is wandering around without a neck brace is probably an indicator that while painful the neck is not that close to giving way.

 We do publish a fact sheet on neck pain

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

which quotes a number of encouraging studies, and certainly neck pain is one of the more frequent reasons why people seek treatment. Since the greater majority of referrals are by word of mouth res ipsa loquitur, as solicitors say - we wouldn't get the referrals if it didn't work.

 The best advice, which we invariably give, is to see if your father is willing to drop in to see a local BAcC member who can assess his specific presentation. Most members are happy to give up a little time without charge, and seeing a problem first hand gives a much better idea of what may be possible. We also are very emphatic that we treat the whole person - body, mind and spirit - so it may even be that your father could derive some benefit in other ways to help him deal with what must have been a very painful bereavement for him.


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