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92 questions

Q: Can accupuncture help my husband who has had facial/ head surgery? About 2 years ago a flap was taken from his r/side forehead to re-build his nose that had skin cancer. During the surgery nerves were cut above his eyebrow and since then has suffered terrible pains. He was told there is nothing to help him if morphine does not work!

We always find it very difficult to comment on very specific problems like this which are almost always unique in their presentation, not because we have nothing to say but because we do not want to excite expectations that cannot be met.

We have come across many cases of this type where there has been a post-surgical outcome for which no treatment options are available except strong medication. From a Chinese medicine perspective pain usually arises from blockages or excesses/deficiencies in the flow of energy (called 'qi') in the body, and on this level there isa a considerable amount of documentationa and research suggesting that acupuncture can be of benefit, as our fact sheet on chronic pain shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

There is also a growing body of evidence for the use of acupuncture in the treatment of phantom limb pain, and this perhaps is the best cause for hope in your husband's case. The severing of nerves in an amputation or injury involving a loss of limb are an approximate analogue for what your husband has suffered. In answering a query about this we said:

Phantom limb pain can be a very distressing phenomenon.

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:
http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97
Hecker H. -U et al (2008) Color Atlas of Acupuncture 2nd Ed. Thieme, Stuttgart
Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142
Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112
Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213
Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

A:  The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in 'conventional' Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

However, if this expert were to look at the problem, his first impulse would be to look carefully at the reconstructive surgery and see how this might have affected the flow of energy. It would not simply be what potential there had been for nerve damage, but also a look at scarring in the area. Scar tissue itself can also generate some very intense pain if it cuts across the channels of normal flow, and there have been many anecdotal reports of acupuncture treatment being used to 'join the dots' and restore normal flow, this in itself being enough to take care of some local symptoms.

Each case is unique, however, and the best advice is to visit a BAcC member local to you for expert advice on what may be possible from a proper face to face assessment. Most BAcC members are more than happy to give up a little time free to enable people to make informed choices about the best course of action for them.

Q:  My mother aged 88 years old has balance problems. The hairs in her ears have flattened and I was wondering if acupuncture could help.

A: A great deal depends on whether the 'flattened hairs' is a specific clinical description in layman's terms or whether it is a broad brush definition being offered by your mother's GP. There are a number of situations where the minute hair-like structures in the inner ear which are responsible for our sense of balance are thought to become obstructed by crystalline deposits, so the person affected does not have a clear sense of their position. A second set of fluid-filled tubes gives us a sense of acceleration and movement. If there are major physical changes in either of these structures, or serious deposits affecting the movement of fluids, then there is less chance that a course of acupuncture treatment will have a significant effect. That said, the structures themselves are microscopic, so clinical investigations are not as precise as one might wish.
 
There are a number of small studies of  balance which provide some encouraging evidence that acupuncture may be of benefit, but these are mainly associated with balance problems after strokes or specific neurological damage. However, there are a great many studies of vertigo as a part of a number of named western conditions, such as benign paroxysmal positional vertigo or Meniere's Disease, where the evidence for the benefits of acupuncture treatment is much stronger. Our factsheet

 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/vertigo.html

 

summarises some of the better research.
 
Therefore, if the diagnosis is not based on CT scans or MRI evidence, or in some cases even if it has, there are many ways in Chinese medical understanding of the body to explain why someone's balance can be affected. The Chinese medicine view of the body is that everything is a manifestation of an energy called 'qi' whose flow, balance and rhythms determine our overall state of health and well-being. If there are local blockages in the flow, these can result in disturbances in the workings of the body where the blockage is. If there are functional disturbances, i.e. deeper imbalances in the system where whole body functions are disturbed, these too can lead to symptoms such as loss of balance. In cases like this, though, the loss of balance will be just one of a number of symptoms which the practitioner will identify as evidence of this loss of function, and the diagnosis will be confirmed by a number of specific Chinese medicine diganostic techniques such as taking the pulse at the wrist or looking at the tongue.
 
Essentially a properly qualified and trained practitioner, such as all BAcC members are, should be able to tell you on the basis of a brief face to face assessment whether there is anything from a Chinese medicine perspective which encourages them to believe that acupuncture treatment may be able to offer some benefit. Our advice is very often that someone should see a BAcC practitioner local to them for face to face advice. It has to be remembered also that some of the more traditional forms of Chinese medicine always treated the person as opposed to the symptoms with which people presented, and applied the simple premise that if the system as a whole was in balance then symptoms would necessarily disappear. This could mean that even in the absence of a direct correlation between symptom and named syndrome treatment may still be of benefit.

 

Q:  I have recently been diagnosed with a condition called spasmodic dysphonia which means that my vocal cords go into spasm when trying to speak. Has anyone come across this and is this something you could help with?

A: There are a very small number of studies such as these
 
http://www.ncbi.nlm.nih.gov/pubmed/14513964
 
and
 
http://www.ncbi.nlm.nih.gov/pubmed/9181547
 
which provide a basis for arguing that a larger scale trial would be useful. However, small scale trials are always problematic when being used in evidence for a form of treatment. Although we are not great fans of the randomised double blind control trial which is often taken as the gold standard for research, the need to take individual and unique variations out of the equation is important, and case studies on this scale can often owe a great deal to extraneous factors.
 
