Ask an expert - neuro and psycho logical

214 questions

Over the years we have had a number of questions about phobias, and the most recent composite answer we gave about a fear of flying was:

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 skillfully 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. From a Chinese medicine perspective every aspect of the human being, every inappropriate mental, physical, emotional or spiritual state, is theoretically amenable to change by treating the person as a whole. However, our clinical experience is that there are many problems, such as terminal illnesses or serious psychotic states, where expectation of recovery is virtually nil, and it is highly risky to feed the desperate need of patients with statements which might lead them to have hope where there is none. Cases like yours, although not quite as serious, nonetheless can represent entrenched patterns of thought and behaviour which require specialist skills to unravel.We think that this still represents the best advice that we can give, especially given the timescales involved. If you are London based, and your friend is also London based this is probably the best place to be in terms of finding someone who could possibly help. Your friend may even be able to get CBT sessions through the NHS if she has a sympathetic GP who understands both the urgency and importance of the situation. If not it can be a bit of a minefield finding someone who is appropriately qualified and appropriately skilled. The challenge is finding someone who does what your friend needs.If you want to see what we mean you could do worse than look at this brief video presentation by Richard Bandler, who along with John Grinder first set down the principles and practice of Neuro-Linguistic Programming (NLP). http://www.nlplifetraining.com/Spider-phobia-Overcome-yours-with-NLP-and-Richard-Bandler

There are many hundreds of practitioners in and around London, as there are throughout the UK, who use the same techniques, and we would assume may be able to offer the same effective process. Of course, as practitioners we would always be interested to see how the energy of the person had been affected for such an inappropriate response take such a strong hold, and perhaps when she returns from a successful and wonderful trip she might choose to explore this. Howe ever, first things first, and with only three weeks to spare, what we have suggested is probably the most likely way to get her to Australia.
We have repeated below a 'nested' response (two responses, one inside the other) which we gave some time ago;

We tend to be a little tentative in offering advice on conditions like Parkinsons which are often chronic and degenerative. A typical response that we have given in the past reads:
 From the perspective of research studies alone it would be difficult to give any firm recommendations for acupuncture as a treatment of Parkinson's Disease. There are a number of studies, some undertaken in the US but the vast majority in China, which show some positive signs, but not of sufficient change in a significant number of patients under study to draw any firm conclusions. You can see some of the studies if you google 'ncbi acupuncture parkinson's disease' - the National Centre for Biotechnical Information in the States is a convenient way to find many of the the more significant papers. There is also a Cochrane Review of a protocol for assessing the value of acupuncture, but as far as we are aware this has not been put into action yet.With all chronic degenerative conditions the extent to which acupuncture can help has to be carefully explained. It is often, as one rather ironic patient said, a case of 'getting worse slower', and this is extremely difficult to quantify in a condition like Parkinson's where the disease progression is neither smooth nor predictable. Anecdotally there are many accounts of patients finding that treatment helps with some of the manifestations of the disease, such as the periods of rigidity and freezing, and a general sense of well-being, but these are not documented sufficiently well to be able to claim any undisputed levels of efficacy.The best course of action is to see whether a BAcC member local to you will give you an honest assessment from an eastern perspective of what they might be able to achieve for your own unique patterns. There may be elements of how the condition manifests which they may feel that they can help.As you can see, we are very cautious in our choice of words. The shaking of the arm with Parkinsons has been tested in some small studies, as in this onehttp://www.ncbi.nlm.nih.gov/pubmed/12210879and there is some optimism in the write-up but it is a very small study.From a Chinese medicine perspective there are a number of syndromes which describe the shaking of the limbs, and which provide explanations of them in the terms which we use as practitioners. This can sometimes cause a little confusion because it gives an impression that a symptom which is treatable in Chinese medicine may mean that the same symptom might be easily treatable from a western perspective. Where there is a physical change in the brain, however, it would be unwise to get too excited about the possibilities.In any situation like this, though, we find that it does not help to be negative because there may be multiple reasons why someone's tremor might be quite bad, not least in the fact that stress itself can make the symptoms of Parkinsons more noticeable. We have found in clinical practice that reducing stress can sometimes make the frequency and severity of symptoms reduce, and it would certainly be worthwhile talking to a BAcC member local you you about what may be possible.We are not quite sure why we did not refer to our factsheethttps://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/parkinsons-disease.htmlwhich has some quite encouraging information under the 'evidence' button.We always add the observation that we often find that once someone has a 'headline' condition everything in their overall healthcare picture is assumed to be a secondary symptom of it. This expert has a patient with Parkinsons in whom several minor symptoms which have been declared to be a consequence of the disease have disappeared.  It may be that from a Chinese medicine perspective there are a number of your problems which are not directly related to the Parkinsons. We are not in the business of giving people false hope, simply recording what we have seen over the years.We also always check the current research, and since our factsheet was assembled there has been another very comprehensive systematic review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5279085/which while not conclusive certainly would encourage us to say that while we could not guarantee results the available evidence for amelioration of some of the symptoms is certainly stacking up.As always, a brief visit to a local BAcC member is worthwhile to discuss how acupuncture treatment might help your specific presentation.
We are very sorry to hear of your daughter's problems; that is a very long time to be carrying the burden of an undiagnosed complaint in one so young.

