Ask an expert - muscles and bones - neck - trapped nerve

4 questions

Q:  I've recently developed sensory nerve discomfort on my shoulder blades .I already have idiopathic peripheral neuropathy so I know what nerve pain is . This is touch related as there is no discomfort when there is no clothing touching my shoulder blades . I did a simple experiment with 3 shirts/t-shirts . The first had a rough/course texture , the second had a gripping texture , the latter was soft & smooth . The first two both caused discomfort , the latter virtually none , I had a friend present & we both agreed on the descriptions regarding the "shirts" .
I would also add that I use a thoracic brace for exercising & the pressure of the brace on the my shoulder blades seems to alleviate the discomfort .
I thus thought , albeit from a very limited understanding of acupuncture : its use of pressure points & the fact that a GP at  my practice has used acupuncture for many years for a variety of maladies for the benefit of practice patients is there any evidence of its efficacy in treating sensory nerve discomfort .

A:We do have a number of fact sheets on our website about neuropathic pain and also a number of answers to earlier queries about diabetic neuropathy, but none really quite addresses the problem which you describe.

We suspect that with your problem it really is a case where going back to first principles may offer the best chance of finding some relief from the problem you have. As you probably already know from background reading, the theories of traditional acupuncture are based on the flow of energy called 'qi' and its rhythms, flow and balance in the body. Understanding how problems occur means being able to identify and understand how the flow might have been disturbed where the problem is and also how this fits against the overall backdrop of someone's health. The practitioner invariably, as with any pain, asks questions about whether the problem area feels hot or cold, responds to hear or cold, responds to pressure, is better or worse at different times of day, and so on. The answers to these questions all point to specific disruptions in the flow of energy and hopefully towards solutions.

There are a number of formula points which can be used as short term palliatives, and on occasion these may provide a permanent solution. The majority of cases like this, though, where there is an area of skin and superficial muscular discomfort, require something more sophisticated by way of treatment. Of course, in saying this, we would ourselves be looking at the other possible environmental factors which might be causing the problem, but we assume that you have probably done an exhaustive check on things which might have affected the area.

The best advice we can offer, since it is an unusual and specific presentation, is to visit a BAcC member local to you for a brief assessment of whether acupuncture might be of benefit. A skilled practitioner could usually elicit in a very few minutes how treatable something is, and most of our colleagues are happy to give up a short amount of time to make this determination

A: This is quite a difficult question to answer. All forms of impingement and entrapment can arise for a number of reasons, and these determine whether there is a realistic chance of success. If the problem arises from a displacement of the physical structure of the body, like a joint having been knocked slightly out of alignment then it may be more appropriate to see a practitioner like an osteopath or chiropractor who can manipulate the structure back into place. It is probably possible to do the same thing with acupuncture over time, but re-arranging the bones first and then using acupuncture to consolidate the change is how many of us work alongside osteopaths and chiropractors.

If the changes in structure are due to deterioration of the bones, the problem can be more intractable. We find that impingements of nerves where the spine is starting to collapse with age are often difficult to address, especially in the neck and in the lower back. This is a simple mechanical fact; if the gap between two bones closes then nothing short of surgery is going to fix it.

In some cases, however, inflammation arising from structural changes or simply inflammation can cause the entrapment, and in this case there is some evidence suggesting that acupuncture can do more than simply offer short term pain relief and can break the cycle of inflammation which is causing the discomfort.

The short answer, though, is that each case is unique and different, so it is very difficult to quote general principles about what is best. The advice we tend to give all the time  is to arrange a brief face to face consultation with a local BAcC member to see whether in their professional opinion a problem is amenable to acupuncture treatment. The majority are quite open to suggesting alternatives if they think a patient would be better suited to another form of treatment.  

A great deal depends on the reason for the entrapment. In some cases people are beginning to show deterioration of the cervical spine through age, and the compression which this can cause, with consequent nerve impingement, is not something which treatment can reverse.

However, this is to take a somewhat pessimistic view of what is happening. We tend to look at structure first. Although acupuncture can be quite effective at treating chronic neck pain, as our factsheet shows

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

if there is a structural misalignment which is the likely cause you may be better off seeing a chiropractor or osteopath in the first instance to pop the neck back into place. After this, there may well be good reason to have acupuncture treatment because the adjustment might be resisted by muscles which have become 'set' in an abnormal state, and need some help to re-adjust to normal function. Many members work closely with osteopaths and chiropractors, referring backwards and forwards to nudge the system back into place.

A:  This, though, is to take a very western view of what is happening. From a Chinese medicine perspective the pains which are described as 'trapped nerve' or 'muscle spasm' can often be a direct expression of a blockage in the flow of energies or a more long standing systemic weakness. If this is the case, no amount of manipulation will hold changes in place, and acupuncture may treatment well be the best option.

The best advice we can give, without knowing the wider context of your problem, is to pop in to see a BAcC member local to you and seek a brief face to face assessment of what may be possible. We are confident that they will offer you advice which is geared to your specific needs, not simply book you straight in without demur.

Q:  Can acupuncture be used for a trapped nerve in the neck and what would the treatment involve?

A: We gave this reply some time ago to the first part of your question:
 

 

The term 'trapped nerve' usually describes what is more technically called a nerve impingement or nerve compression. A common cause is a bulge in one of the vertebral discs which compresses the nerve root, but there are a number of other fairly frequent causes which do not necessarily involve a structural change in the upper spine.

 

 

 

If the problem is structural there may be some value in having some form of manipulation alongside or instead of acupuncture treatment. Osteopaths and chiropractors often treat this problem as one of their 'stock' items for referral. However, a great many problems of this nature are caused either by spasms of the muscles which in turn impinge the nerves or by inflammation of the surrounding tissues. In both cases acupuncture, both in the traditional Chinese form used by BAcC members and in the western medical form used by doctors and physios, is frequently used to good effect, and there is considerable evidence for the successful treatment of inflammation and muscle spasm with acupuncture. Most studies are done on chronic, rather than acute, neck pain, but the results of a very large German study condcted five years ago

 

 

http://www.ncbi.nlm.nih.gov/pubmed/16781068

 

 

 

are typical of the kinds of outcomes reported, although Ernst and White were not quite so positive in their review

 

 

 

http://www.ncbi.nlm.nih.gov/pubmed/10342627

 

 

 

However, there are significant problems with 'sham' acupuncture, so one has to take their conclusion with some reservations.

 

 

 

There is often a significant overlap between the acupuncture points and techniques used by both traditions, but we believe that an advantage of traditional acupuncture is that it looks at the whole system in determining what treatment to offer rather than simply treating the part which hurts. In most cases the treatment will focus on the problem but there are often occasions where the causes, from an Eastern perspective, of this one problem are not simply to do with the area affected, and the skill of Chinese medicine lies in making sure that the symptom does not come back, not simply that it goes away.

 

 

 

It may well be worth while contacting a BAcC member local to you to ask if they will give you an honest assessment of whether they can help your specific problem.

 

It may well be worth while contacting a BAcC member local to you to ask if they will give you an honest assessment of whether they can help your specific problem.

 
In answer to your question about what treatment involves, the best thing we can do is refer you to the section on our website

 

Please click here
 
which outlines succinctly what the first session of treatment involves

 

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