Ask an expert - neuro and psycho logical

222 questions

Q:  I have a big problem with cigarette smoke I hate the smell and it makes me feel sick I do get anxity and stressed when smelling it making me very unsocialabe do you think acupuncture would help thank you in advance

We are sorry to hear of your problem with cigarette smoke. Clearly your problems will have eased a little over the last few years as the smell has become less prevalent, but we are sure that you have experienced that odd sensation that the less common cigarette smoke has become the more noticeable it is when it does turn up.

We have to be honest and say straight away that we have never come across anyone with the same problem and as you might expect there is no research of any kind into this specific problem. We do occasionally come across people with phobias, and we wrote a long answer last December about the fear of flying in which we said:

It was always said that if you wanted to get a straight answer from a doctor, you should ask them, 'would you be happy for your wife to have this treatment?' So, I suppose if you said to us, 'would you recommend acupuncture to your family to overcome a fear of flying?', the answer would probably be 'no'. This is not to say that it might not work; over many years of practice we have heard of a number of almost incredible stories about changes which people have managed to make thanks to treatment, and quite often by the practitioner simply sticking to very basic traditional acupuncture. 

Extreme reactions of any kind are, from a traditional acupuncture perspective, indications that a part of the system is out of balance and generating inappropriate emotional or mental responses. It is sensible to be mildly apprehensive about flying, just as it is to be mildly scared of heights. If the faculty of sensible fear is out of balance, then extreme reactions abound.

However, with a problem such as this there are other possibilities which seem to us to go to the heart of the problem much more directly. Hypnotherapy or CBT (Cognitive Behavioural Therapy) are both well tried approaches for phobias, with the added advantage in the case of hypnotherapy of being able to do trial runs under the power of suggestion. There are a great many forms of hypnotherapy, all of which have their strengths, but those based around NLP and the work of hypnotherapist Milton Erickson seem to have the most well attested handle on treating phobias.

There is no doubt that you would probably derive some benefit from acupuncture treatment in terms of a reduction in anxiety, as our factsheets show, and always the possibility that a skilled practitioner might look at your overall balance and get that feeling that there is something obvious to be done which may help. It is more probable, though, that they would do as this expert would, refer you to a trusted colleague who does hypnotherapy or CBT to ensure that your needs were skilfully and professionally met. Because traditional acupuncture treats the person, not necessarily the condition they have, there is a danger that this can be re-framed as 'acupuncture can treat anything', and occasionally incautious practitioners let patients' expectations run away with them. 

 If you substitute the words 'extreme reaction to cigarette smoke' for 'fear of flying' the same advice holds good. It might well be worth your while talking to a local BAcC member about your problems because in conversation they may see that the issue is really your anxiety which has latched on to a specific trigger. In this case they may well think that something could be done. If not, then it is a trusted source of a good referral to other forms of treatment. It's often very difficult to know where to turn in the field of CBT and hypnotherapy, and personal recommendation is usually the best way to find a good practitioner.

Q:  I'm trying to find help with my (central post-stroke pain syndrome) I've had for 28 years after a stroke hemorrhage in 1990. I have tried everything from oramorph , Trans cranial magnetic stimulation, deep brain stimulation, spinal cord stimulation HF10 and other interventions all with no benefit so would acupuncture help?

A:  We have to be honest and say that if all of the other therapies you have tried over the last 28 years have failed to effect a change it would be a very considerable surprise if acupuncture treatment suddenly proved to be the answer. However, we are not entirely sure what the CVA has caused by way of continuing symptoms under the generic title of CPSP, and there are aspects of post stroke treatment where the blockages which arise at the time of the event will stay blocked until someone clears them. We do occasionally hear of people having dramatic changes twenty or thirty years after a problem began but this is quite a rare event, and we would never use examples like that as the basis for a recommendation.

We have gathered a considerable amount of information about the treatment of strokes in a rather dense review paper which can be found here

https://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

but the short answer to questions about efficacy is that in China acupuncture treatment, when used, commences almost immediately before the system has become 'fixed' in a state of disrepair, and the evidence suggests that this maximises the chances of regaining residual function quickly. The longer people wait for acupuncture treatment, the less well it seems to work and the less overall effect it seems to have.

Pain management is something for which acupuncture has developed something of a reputation since Nixon's visit to China in the 1970s and the sight of people having operations under acupuncture anaethesia. This led to a proliferation of trials and because neurotransmitter levels are easily measured a great deal of good evidence about the use of acupuncture to stimulate their release. Many Pain Management clinics base their work on this. The central question is how much relief and how sustainable, and it may be a matter of weighing up the cost and inconvenience against the amount of relief treatment can offer, it indeed it does work a little. 

The best advice that we can give is that you visit a local BAcC member to seek their view in a brief face to face assessment of what may be possible, depending in the exact presentation it is that you need help with. We also think that cranial osteopathy might be another pathway which might offer some potential for change, but we don't have a central referral point to which we can direct you. Many osteopaths use cranial techniques, but some spend a great deal of time on this work and are often the local 'go to' people for difficult cases. we would hope that any you might contact direct you to the most

Q. I have carpel tunnel syndrome starting after I had a fall and broke by shoulder. Pain in my neck shoulder upper and lower arm ending in my hand. Can acupuncture help?