However, that said, Chinese medicine has a very different way of looking at the functioning of the human body, one which rests on a theory of energy called 'qi' and its flow and circulation around the body. When blockages or deficiencies occur, this can lead to aggravation and symptoms. The Organs of the body as understood by Chinese medicine (always capitalised to differentiate them from a western understanding of organs) have a variety of functions on all levels - body, mind and emotions - some of which may have an impact on the ability to speak. One of the great strengths of Chinese medicine is that each patient is seen as unique and different, and the practitioner will look at all of the systems of the body, as well as all of the circumstances surrounding the onset of the problem, to try to understand the patterns of causation.

 

Although symptoms can suddenly appear out of nowhere, there are often underlying issues which predispose someone to develop these symptoms. If this were to be the case with your problems, then there may be something in the overall presentation to encourage a practitioner to feel that they may be able to help to sort things out. Given that each case is unique and that research on this condition is sparse, your best bet would be to visit a BAcC member local to you for a brief face to face assessment of whether in their view acupuncture treatment might be of benefit. Even when there isn't a clear 'audit trail', the premise of the very old traditional systems was that treating the person and re-establishing balance would surely remove symptoms. This can cause problems in modern practice; it is possible to get rid of a symptom without anyone ever establishing what caused it, which some people find perplexing!

 

The standard options, such as botulin injections, remain available to you, we imagine, but these offer only temporary relief from the problem. It would be nice to think that acupuncture treatment might offer a more lasting solution, but we have to be realistic and say that if you do choose to have some acupuncture sessions, you should set a very clear review date to make sure that acupuncture doesn't become a habit process. We have known patients to clock up a dozen sessions or more without much change because weekly bookings become a weekly pattern which easily stacks up to a large-ish sum of money.  

 



 

As is often the case there is an article or a study which has some very positive outcomes for a condition which it is difficult to treat with conventional medicine. This is then frequently cited and gives the impression that there is a great more activity than is the case. Such is the case here. The article itself

http://aim.bmj.com/content/21/4/153.full.pdf+html

now has the contents 'locked' since Acupuncture in Medicine was taken over by the BMJ, but it does describe a quite dramatic improvement in a single case.

Sadly our clinical experience is not quite as encouraging as this. Chinese medicine works on an entirely different theoretical basis, predicated as it is on the notion of energy, or 'qi', as it is called, and the functional relationships which the Organs have. These are very different from the western understanding of an organ, which is why we capitalise them, and they do encompass things like the sense of smell. In rare cases there is a direct correlation between this loss and other symptoms which points to a specific functional disturbance. However, we have to be honest and say that this is rarely successfully treated.

A huge amount depends on what else, from both a conventional and Chinese medicine perspective, going on. Many of our faculties become less acute with age, and the sense of taste and smell can also be badly affected by sinus problems, as well as by neurological problems. Determining what else is happening, as well as how the problem started to manifest, is equally important for both systems of medicine, and no practitioner would give a view unless and until they knew more about the background to the problem.

Our advice becomes a littl;e repetitive at times but the nature of this problem especially means that you would benefit from contacting a BAcC member local to you and seeking a brief face to face consultation, hopefully without charge, at which someone can give you a better idea whether there is something in the overall presentation or history of the problem which would give a better indication of whether acupuncture treatment may be of benefit.

Q: I have been suffering with Uveitis for around 5 months and have ready that acupuncture can really help to reduce the inflammation. Are there acupuncturists that specialise in eye treatments or will any acupuncturist be able to look at this problem?

A:  We have to sound a note of caution, insofar as there is not a great deal of research to underpin claims for efficacy in treating uveitis with acupuncture. There was a small study in Vienna three years ago

http://onlinelibrary.wiley.com/doi/10.1111/j.2042-7166.2003.tb05820.x/abstract

which demonstrated reductions in pain and improved visual acuity in five patients, but this is not robust enough evidence to make any more serious claims about efficacy.

From a Chinese medicine perspective, there are obviously other ways of looking at what happens in uveitis within the diagnostic framework. The manifestations of the problem are understood within an entirely different paradigm based on a concept of energy, called 'qi', and its rhythms, flow and balance within the system. There are both functional aspects of eyesight which are governed by different parts of the system and local energy flows which might be compromised and generate problems such as this. The skill of the practitioner lies in making sense of the symptoms within the diagnostic framework and seeing what may be done. This can sometimes generate solutions where western medicine has none to offer, but one has to be realistic and recognise that some conditions do not respond well to acupuncture.

Your best avenue is to see if a BAcC member local to you can offer a brief face to face assessment of whether acupuncture treatment may help your specific presentation. There are none that specialise in eye conditions as such, although if you undertake a google search you will find one or two who have written quite a great deal about eye problems and acupuncture. We remain committed to the policy, however, that all our members are equally well qualified to address the great majority of problems which their patients bring them, and we do not promote individual members.

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