Ask an expert - neuro and psycho logical - neuralgia

17 questions

Q: I had chemotherapy 4years ago, I lost my finger and toe nails. Since I have suffered terrible discomfort in my feet. I now find it hard to sleep because of the pain. Would acupuncture help?

A: We are sorry to hear of your problems after chemotherapy, and hope that the treatment worked for the condition at which it was aimed.

As you can imagine we have been asked before about neuropathy induced by chemotherapy, and a typical answer has been:


There is a growing body of evidence which suggests that acupuncture can be very effective in helping to reduce the severity of peripheral neuropathy (PN) induced by chemotherapy and to speed up the rate of recovery. If you search on google using the terms ' ncbi acupuncture neuropathy chemotherapy' you will access a major American research database gathering studies from all of the established online collections like PubMed and Medline. The first half dozen results point to a number of recent studies which show very encouraging results, but most of which conclude that a much larger study is warranted before any definite conclusions can be reached. This is not uncommon; research funding for acupuncture is not that freely available in the West, and Chinese studies are often regarded as methodologically unreliable. There is certainly enough to say that acupuncture treatment will probably help.

We have to be careful not to get too drawn into a conventional medicine perspective when answering questions like this, though. If there has been physical damage to the nerve endings then the condition is less likely to be reversible, although there is some cutting edge research which does suggest that peripheral nerves can regenerate. If the nerves are not too badly affected, however, it is important from a Chinese medicine perspective to see how the chemotherapy has affected the whole system. A symptom can be generated by any number of functional disturbances as understood within Chinese physiology, and can also arise from a simple blockage in the flow of energy at a local level. Problems like neuropathy are often a manifestation of both phenomena, and offer a number of treatment options. The skill of the practitioner lies in seeing how the system as a whole is functioning to narrow down the possibilities for treatment selection.

This does not mean that acupuncture can achieve miracles where modern medicine cannot. What we find, however, is that where western medicine assumes a direct causal path between the chemicals and the nerve damage or loss of function, Chinese medicine offers a number of potential routes where, for example, the chemotherapy may have affected a functional unit which in turn has weakened the energy at the periphery.  This is turn may offer a slightly different focus for treatment with better chance of success.

It also explains why people are often confused by the fact that the same symptom  can be apparently treated twenty different ways. From the Chinese medicine perspective the symptom is often only an alarm bell sounding for wider-ranging imbalances, and the practitioner will always look at the overall context to determine how to proceed.

Having looked at this as an answer we think it still represents the best advice that we can offer. We have had another look at the databases, and there has been nothing new since we wrote the earlier reply. Franconi's systematic review, a paper which gathers together results from all other papers, is perhaps the most recent and best summary, but as we said in the earlier reply, he concludes that the results, while encouraging, are far from conclusive.

What we didn't say is that most BAcC members are more than happy to take a look at problems for prospective patients by giving up a few minutes without charge. A short face to face assessment is always going to be far more authoritative than anything we can offer at this remove, so it would be worthwhile contacting BAcC members local to you to see what they think. This also gives you a chance to meet them and see where they work before committing to treatment.

Q: Can acupuncture help with post herpetic neuralgia?

A: As you might imagine we have been asked about this many times over the years, and a recent answer was:

Shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/herpes.html says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

We have had a good look through the research databases to see what further evidence is available (the fact sheet seems to stop around 2008) and we have found a few which are positively encouraging, such as:

https://www.ncbi.nlm.nih.gov/pubmed/21639941

https://www.ncbi.nlm.nih.gov/pubmed/22502623

but the systematic review proposed in 2014 has still to be completed (at least we can find no trace of a publication by the principal author).

The advice we gave earlier holds good, and that is to visit a local BAcC member for an informal chat about what may be possible. This is by far the best way to get a clear idea of your prospects, and most members are only too happy to see prospective patients in this way.

Q: Due to 32 years of diabetes, neuropathy in my foot has set in.Feeling of heavyness in the fingers is felt though blood flow is ok in the legs. Can acupuncture be of help to restore normalcy in the foot areas?