A. We are sorry to hear of your predicament. As our factsheet on carpal tunnel syndrome shows

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/3629-acupuncture-and-carpal-tunnel-syndrome.html

there is a growing body of evidence which suggests that acupuncture treatment may be effective. This certainly reflects our clinical practice where we invariably see some change and improvement, although the extent and sustainability are an issue. If improvements only last a short while then there may come a point where we have to question the value of continued treatment.

However, from what you describe, it may not be the 'traditional' version of carpal tunnel problems which the research reflects. Damage to a shoulder which appears to be reflecting down the whole arm would suggest that something about the injury has, from our Chinese medicine perspective, caused some enduring blockages in the flow of energy, or 'qi' as we call it. Even from a conventional medicine perspective there may have been and may still be some value to be had from a neurological assessment to see whether and where there may be impingement of the nerves traversing the shoulder joint. This is a notoriously difficult joint to manage, insofar as the slightest change or variation in the muscles and tendons can cause problems in both directions, and it is almost impossible to go through daily life while resting it as much as may be needed.

The strength of Chinese medicine is that it looks at problems like this in the overall context of someone's health. There may be other more systemic factors in play which have weakened the body's ability to recover, and we consider it a major part of our task not simply to get rid of symptoms but to ensure that they do not return by strengthening the constitutional energy of the person. Making this judgement, whether a symptom is just what it is or whether it is a reflection of the body's inability to heal, is at the core of our work.

The best that we can advise is that you visit a local BAcC member for a brief chat about what may be possible. Most of our colleagues are happy to give up a few moments without charge to prospective patients to ensure that they are properly informed before committing to treatment. This means that you will also be able to meet them and see where they work, which is always a good way of setting off.

Q. I have been suffering from migraines for a few years and have just started acupuncture in the hope it will help. Could you kindly advise how often I should have a treatment and for how long should I plan to continue to have the sessions to fully see if it is successful?

A. It is surprising how infrequently we are asked about the treatment of migraines, since it is one of the more common referrals we get. The evidence, which you can see from our factsheet

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1148-migraines.html

is pretty good.

Of course, the one thing that we always have to say is that each person is unique and different, and the standard treatments used in these trials are not always indicative of the way that we actually work. Twenty people presenting with the same named condition might be treated twenty different ways.

This also means that each individual presentation, the problem and the context in which it lies, can profoundly affect how much treatment and for how long. Most of us would regard a good routine as four or five sessions at once a week, and then stretching the gaps to a fortnight and up to a month over the next three to four months. We have found that simply treating weekly until the symptoms abate is not always successful, and that without later follow-up there is a danger that the migraines will return. Patients then conclude that the treatment didn't work, which is probably not the case.

Of course, this routine can vary tremendously. If someone has three migraines a week then treatment might be more than once a week to bring things under control. In other cases, where the migraines are related to specific patterns like the menstrual cycle a practitioner might target particular times of month for a few months.

All we ask that our members do is that they review treatment at regular intervals to ensure that there really is some progress, and to ensure that the patient is happy to give continuing consent. What we try to avoid is a treatment 'habit' where someone books week after week without realising that they've run to ten or fifteen sessions without result. This can sometimes make patients unhappy.

However, most people appear to benefit from treatment, and we hope that this is the case for you.

Q. Can it help with tension headaches and TMJ?

A. These are both problems of which we see a great many cases in practice. There is a certain amount of research, as you can see from our two factsheets

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/2819-facial-pain.html

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1581-headache.html

but it has to be said that the quality of trials is not that great and as ever the conclusion from any trial will always be that more and better research is needed.

The predominant reason for this is that there are so many precipitating causes for both problems that even researchers fight shy of testing whether the symptom can be relieved by treatment. This is rather ironic, because this is precisely the way that Chinese medicine looks at every symptom, not as a problem in itself but as a problem which has emerged against a backdrop which is unique to each individual. That means that twenty people with the same problem may end up being treated twenty different ways because the underlying patterns were different.

Obviously there are going to be some cases where you can pinpoint the cause. We often come across TMJ syndrome which has been caused by rough dentistry when the jaw has been pushed wide for some time and slightly dislocated. It's not a fantastically stable joint, and once it is slightly out of alignment it can cause facial pain and sometimes headaches too. If we suspect that this is the case we sometimes refer people to cranial osteopaths who can go straight after the problem. This doesn't mean that we aren't interested in why this happened in this particular patient, but it could take a great deal longer to get the same change by restoring better function.

As far as headaches are concerned, though, there are literally dozens of differentiations in the more syndrome orientated acupuncture styles which can define precisely what kind of headache it is and alongside that several very long established styles of treatment aimed at restoring the overall balance. That is why we would never venture a view on a specific question because so much depends on the individual presentation. That is why we invariably say that a brief visit to a local BAcC member for a chat is a great idea. Most will offer a small amount of time without charge to prospective patients to give them a better view of what might be possible, and help them to make an informed choice. It has to be said, though, that headaches remain one of the more common presentations we see in clinic, and many are referrals from people who have been successfully treated themselves.

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