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Q.  Hi. I have never had acupuncture before. I have a very rare bone conditon. I had surgery in April last year which involved breaking my tibia in two places and my fibula once, stretching my leg and puting a nail down the shaft of my tibia.

My foot and toes are still a bit swollen and sensitive but also numb.I can't stretch my little toes apart. My surgeon thinks it will return to normal in time. I wondered if acupuncture would be useful in aiding the healing of the nerves? Thanks.

 

A. One has to be very careful in giving advice in cases like this. From a Traditional Chinese medicine perspective the body is understood in terms of the flow of energy, called 'qi', and anything which breaks the flow of qi, for whatever reason, will be viewed as a potential cause of a weakness of energy 'downstream' from where the injury has been. It is not unusual, for example, for acupuncturists to treat scar tissue in this way, as a material blockage through which a good flow of qi must be restored.

 

From within the paradign of Chinese medicine the problems which you experience would make sense, and treatment would probably address both the over-arching constitutional balance as well as addressing the local issues where the problem lies. However, from a western perspective there is little or no research evidence (apart from a few studies of acupuncture on rats) that nerve healing can be increased or improved by the use of acupuncture. To put this in its proper context, though, the current gold standard of research against which acupuncture is measured is the randomised double blind control trial, and it is difficult to imagine how one could begin to design a trial which met the criteria for assessing this problem.

 

We would recommend, if you do decide to have acupuncture treatment, to talk to your consultant and ensure that they are happy for you to take this route. Acupuncture is a very safe therapy with very clear guidelines for safe and hygienic practice. Some western medical professionals still believe that the risks of infection are high, and the BAcC is happy to provide details for the benefit of patients to help them to convince their healthcare teams that treatment is not a risk.

Morton's neuroma is often caused by running and jogging, and treatment usually appears to be aimed at correcting the gait by the use of orthotics to relieve some of the pressures which are thought to cause the problem and then reducing the inflammation and pain by the use of medication. Although there is very little specific evidence for the use of acupuncture for this specific condition, acupuncture treatment is often used to reduce pain and inflammation in a number of conditions for which there is ample evidence, so it is within the bounds of what one might go to an acupuncturist for.

 

 

Traditional Chinese medicine has a different take on why and how such conditions are caused in the body, and a practitioner might well look at the overall balance to understand why this has arisen. In the majority of cases the cause is straightforward - over-exercise or poor alignment - and if acupuncture is successful in reducing the inflammation and pain there may well be some longer term management issues about how to balance continued running with treatment aimed at ensuring that the condition is kept under control. It may bne useful to involve a podiatrist or osteopath in the overall strategy.

 

If you do decide to go ahead with treatment we advise you to agree very specific outcomes with your practitioner and review progress on a regular basis. Conditions like these can be quite obstinate, and there is no point in having a long course of treatment if there is no change. For cases such as this there are surgical options which have a reasonably good success rate.

Gastroparesis has been the subject of some limited research, and there are encouraging reports that acupuncture may be a useful as part of the treatment strategy. One 2010 case study is reported:

 

 

http://aim.bmj.com/content/28/2/101.1.extract

 

and in 2004, a slightly more complex study

http://www.ncbi.nlm.nih.gov/pubmed/15510787

 

suggested that acupuncture might be helpful. However, the whole body of evidence is a long way short of what health commissioners in the West would regard as sufficiently conclusive to make any definite claims.

 

Chinese medicine, however, uses an entirely different conceptual structure to understand the body and mind in good health and in disease, and the diagnostic systems are often able to make sense of symptoms in terms of functional weakness in a way that is alien to western medicine. Since each person has a unique pattern of energy it is impossible to say for under-researched areas of illness that acupuncture would be of definite benefit. However some of the symptoms which are regularly associated with the condition fall very neatly into diagnostic patterns and syndromes in Chinese medicine for which an estbablished range of treatments do exist. It would be worthwhile talking to a BAcC member local to you to establish whether, in their view, acupuncture may be able to help.

 

Even if there is not a direct equivalence, it is worth bearing in mind that some of the systems of Chinese medicine work in a very different way, aiming to re-balance the body's energies, without specific regard to symptoms, in the belief that a system in balance will not create the alarm bells which symptoms represent. This can be as powerful as direct treatment of the symptom.

There is a growing body of evidence now being accepted in the West that acupuncture may well be an effective treatment for neck pain. Two studies which reviewed all of the trials they could find were cautiously optimistic about the short term benefits of acupuncture treatment and proposed that further long term studies were needed.

 

 

http://www.ncbi.nlm.nih.gov/pubmed/19216662

 

http://summaries.cochrane.org/CD004870/acupuncture-for-neck-pain

 

That said, you GP is not probably not wrong - by the time that someone is in their 70s or 80s there is often quite a lot of degeneration in the vertebrae in the neck, and if this is causing impingement of some of the nerves emerging at the neck, or tightening of the ligaments and tendons which is itself causing pain, there may be a limit to what acupuncture treatment might be able to achieve. If the restriction of movement is mainly caused by muscles which are guarding to prevent further pain there is a possibility that the treatment may relax them sufficiently to improve the range of movement.

 

If you do choose to have acupuncture treatment it will be important to establish whether the treatment is providing the same kind of relief for a period but no more on each occasion. Although a practitioner will aim to bring about overall improvement there are times when even a guaranteed period of less pain and easier movement is an acceptable outcome for a patient. This has to be an agreed outcome, though, not simply assumed by either party.

This is quite a difficult one to answer for two reasons:

 

  1. although the BAcC does not yet recognise standards of specialist qualification, there is a growing number of members who spend their time working with particular groups of patients, such as children or pregnant women, and who undertake further training directly related to these groups. While the acupuncture used to treat most 'special' groups is identical to any other kind of treatment, a strong case is currently being made that there are variations in standard patterns of treatment when dealing with the under 5's in particular. However, as a profession we are committed to generalist practise, and are still debating whether to allow people to claim expertise in any one field, so we would not normally be able to cherrypick a number of members in an area based on informal knowledge of their focus.
  2. although chinese herbal medicine is often used very successfully alongside, or sometimes instead of, acupuncture in the treatment of chronic skin problems, we are not in a position to comment on how suitable herbal medicine might be for a two-year old.

 

So, our best recommendation is that you contact some of the BAcC members local to you and ask if any have had further training in paediatric acupuncture and have dealt with this problem before, or perhaps google 'treating children with acupuncture north surrey' to generate a list of people who have undertaken further training. There are also a small number of well-known course providers whose websites often list members who have undertaken further postgraduate trainiing in paediatrics.

 

It may also be worth contacting the Register of Chinese Herbal Medicine (http://www.rchm.co.uk/) to ask its view of whether herbal treatment is suitable for infants. There is no doubt that the regularity and frequency of treatment may be beneficial in maintaining a momentum which weekly or bi-weekly acupuncture treatments may not match.

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