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We are sorry to hear that you are faced with such a long wait for a specialist opinion. All we can say with certainty is that acupuncture is very probably not going to make things any worse and may well help to address the symptoms and reduce the pain.

The theory of acupuncture, as you have probably read, is about the flow of energy, which we call 'qi', and its correct balance and flow within the body. Essentially all of the theory boils down to techniques to understand how and where blockages and imbalances arise, and skills with needles and moxa to reinstate the normal flow. The simple underlying premise is that where energy flows as it should then everything should function as it is supposed to.

When people have accidents there is often inflammation and deep bruising which from a Chinese medicine perspective can mean a blockage in the flow of energy which is more than the body can correct. Sometimes this is a local problem, but at other times it may be indicative of a general weakening of the system which means that there isn't enough energy to sort out the body's more peripheral problems . The great strength of Chinese medicine is that it can look at the overall context rather than simply picking off symptoms one at a time.

Soaking your hands in ice cold water no doubt does help, mainly by providing a temporary deadening of the sensation, but we would advise any patient to be cautious about doing this for too long after an injury. It is always helpful to apply ice straight away to stop excessive swelling, but after a while the repeated cooling actually starts to work against the body, causing the stuck energy to become even more stuck. If you are going to use cold we suggest that you alternate with some heat to try to encourage flow as well. Alternating hot and cold is the option many physios will recommend to people with injuries.

The best advice that we can give is that you visit a BAcC member local to you for an informal assessment of whether acupuncture might be a good idea. Most members are happy to give up a little time without charge to see a problem in the flesh and advise on whether acupuncture treatment might help, and this is your best route. It's a pity we don't know more about the nature of your accident, whether it results from a sprain or a fall. However, the fact that the pain is referring up the arm could be indicative either of nerve impingement (from a western medicine perspective) or a blockage in the flow of energy in the channels (from a Chinese medicine perspective), both of which are more encouraging in terms of potential recovery. we certainly hope so.

We are sorry to hear that in spite of all the treatment you are receiving matters don't seem to be improving. It's a little difficult to answer this question, because as you can easily understand, our expertise lies in using traditional acupuncture so we wouldn't hold ourselves out to be experts in any other fields. However, we invariably suggest osteopaths and chiropractors as alternatives, and indeed, often work with them to achieve change. Our work on the functional aspects of the body together with their work on the structural aspects is often what is called synergistic, the two treatments having more effect than the sum of their parts.

We would want to know a great deal more before offering any other suggestions, though. As our factsheet shows

the evidence of the use of acupuncture in treating sciatica is pretty good, so the fact that you are seeing no change is unusual. It would also be helpful to know exactly how much of a problem it is/was, and how it came about, i.e. suddenly through accident or slowly through wear and tear. All of these have a bearing on what we might recommend to a patient we took on.

The one thought that we can't help have, though, is that this is quite a great deal of treatment to be having all at once. We tend to reserve more than once weekly treatment for really acute problems where the patient cannot function at all. For more chronic problems two or more treatments a week might just be a little disruptive to the healing process. Not everyone would agree, and in China, for example, acupuncture might well be routinely delivered every day for a ten day course of treatment. Many Chinese practitioners do the same in the UK, but the majority of us tend to leave a little more space between sessions to give the body time to adjust. It might just be that less is more in your case, and that letting the treatment bed in for a little longer might encourage more progress.

There are a variety of associated bodywork treatments in oriental medicine - tui na, shiatsu, etc - many of which are used within traditional practice by acupuncturists but also by people who specialise in these techniques. You might usefully see if this could be added to the mix.

More than this we really cannot say without access to more comprehensive background information, but we would encourage you to ask your practitioner about what else you might usefully do. They, after all, have access to all the information which we would need, and have undoubtedly come across similar cases in the past and know what is likely to be a good adjunct and who locally is best qualified to offer it.

We are very sorry to hear that you have lost your practitioner after so many years. Sadly as we become a more mature profession this has started to happen a little more frequently. We know just how much people value the fact that there is someone who has seen them through a great deal and with whom there is no need to go over ground that is already long familiar.

In these situations we always advise people to contact other local practitioners, and for want of a better word 'interview' them. You will find that nearly all will agree to talking to you for a long enough time to see if they and where they work are to your taste, and if they won't then to some extent you have already saved yourself the bother of someone who probably isn't going to be the one for you. From the practitioner's perspective this makes perfect sense. You have shown a commitment to long term treatment, and as such they would be 'inheriting' someone who is very likely to be coming to them for some time.

Although it should be possible for any new practitioner to get hold of the existing notes we find that most patients and practitioners in this situation like to make a fresh start. We all have slightly different ways of approaching our work, and although case history is important there are other factors which are likely to be more central to a new beginning.