A: As you can imagine we have been asked about peripheral neuropathy on a number of occasions. One of the more recent answers we gave was:

There is some evidence that acupuncture may be helpful in the treatment of neuropathy, as our factsheet http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html shows but this is not yet compelling enough for us make a firm recommendation. If you google for results from the US National Centre for Biotechnology Information, a very useful research resource, as 'ncbi acupuncture peripheral neuropathy' you will find references to a number of studies, some of which seem to show very positive results, others less so. Treating nerve damage with acupuncture, however, suffers from the same limitations as any other therapy. If the damage is already considerable there is less chance of reducing the pain and loss of sensation.

Chinese acupuncture is based on a theory of energy, called 'qi', and its flow and balance in the body. This can often mean that the needles used in conditions like peripheral neuropathy are often local to the problem and seen as a blockage in the flow of qi, but Chinese medicine has an elaborate understanding of the functional nature of the internal organs, understood entirely differently from in the West, and will often look at how the problem may also be a manifestation of a wider functional disturbance in the system. Then, of course, you have the underlying premise of the original Chinese medical systems which were largely asymptomatic, regarding the achievement of overall balance as the primary aim in the belief that this would deal with symptoms wherever they manifested.

The important element in treating peripheral neuropathy is understanding the physiological basis for its appearance in western terms and being realistic about what may be achieved. If this amounts to maintaining the status quo, or even as one very wise patient expressed it 'getting worse slower', then as long as this is the agreed basis for treatment, that is fine. Our members are trained to avoid raising unreal and unreasonable expectations in people with degenerative conditions or permanent physical damage. Talking to a BAcC member local to you face to face may be the best advice if you are considering treatment. They should be able to assess relatively quickly whether acupuncture was a worthwhile option for you.

This remains the best advice we can give you. A practitioner may see something in your state of balance which is a basis for treating the system as a whole with some expectation of change, however limited. The question may well be how much change and how sustainable. If it managed to quell the worst symptoms, which based on evidence for acupuncture and pain relief may be possible, then treatment may be very worthwhile.

However, we would have to say that restoring 'normal function' is unlikely. There is a small amount of evidence from the world of animal experimentation with acupuncture that some nerve tissues can regenerate, but these tend to be very small and non-essential nerves. We have also found a number of small studies which showed slightly improved conductivity in PN after the use of acupuncture, but these are too small to draw any conclusions which could be generalised for all patients.

The best that we can say is that acupuncture may improve the quality of the nerve signals which are present, and may thus help with some pain reduction, but each case is unique and different, so the best option will always be to see a practitioner who can cast an experienced and skilled eye over your whole system to see what may be possible.

Q: Is there much evidence for treating CRPS with acupuncture? My 15 year old daughter has it in her ankle/foot.

A:

We were asked a similar question a year ago and our response then was:

Diagnosing the pain as CRPS (we normally call this Complex Regional Pain Syndrome rather than Chronic, but it's only a name) doesn't really refine the diagnosis a great deal. If you look at the wikipedia entry on CRPS, as we are sure that you have, there is no clear-cut cause, the term mainly being used to describe a complex array of neuropathic and sensory pains of great severity. From an acupuncture treatment point of view, both in traditional Chinese and western medical versions, chronic pain was one of the main focuses of research in the 1970s and onwards following Nixon's visit to China and the film footage of people having operations without anaesthetic. There has been a great deal of research, as our factsheets on chronic pain and neuropathic pain show http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html & http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html When we are asked about the value of treatment all we can say is that it is worth trying, and that the major issue will not be whether it works but the extent to which it works and how sustainable the improvements are. Generally speaking we do not like to continue treating someone where there is no overall improvement but simply respite from pain which always lasts only for a short while. However, patients over the years have told us emphatically that if the trade off for a little regular cost is the ability to maintain a valuable and valued lifestyle then it's their call, not ours. However, from a Chinese medicine perspective there is often a great deal more hope than simply symptom suppression. The system of medicine is predicated on the balanced and effective flow of energies in the body, and if for any reason this flow becomes imbalanced - overflowing, weak or blocked - then pain will result. The re-establishment of proper flow will restore balance and in theory the pain should go. The major task the practitioner faces is determining how much the problem is simply local and how much it depends on underlying systemic weaknesses for its enduring nature. In your daughter's case her youth probably means that she's in good health, and twelve year olds tend to respond well to treatment, as do most children. Undoubtedly, though, the pain and trauma will have taken some toll. It would be well worth while contacting a BAcC member local to you for advice based on a brief face to face assessment of what is happening in your daughter's case. Although we have not yet finalised our discussions on expert practice in relation to paediatrics, it is likely that in the next few years we shall recognise the postgraduate training that many members undertake in treating children. They are not simply small adults, and it may well be worthwhile using google searches for 'acupuncture' and 'children' to see if there are, as is likely, BAcC members who have followed this path. We are not quite yet in a position to identify them directly. That said, any practitioner worth their salt will be more than adequately able to help and offer their advice.

