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Do you have any evidence for the use of acupuncture in Polymyalgia Rheumatica?

Q: I am a medical acupuncturist in Australia. Just wondering if you have any evidence for the use of acupuncture in Polymyalgia Rheumatica?

A: As you can imagine we have been asked about this condition by prospective patients on a number of occasions, and the most recent answer we gave was:

There are surprisingly few studies into the effects of acupuncture treatment on polymyalgia, and this does limit what we can say from a conventional medical perspective about the treatment of the condition.

However, we suspect that this is a great deal to do with the diffuse ways in which the condition presents. In our experience the definition is imprecise, and we have seen patients with identical presentations diagnosed very differently. From a Chinese medicine perspective, though, this doesn't really matter. For us the description of the patient's symptoms is seen against an entirely different theoretical framework. This involves an understanding of the body as a flow of energy whose rhythms, flow and balance can affect someone's health. When pain arises it is usually a sign of blockage in the system, or excesses and deficiencies which we can correct with the use of needles. The real skill and art of the practitioner lies in identifying the true source of the problem. Such is the complex web of inter-relationships within the body a symptom will often not be the same as the cause of the problem. Finding out where the root cause is and addressing it is what differentiates a traditional practitioner from someone using simple all-purpose formula points. If the root is not addressed then the problem will come back. This also explains why a dozen people with the same symptom can be treated in a dozen different ways, with treating being individualised to each case. The best advice that we can give is that you visit a BAcC member local to you so they can give you a brief face to face assessment of what could be possible. A skilled practitioner should be able to give you a rough idea quite quickly of how much change they think they might achieve and over what period of time. Most of our colleagues are happy to give up a few minutes without charge to enable the patient to make an informed choice, and will also be likely to offer good alternatives if they think these will address your problems better.

This explains the situation very clearly from a Chinese medicine perspective, but for someone using acupuncture within a conventional medical framework this probably wouldn't help. We have shared a very helpful and informative relationship with our medical acupuncture colleagues in the UK, and they have often found that trigger point acupuncture has been helpful, as has segmental acupuncture to a degree. The theories behind these approaches can overlap usefully with the main presenting symptoms of PMR, but naturally the overall diagnosis overlaps with dozens of other local conditions, so rather than being points for PMR these would be better seen as 'area acupuncture.'

The one thing which medical acupuncture lacks, and we mean no disrespect by saying so, is a systemic approach to ill health in the body. Many of the patients who present to us as traditional acupuncturists have problems which clearly point to weaknesses in the overall functions of some of the body's systems, and we often find that unless these are addressed as well then treatment may only have a short term effect.

If asked by a patient what the evidence for the success of acupuncture for PMR is, though, we would have to be honest and say that not only does it not meet the gold standard of western research, the RCT, but often fails to meet any reasonable standard. We believe that this is partly to do with the difficulties of assembling a meaningful cohort for a trial, the diagnosis not always being precise, but partly to do with the fact that treating it as a purely physical condition may not be dealing with the underlying causes, some of which are often mental and emotional.

We are sure that your non-medical colleagues in Australia would be happy to discuss this whole area of treatment with you.

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