You will probably find that if someone has been around for a very long time there are going to be colleagues who have been inspired by him and try to emulate the way he worked. This might well make your selection a great deal easier because it is very likely that you will be directed towards people with whom he was in close contact. 

There is occasionally some merit in having a trial session. We knew of one practitioner whose manner with patients was wonderful but whose needle technique might have been described as 'brusque'. It is, after all, acupuncture that you are signing up to, so if someone really doesn't suit you in that department it would be good to find out sooner rather than later.

We hope that this helps and that you find someone who will last at least another thirty years.

We have been asked about the treatment of sciatica many times, and a recent answer was:

As you can read from our factsheet

there has been a significant amount of research into the treatment of sciatica with acupuncture, and the results have been increasingly positive. The threshold for being able to make a definite claim is based on a research process for which very little acupuncture treatment except non-traditional formula work will work, but there have been dozens of Chinese studies aimed at finding what works better which seem to show that sciatica responds well to treatment. Certainly this 'expert's' experience is that sciatica seems to respond well to treatment in most cases.

There is no doubt that formula treatment will work to an extent, and there are many medical acupuncturists and 'cookbook' practitioners who will use the same 'sciatica' patients on every patient. The real strength of traditional acupuncture, though, is that it addresses the problem of why sciatica occurs in this particular patient, or more properly why the system does not put right and recover from the injuries which normally cause it. Twenty different people may have the same named condition but be treated in twenty entirely different ways. What this does is not just put the problem right but try to make sure that it does not recur.

There are no special treatments for sciatica, and no specialists, so any well-trained traditional acupuncturist should be able to help you. The best advice, though, since there are one or two cases which would not make us feel so optimistic, is to pop in to see a BAcC member local to you for a chat and to get a short face to face assessment of what is going on. This will not only give you more precise information but also give you a chance to meet a practitioner and see where they work before committing to treatment.

We are surprised that seeing an osteopath has made no difference, but the one strength of acupuncture is that it mainly deals with function, not structure. If an osteopath puts a lower spine back into shape but the surrounding musculature still retains levels of poor function, then it will revert quite quickly. Encouraging better function in the local tissue can of its own accord spring the spine back into shape, as well as balancing up the whole system which in and of itself can achieve good results. Many people come to acupuncture treatment for back and hip problems.

Of course, if the problem is pseudo-sciatica, the most likely cause of which is piriformis syndrome, then this is all the more likely to be the case. The effect of the spasm in this muscle can put pressure on the sciatic nerve which generates exactly the same symptoms as one would get from compression of the nerve root. Acupuncture treatment can be effective in helping to address this as well.

In summary you may well find that acupuncture can help your wife. The real question is how much help and how sustainable the outcomes are. We have great faith in treatment always doing something, but there are times when the effects are short lived and non-incremental, so it is very important to try to establish good measurable outcomes and also to review progress every five sessions or so to ensure that you don't build up an unintentional treatment habit where the weeks can slip by unnoticed.

Restless leg syndrome is awful, as this 'expert' knows from personal experience back in the 80s when nothing, but nothing, would make the problem relent. It is nowgaining recognition as a diagnosable problem, with a new name(!), and there are a number of treatment options which are being explored. A review article cites several of these, and the one acupuncture review this in turn cites

mentions two to three studies which are interesting but generally concludes that the majority of studies are too small and not methodologically sound enough to draw firm conclusions.

From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised' can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.

Even where this is not the case it is important to mention that the older theories of Chinese medicine were primarily aimed at balancing the whole system, seeing symptoms only as alarm bells, not the problem itself. Working in this kind of way our members very often have an effect on problems without necessarily being able to give a highly specific audit trail of what is causing something to go wrong.

We have not come across much in the way of new research, although another small study published early this year (2015)

repeats the general pattern of significant effects but small study sizes which means that we cannot give a more unqualified recommendation.

As far as motor axonal neuropathy is concerned, there is very little focused research on this specific presentation of peripheral neuropathy. There is a systematic review published earlier this year

which embraces a number of papers about neuropathies very similar to axonal neuropathy, but nothing specifically about it. Most studies of this kind tend to be very small, and inevitably the conclusion is that more studies on a larger scale would be necessary. The main question which is left unanswered is 'who will pay for them?'

If you are considering acupuncture treatment for the problem the best advice we can give is that you visit a local BAcC member to ask for a brief face to face chat about what may be possible. It follows from what we have said before that each case is unique and different, and a face to face assessment is the only way to get a specific answer about what you might expect. Many practitioners are happy to give up a small amount of time without charge to prospective patients to make this kind of assessment.

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