The question of whether pain or anxiety came first is very difficult to settle. In most cases there is a very unpleasant circularity about these kinds of problems, and both conventional and Chinese medicine look for ways to break the cycle. As far as treatment of both is concerned, there is a pretty good amount of evidence suggesting that acupuncture treatment can be helpful. As we wrote recently in response to a question about depression and anxietyThere is some increasingly good evidence for the use of acupuncture in the treatment of depression, as out factsheet showshttp://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html

as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recentlyhttp://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001518


Where the depression is linked to a continuing health problem, however, the situation becomes a little more complex. We find that when someone has a chronic condition it can become a great deal more difficult to deal with the depression that this causes and the underlying depression to which this has added.The great strength of Chinese medicine, however, is not that it treats this or that condition, but that it treats the person. This is why twenty people with headaches may be treated twenty different ways. Clearly some points will have a direct effect, but treatment is not the equivalent of an aspirin, and the practitioner will be at pains to discover why this symptom appears in you and not in someone experiencing similar external stresses. The best treatment always combines treating the symptoms within the context of their overall pattern, and the pattern is the primary factor. Indeed, in ancient times some of the older systems used to treat the people without necessarily taking any notice of individual symptoms, in the simple but effective belief that a system in balance took care of its own problems.The best advice we can offer is that you visit a BAcC member local to you, and see if they are prepared to give up a little time without charge to discuss whether your specific presentation. Anxiety and depression are rather broad labels which cover a huge range of possibilities, and sometimes we have to say to patients that what they are dealing with requires more of a talking therapy approach than we can offer. Given that it is rare for mental and emotional issues to arise without accompanying physical changes, even where these do now generate symptoms, a practitioner of Chinese medicine may well be able to see overall patterns which give them confidence that they may be able to help.The issue of chronic pain is also one on which a great deal has been written, but most practitioners would be trying to get as much information as possible about her life at the time when the chest pains started. Chinese medicine has some very broad brush principles about the flow of energy in the body which underpin an understanding of pain which arises from blockage or poor flow. It would be interesting to find out whether something had impaired the overall flow We think that this still represents very good advice, and we are sure that you will be able to find someone locally who will sit down with your daughter and see whether they think they can  help her. As follows from above, Chinese medicine is an inherently generalist practice, and all of our members are equally well qualified to provide the same level of exemplary care. Using our postcode search facility on the home page will identify your nearest BAcC members.The only caveat we have is the issue of self-harming, and the extent to which it is happening. It can sometimes be helpful to have had experience of working with people who have self-harmed, and it may be worth asking local practitioners if they know of someone locally who has developed a reputation for addressing complex mental and emotional issues. Most practitioner networks are a very efficient grapevine for directing prospective patients to the best practitioner for them. We hope that you manage to find someone who can help your daughter and lift the burden your family is carrying.

This is a very good question. It is the received wisdom inside the profession that treatment should be started as soon as possible after a stroke, and that the potential for change and improvement diminishes over time. This is driven in part by the fact that in China it is not at all unusual for someone to start having treatment on the day of a stroke, the logic being that the energy of the body has been disturbed and the sooner that it is corrected, the less likely the disturbance is to be 'set' in the system. 

