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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.

A great deal depends on one's perspective. From a western scientific point of view, the mechanisms of acupuncture are largely understood to be neurophysiological but mainly not yet understood. Most of the varieties of western medical acupuncture are based on an understanding that the insertion of needles has an effect on nerves which can release muscles, over-ride brain signals, and so on. There are very often chemical changes in body fluids associated with treatment, and there is a great deal of experimentation on animals to see how various hormones and neurotransmitters are affected by inserting needles in specific areas or points.

 

 

From an eastern point of view, the patholology and physiology of the body is understood very differently. This is not just in China, but in Japan, India and other East Asian cultures where acupuncture is practised. The energies of all matter, both organic and inorganic, are thought to be manifestations of a single universal energy or force called 'qi', the movement and balance of which in the human being is seen as directly linked to the health of the individual. Inserting acupuncture needles in specific points is believed to harmonise and improve the flow of qi, and this understanding can be used both locally if the qi of a specific limb is affected, or systemically if the symptoms are an expression of a deeper underlying disorder. Qi in balance allows all physiological functions to return to normal.

 

The technical terms used to describe systems of medicine viewed in this way is paradigms, and following the work of Thomas Kuhn in the philosophy of science are thought to be qualitatively different to the extent that one cannot be mapped onto another. While this is true on some levels, the one bridging factor between all systems of medicine are the symptoms which the person feels and describes, and the observations and signs which the practitioner makes or sees. There are some rather abstruse arguments and theories being generated on the fringes of orthodox science which are trying to equate the East asian understandings of qi, prana or ki with some of the energies found in sub-atomic and quantum physics, but this is still highly speculative work, however telling some of the similarities may be.

 

The major difficulty which this paradigm difference presents to traditional acupuncture is that to gain acceptance in the West a great deal depends on claims for efficacy for particular named conditions based on trials which are based on the randomised double blind control trials used for drugs. These try to reduce the variables to a minimum to assess whether a single change has an effect, whereas acupuncture is a world of variables, a form of treatment which evolves and changes in response to feedback, not simply a mechanistic repetition of formula treatment.

 

In short, though, from an eastern perspective it is simply a way of moving qi, whereas from a western perspective it's mechanism is not fully understood but thought to be neurophysiological.

Q. I have a question on the possible side effects of accupuncture.

 

I have been lower back pain for 6 months. This may have originated from a slipped disc but the pain is now less severe but shifting. It is primarily in my hips and buttocks, with some down the back of my legs. The pain is sometimes a stinging sensation, sometimes a burning. My NHS physio has given me one session of accupuncture. However, the stinging has been worse since (almost a week ago). Is this of any concern? I am due to go back for more in 2 days. Many thanks.

 

A.  Acupuncture is a very safe intervention - adverse events are very rare. In cases like this, where a pain seems to increase after treatment there are three possibilities:

  1. that the increase in the pain has coincided with, but not been caused by, the treatment. It is not unknown for an acupuncture treatment to be held responsible for anything which happens after a treatment.
  2. this is a healing reaction - it is also not uncommon when treating musculo-skeletal problems to find that some of the symptoms are exacerbated over the next 24-48 hours, after which they usually subside and there is then a gradual improvement in the presenting condition
  3. this is an adverse event associated with the treatment itself. Most adverse events are temporary and transient, such as minor bruising or slight discomfort. Only a very few involve cause damage or persisting pain to the patient.

In this particular case, the best course of action is to discuss the matter thoroughly with the physiotherapist to see what their take on the problem is. He or she will have the techniques available to assess whether the discomfort which you are experiencing is associated with any changes in the structural alignments in the lower back brought about by the overall package of treatment. In general terms, however, it would be more likely that the stinging has increased as a consequence of an overall shift in the structure of the lower back, rather than being a direct consequence of the physical insertion of a needle. In the rare cases where a needle touches a nerve the sensation is immediate and unmistakeable. Your physio will be able to assess whether the points they have used could have caused such a reaction.

 

It is important to remember that treatment of any kind involves the informed consent of the patient. If you have reservations about the use of acupuncture as a part of your treatment you are free to request that it not be done.

Weight loss was the subject of some critical scrutiny a decade ago, and the conclusion drawn at the time was that acupuncture did not have any significant effect on weight loss. However, trying to test whether acupuncture can help someone to reduce their weight is likely to be a difficult matter; there are dozens of reasons in Chinese medicine why someone's weight may be increasing. Trying to group together a sufficiently large number of patients whose western problem and eastern diagnosis are the same is extremely difficult.

 

 

In one or two cases there is a very direct correlation between someone's weight and their underlying imbalances from a Chinese medicine perspective. Correcting these may have an immediate impact on, say, the amount of fluid someone is carrying, and that could create a 3-5kg loss very quickly.

 

However, all of the best dietary programmes say that after the initial and often quite dramatic week or two most good weight loss programmes at best will see someone lose only a pound or two every month, and in fact, there is discouragement from trying to do more in order for the body's system to keep pace with the change. Acupuncture may well have been used successfully alongside some fairly strict dietary rules, and from a patient's perspective it would be very difficult to say whether the acupuncture treatment added value to what someone was doing already.

 

The bottom line is that there are are no 'magic' points which reduce someone's weight without effort, and the effect of acupuncture may be no more than to give someone the support and commitment to keep trying with diet and exercise programmes. However, if someone remains motivated as a consequence of acupuncturre treatment that itself would be a very positive outcome.

 

There are a number of experience practitioners in Lincoln, and you can find them all by clicking on the search button. Any of then will be able to advise you whether acupuncture might be worth pursuing in your individual case.

The cost of treatment varies around the country. In the Greater London area costs for the initial diagnosis session can be in the range of £50-£70, with subsequent sessions costing £30 - £50, whereas in other areas the costs can be as much as £10-£20 cheaper, with the first session costing £40-£50 and subsequent sessions £25-£40.

 

 

Most BAcC members are willing to reduce fees if someone is in considerable financial hardship, but this is a matter for each individual practitioner, and not something which the BAcC would require of members.

 

Each person is unique and different, so it is very difficult to generalise about how much a course of treatment will cost. If the condition is chronic and has existed for several years, it may take longer to encourage a healthy pattern to re-establish itself, whereas short term acute problems can sometimes respond very quickly.

 

As a general rule of thumb we say to patients that they can expect to have at least four or five sessions, and for the practitioner to review with them at this stage whether the change they have achieved is sufficient and sufficiently sustainable to make further treatment advisable. If the patient at this stage is confident thta things are on the move they can choose whether or not to continue to invest their money in further treatment.

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