We don't think there's a great deal we can add to this answer. We have conducted a search of the databases and found case reports like this one https://www.ncbi.nlm.nih.gov/pubmed/23113454, although you are not going to find it easy to locate a Chinese scalp acupuncturist in your area, this being a modern development for which there are as yet no agreed standards. There are also studies like this one https://www.ncbi.nlm.nih.gov/pubmed/21208130.

But single case studies are far too unreliable for drawing useful conclusions. They may prompt further research, but there are too many confounding factors in play to be sure what has effected the change. Many people who become the subject of a study improve by virtue of the extra attention they are getting.

We always find that going back to basic principles is the best answer. From a Chinese medicine perspective pain arises where there is a blockage in energy flow, an excess of a deficiency in the system as a whole, and usually a combination of local and systemic issues. Since each patient is unique and different it is really only possible to say whether a treatment for one of the less common presenting problems will work through actually seeing what is happening.

The advice we gave in the previous answer is your best bet. If a local practitioner can spare a few minutes to see your daughter to assess the situation you will get an honest appraisal of what acupuncture may do and also recommendations for other forms of treatment if the practitioner thinks these might be better.

Q:  I have suffered from pudendal neuralgia for 2 years. I would like to know if acunpuncture can be used to treat this condition? Also, details of practices that can treat this condition. I live in Newcastle-upon-Tyne

A:  Pudendal nerve problems can be a source of immense discomfort and can often lead to severe depression, especially if entrapment of the nerve not only causes the neuralgia but also affects functions in the lower abdomen.

We would first want to ask a great many questions about what brought the problem on, or if there was no obvious cause what was happening at the time of onset. We would also probably want to know whether the onset was sudden or gradual, whether you had found anything which seemed to relieve the problem, and what tended to exacerbate it. These questions would be standard fare for any doctor, but the underlying theory of Chinese medicine can often make sense of symptoms and how they present within an entirely different framework.

The bottom line, though, is that quite often pudendal nerve problems result from physical changes in the lower spine or in the internal musculature, and these can often be difficult to reverse. Occasionally there is a level of entrapment brought on by a hobby like cycling or working for long hours in a fixed position, but these are easily identified and easily remedied. The majority of cases are more treatment resistant, and it would be unfair to give you unrealistic expectations of what was possible. We have trawled through the research databases and found very few studies which even look at the problem, let alone indicate that it might be amenable to treatment.

However we must not sell ourselves short! Acupuncture treatment is often the last resort for intractable problems, and occasionally generates results in the most unexpected cases. If a practitioner can make sense of the presentation you have from a Chinese medicine perspective then there may be some cause for hope that the symptom can be reduced in severity or even removed. The best way to establish this would be to see a BAcC member local to you for a chat and brief face to face assessment.  The only caution we ever offer is that where we are not sure whether treatment will work it makes sense to try to find measurable outcomes and to review progress regularly, and certainly after the first four or five sessions. If there has been no change of any kind then it may be wise to call it a day early rather than run up a large bill going nowhere.

As generalists all of our members are capable of treating this problem, and using the postcode search facility on our home page www.acupuncture.org.uk will generate a list of members geographically closest to you. 

 

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