We have some sympathy with this view. There have been several books published in the last couple of decades which have explored the possibility that once an energetic pattern has become established it is no longer seen as a pathological factor but becomes the essence of the person. This means that someone can in a rather peculiar way become invested in the post-illness state as their reality, with the attendant difficulty in getting things to change. If you talk to people who teach the Alexander Technique you find the same model; once the body has  a set pattern it takes a long time to re-train it.

However, our clinical experience with post-stroke patients is rather more mixed than this. Whilst we have always warned patients who come in many months or years after the initial stroke that progress may be slow or in some cases non-existent, we have found that some people do have a marked and immediate response to treatment, often in direct proportion to their underlying constitutional health. A person who was strong and energetically in good shape before the CVA often has a greater power to recover.

There has been a mountain of research into this area, as you can see from the rather long review paper which we have on our website

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


but which may be a little technical for many readers. It has long been our hope that the evidence will reach a critical mass where we can argue a case for early intervention within the NHS with acupuncture treatment, if for no other reason than the fact that increasing the speed of recovery would save the NHS millions of pounds in rehabilitation costs. We have some hope that familiarity with the Chinese system will encourage some trials in the UK.

As far as your brother is concerned, however, it is rather difficult to say what might be possible without a face to face assessment. What you and he will find, however, is that most of our members are very happy to give up a little time without charge to prospective patients to see whether acupuncture treatment would be a good option. Most of us are very frank about someone's chances because the disappointment of achieving nothing or very little is just as palpable by the practitioner as the patient. We get it wrong - some people we think we can't help recover amazingly and we think we can help don't. In the main, however, we tend to recognise those people for whom acupuncture is well worth a try.

The crucial thing is to try to set measurable outcomes so that improvements are not just a matter of feeling better in oneself, good as this is, but visible through verifiable markers - better range of movement, greater endurance in in walking, and so on. This avoids the problem of running up a large bill without really getting anything back. If it isn't working after five to ten sessions it is better to draw a line unless there are secondary improvements which render the treatment worthwhile.

Although there is an increasing amount of research into the use of acupuncture treatment after radiotherapy the majority of studies are aimed at specific symptoms which often accompany treatment - nausea, dry mouth, fatigue etc. Unfortunately nerve pain or generalised pain in the pelvic region is not amongst them, and we suspect that this is because the generality of the symptoms makes it difficult to assemble meaningful trial groups. The results of the research show some quite positive outcomes for dry mouth and nausea, but as always is the case with acupuncture research the conclusion is that larger and better designed trials are needed. Even if someone had researched nerve pain specifically, the chances are that this is what the conclusion would be. The bar is set very high, and not always appropriately, for the work we do.

That said, there is a substantial and growing body of evidence for the treatment of neuralgia with acupuncture, even in the strange limiting cases like phantom limb pain, so it would not be a bad idea to see if treatment could alleviate some of the discomfort. The effects of radiotherapy in terms of the heat and scarring of tissue are outcomes which can clearly be translated into the diagnostic systems of Chinese medicine, and a practitioner can hope to address some of these within the overall constitutional setting within which they have had an effect.

The idea of context is central to Chinese medicine. Every is a unique blend of energies, so even when two people have the same symptoms they might arise from different internal disturbances. The skill of the practitioner of traditional acupuncture lies in treating not the symptom but the person as a whole. This means that the kinds of damage which radiotherapy can do will differ from person to person, both in terms of severity and in terms of potential for recovery.

The best advice that we can give is that you visit a local BAcC member for an informal chat about what may be possible. Most of our colleagues are happy to give up a little time without charge to establish whether acupuncture treatment might be worthwhile, and this gives you a chance to meet them and see where they work before committing to treatment. There is nothing to lose from trying treatment. Not only is acupuncture a very safe therapy but it does not have any major side effects. Even if the treatment managed to help you to deal with the discomfort it may be worthwhile.

The key thing is to set measurable outcomes from the beginning so that you can judge how well the treatment is working. Amounts of painkillers, sleep disturbance and general energy levels are the usual markers, and using them sidesteps the problem that people can feel good on some days, bad on others, and are not always able to say on any given day whether they are feeling better overall. 

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