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Q. I had a shoulder replacement (just the ball of the joint) done one year ago. It has remained extremely painful, and I am unable to move my upper arm more than 30 degrees without pain. My surgeon says that I fall into the 5% of cases where there is no clear cause that can be rectified, and that I should consider having a full shoulder replacement. However I am reluctant to do this as there is a 30% chance of it failing within 10 years, and then there is very little they can do, as the bone around the socket will be too weak to take a further replacement. I am 62 and hope to have at least 20 year's active life ahead of me, if not more. Otherwise, I am healthy and fit.

Would acupuncture help with pain relief in this instance?

 

 

A. We have to be a little cautious about answers to questions about pain per se rather than named conditions in which pain is present. As you are probably aware healthcare professionals of all persuasions are governed by strict rules of what counts as good evidence in advertisng and marketing, and there is no specific evidence on which we could base an unqualified positive answer. However, much of the research into acupuncture in the early days was about its capacity to reduce pain, and the results, both on humans and animals, meant that it has continued to remain a worthy focus of attention for at least forty years.

 

From an eastern medical perspective pain and inflammation are usually described in terms of blockage or stagnation of energy, and the practitioner's task is simply to try to move the energy with needles and in some cases moxibustion to try to improve the flow. There are certainly a number of protocols used to free frozen shoulders which may have an impact on what you are dealing with, but in general the strategy is often the same as that used by western professionals in conventional healthcare, breaking the cycle of restriction, inflammation and pain which perpetuates itself. In your specific case there may also be issues with the way that the muscles are functioning around the new joint; the shoulder joint is much more heavily dependent on an exact balance of muscle than the more pronounced ball and socket of the hip, and it often takes an extended period of exercise and physiotherapy to regain full movement.

 

In Chinese medicine each case is regarded as unique, and a practitioner will always want to see the overall picture before making any projections about how effective treatment may be. Your best course of action would be to consult a BAcC member local to you to let them take a look at the problem to see whether in your case there is something which acupuncture might do. We are sure that if they feel that acupuncture would not be the best option they will have other positive suggestions about other forms of treatment that may be of benefit to you.

 

What counts as a good outcome may need to be carefully defined. For most people the outcome is fairly clear - 'I want the pain gone' - but in some cases it is a case of pain management, and the judgement has to be whether the extent and sustainability of relief after treatment warrants the time and expense. Regular reviews of what is happening are essential to ensure that everyone is clear about and happy with continuing treatment.

Post-herpetic neuralgia is a highly unpleasant condition. Acupuncture has been used for a number of neuralgias, for some of which we have prepared factsheets on our website, but the factsheet for post-herpetic neuralgia is still in preparation. There are some encouraging signs from recent research, as in this Italian study of severe pain during the zoster attack

 

 

http://ukpmc.ac.uk/articles/PMC3125389//reload=0;jsessionid=Hmmss672XQCZjw7C1cgg.4

 

but no conclusive evidence accepted in the West as yet on which we could base a firm recommendation.

 

However, post-herpetic pain has been around as long as mankind, and the diagnostic systems of Chinese medicine have been used for many centuries to make sense of the way that the pain presents. Treatment is often a complex mixture of treatment local to the area of pain and more systemic treatment to correct the imbalances from which the treatment stems.

 

Whichever system of medicine is used to treat post-herpetic neuralogia a practitioner will always be understandably cautious about the outcome. This is one of a number of conditions which can prove intractable to treatment, and while it is fair to say that a central question for an acupuncture practitioner is how much change and how sustainable, for conditions like these there is often a period of short term relief which is not progressive, i.e. treatment will achieve the same result but not necessarily extend that period of relief. We expect our members to be alert to this kind of situation and to comunicate clearly with patients about their findings. After all, even a short period of relief may be something which a patient is prepared to accept, but it is important that this becomes the clear understanding of what is happening.

 

One of the great strengths of Chinese medicine, though, is that it treats the person, not the disease, and since from this perspective everyone is unique, as is their disease pattern, there will be cases where more progress may be possible. Seeking advice from a BAcC member in a brief face to face chat may be the best way to establish the extent to which acupuncture may be able to help your specific case.

The evidence for the treatment of osteoarthitis of the knee with acupuncture is relatively good. As you can see from our factsheet there is very good evidence that acupuncture alongside conventional treatment can make a significant difference to the outcomes. Indeed, acupuncture very nearly made it through the process of becoming an option within a NICE guideline!

 

There are many different approaches to acupuncture, eastern and western, and most use the same points local to the problem to help to reduce the pain and inflammation associated with the condition. A traditional acupuncturist will also be looking at your overall constitutional balances to establish whether this is a local problem brought on by over-use or injury, or whether it is a symptom of a more general underlying pattern. Traditional acupuncture treats the person and the condition, and its primary aim is not simply to get people better but to keep them well.

 

All patienst are unique, and although most cases of osteoarthritis are amenable to some improvement, there are a few which are too far gone to achieve much change. It is worthwhile seeking an informal view from a BAcC member before committing to treatment, in order to get a sense from them of how much change might be possible and how sustainable it might be.

The treatment of muscular injuries by BAcC members is relatively common, and often takes place within an existing course of treatment for another presenting condition - many patients are surprised to find that their practitioner can do something about a contingent injury while they are being treated for somethin entirely different. Their experience is usually of western medicine, where each condition opens up a new path for treatment. Chinese acupuncture, however, treats the patient, not the condition, and while some things are simply a consequence of injury or accident, there are often underlying patterns which inform why the problem has arisen and how to deal with it.

There are, however, relatively few studies of the treatment of specific muscle groups, and most studies are often very diffuse, or tend to look at specific and very precise physiological mechanisms, as our factsheet on sports injuries shows.

 

Where someone has a specific injury of this kind we always recommend that they visit one of our members for a better and more informed view of whether treatment will help their specific situation. They may want to look at the way that the problem manifests, as well as asking what makes it feel better or worse, whether the time of day makes a difference, whether medication helps and whether it causes other side effects, before giving you an idea of how acupuncture may be of use to you.

Q. My wife suffers from Primary Orthostatic Tremor. This is a condition where signals from the brain do not reach the legs correctly, and causes instability when standing still. It does not affect walking. Has any member had experience of treating this condition.

 

A. With over two and a half million treatments being administered by BAcC members every year it is highly likely that someone has been treated for orthostatic tremor or one of a number of similar conditions. Unfortunately, we do not keep a central record system which details all of the problems which members treat, and rely on our own internal networks for information gathering.

 

A common response, however, when a member posts on an internal forum 'has anyone treated x?' is for other members to say, 'don't tell me about the western name for the condition, tell me about the signs and symptoms from a tradtional acupuncture perspective and describe how the problem manifests.' The whole basis or paradigm of chinese medicine is different, with an entirely different understanding of physiology and pathology. There are sometimes occasions where a description of a condition will make sense and offer a prospect of treatment in traditional chinese medicine where in the west it is regarded as permanent and beyond help.

However, this is the sort of statement that has to be made with extreme care, because these occasions are more rare than not, especially where complex chronic conditions which defy western treament are concerned. It is true that Chinese doctors have been treating the same problems for two thousand years under a different name, but equally true that they had their fair share of cases which did not improve.

 

The best course of action is to visit a BAcC member local to you to see what they make of the specific symptoms which present here and whether they have experience of similar presentations and can offer you a view of whether this specific case may be helped. If you do decide to go ahead, it would be essential to set very clear outcomes and review periods from the outset. Conditions such as this usually fluctuate a little, and there is often a will from all sides to see any small improvements as a sign the treatment is working when it is no more than a normal pattern of variation.

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