Ask an expert - neuro and psycho logical

215 questions

As you might imagine we have been asked this question on several occasions and our answers have tended to be rather upbeat, as for example:

The evidence for the use of acupuncture to treat migraines and tension type headaches is encouraging enough that NICE, the National Institute for Health and Clinical Excellence has recommended it as a treatment for many types of headache. Our factsheet

provides details of a great deal of the research which has been undertaken. 

However, we have to be a little cautious. The great strength of Chinese medicine is that it understands the symptom within its overall context, and that does mean that while the majority of people will experience some benefit there will always be those whose overall balance means that short term success is less likely. On the other hand, the majority of research trials tend to be undertaken with formula acupuncture in order to meet the criteria espouse in the West, where the outcome is the only variable, and we have long argued that this is not the best way to test a system which is geared to the individual and where treatment evolves as the patient progresses. In many cases this refinement of treatment generates much better results than the orthodox trials suggest are likely, but until we come up with ways of preserving the integrity of what we do in a research setting we are where we are.

The best advice we can give you is to visit a BAcC member local to you for a short face to face assessment. Most of us are happy to give up a few minutes without charge to assess whether acupuncture is the best treatment for what troubles you, and this will also give you a better idea of what we do, who you might see and the surroundings in which they work. We find that this means prospective patients feel more empowered in making their choices rather than simply being booked in sight unseen.

We think that it is important to add riders like this. Research very often uses formula treatments, and this goes against our ethos of treating the person, not the condition, of seeing symptoms in their overall context. Just as there are occasions when an individualised treatment will exceed formula treatment in effect, there are equally occasions when formula treatment will not be appropriate, nor will individualised treatment be much better. Talking to a practitioner before committing to treatment is a wise move.

The reply should probably point out that the evidence for cluster headaches per se is not quite as compelling, although the one study cited in the factsheet

comes from the GERAC trials in Germany in 2006 which are particularly interesting because the figures were gleaned from German medical doctors and were statistically significant by virtue of the sheer size of the trial.

Our advice from the earlier answers remains very apposite on one main point, though, and that is the fact that each person is unique and individual in their balance of energies, and for problems like cluster headaches which can arise from a number of systemic problems it is essential that someone has sight of a patient before blithely making any prognostications about what may be possible. Most members are happy to give up a little time without charge to prospective patients to enable them to make properly informed decisions about having treatment.

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).

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 one 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 factsheet 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 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 shows

as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recently

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

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.

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