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Ask an expert - muscles and bones - arthritis

34 questions

We have been asked about knee problems many times over the years, but those relating to osteoarthritis of the knee focus on the pain, as in this response:

If there is serious osteooarthritic degeneration of the joint, probably the best that one could do with acupuncture treatment is to reduce some of the inflammation. With the underlying condition in severe deterioration unlikely to change, the only issue is how much relief the treatment can offer and how sustainable it may be. This may come down to a question of finances; if the cost of regular treatment is outweighed by the benefits it gives, then it may well be worth pursuing. The chances are, however, that only replacement surgery will make a great difference.

There was a huge trial in Germany some years ago, called the GERAC trial, which involved an assessment of hundreds of thousands of treatments.

The outcomes for osteoarthritis of the knee were particularly impressive, and it was a source of deep annoyance to our medical colleagues that acupuncture was not included in the NICE guidelines because the placebo control scored nearly as well as the real acupuncture. In their view, both were so much better than the conventional treatment that it would still make sense to use acupuncture even as a placebo, but that is not the way of modern healthcare policy.

The best advice that we can give is that you visit a BAcC member local to you and see what they make of the specific presentation you have. It may, for example, that there are lifestyle issues like work which keeps you on your feet all day which might adversely impact on treatment outcomes, or it may be that there are specific reasons for the pain like injury or accident which would have to be factored in to their assessment.

Such is the unique nature of each presentation of osteoarthritis of the knee it really is best to have someone have a look at the specific nature of the problem and the context in which it sits. Chinese medicine is premised on the treatment of the person, not the condition, and this is one of its great strengths. Treating symptoms alone can sometimes be successful but treatment of then person as a whole is more likely to keep the symptoms at bay. We are not alone in taking this view. The great Canadian physician William Osler often said 'The good physician treats the disease; the great physician treats the patient who has the disease.'

The only issue we had with the German trials was that they were largely formula treatments undertaken by doctors. This is all very well, but in Chinese medicine there is a concept vaguely akin to arthritis called 'Bi Syndrome'. This looks at arthritic conditions in terms of the more general changes in the energy of the body and how they reflect in particular joints, but what we have at our disposal here is a range of options for looking at joint problems in terms of how they present. Hence, stiffness and lack of mobility with discomfort but not actual pain would point in some very specific directions when seen in the context of the whole system. A mixture of local and systemic treatment may well be able to achieve some improvement. The only thing we aren't able to predict is the extent of the improvement and how well or easily it can be sustained.

The advice we gave in the previous answer, to visit a local BAcC member, holds good especially in your case. Someone taking a look at not simply the joint itself but the context in which the problems have developed (systemic issues, accidents or repeated use, etc) will be able to give you a very good idea of what may be possible.

Q: how does acupuncture help in managing osteoarthritis. Does it only relieve pain or can it also slow down the progression of the disease

A: There is a very large and increasing body of evidence for the use of acupuncture as a treatment for osteoarthritis, as our factsheet shows

Many of the studies are quite clear that reduction in pain with acupuncture is a reasonable expectation of outcome for treatment, and many of the studies cited here speak of the reduction in physical dysfunction which acupuncture treatment seems to achieve.

However, it is a fairly large step from pain reduction and functional improvements to statements about slowing down the progression of the disease. To the extent that changes in physical movement wrought by the pain and inflammation can both make the situation worse, any reduction or change in either will stop the condition feeding off itself, i.e. the symptoms become a part of the causal pattern which causes deterioration. However, the factors which predispose someone to osteoarthritis may still be as active as they were before, be they genetic, environmental or lifestyle, so it would only be reasonable to say that unless these change then slowing down the disease progression may not as easy to achieve.

This is to look at things from a conventional medical perspective, though. The ancient Chinese were just as prone to osteoarthritis as modern people, but the whole nature of the understanding of disease in Chinese medicine is different, and from this perspective there may be something which a practitioner could reasonably hope to achieve to remove some of the causal factors. Chinese medicine is predicated on an understanding of the flow of the energies of the body, called 'qi', and its patterns of flow and balance. Factors which affect this are often described in physical terms  - heat, cold, damp, etc - as a reflection of the conditions in which most people worked on the land. The Chinese would see the joint being directly affected by these conditions and use acupuncture and herbs to reduce the impact on the body.

In doing so they would also be mindful of the unique balance of the individual and the constitutional patterns which they had inherited which made some people more prone than others to develop osteoarthritis (the Chinese called it Bi Syndrome, and classified it according to its presentations - Hot Bi, Cold Bi, Damp Bi, etc). In this sense an experienced practitioner might hope to reduce the symptoms as well as addressing some of the deeper factors which predisposed someone to suffer with OA. From this perspective it might well be possible to look at slowing down the disease progression.

No treatment for OA works in isolation, though. An integrated approach, involving not just acupuncture but physical therapy, diet and exercise, will always offer the best chance of making life more tolerable for an OA sufferer.

Q: Is there a possibility that acupuncture will help me with a bad problem of balance?

A: A great deal depends on what is actually causing the balance problems. We have, for example, a considerable body of evidence for the treatment of vertigo, as our factsheet

shows but there are literally dozens of conditions which are differentiated in western medicine - Meniere's disease, vestibular disorders, labyrinthitis, ineer ear infections and so on - which can generate balance problems. There are also cases of accidental damage, as for instance this study we found about people being researched for balance problems resulting from whiplash injuries

Essentially, there is evidence for the use of acupuncture in treating all of these problems, but the quality is variable, and we would be hard pushed without more to go on to make a positive recommendation in case the problems arise from something which cannot change.

However, as we sometimes have to remind ourselves as well as our patients, we practise traditional acupuncture which is premised on treating the person, not simply the problem they have. The theory is based on a complex flow of energy whose rhythms and balance determine good function, and whose loss of balance can generate symptoms. The skill and art of the practitioner lies not in going to the clearly defined areas which are involved in balance from this perspective but in looking at what is going on to make this symptom appear. Many symptoms are not the root of the problem but just signs that the whole system is out of balance, and without taking care of the root causes any treatment of the symptom alone may have short-lived effects.

Balance problems have been around since people stood upright so the Chinese will have addressed these issues for thousands of years. To know whether this accumulated wisdom can help you, though, the best advice that we can give is that you visit a local BAcC member for an informal chat. Most are very happy to give up a small amount of time without charge to give prospective patients a better idea of what may be possible, and it enables you to check them out before committing to treatment. We strongly suspect that they will feel confident about being able to help you but we trust them to say so if they think this is not the case.

Q: My father is a paraplegic and has been since he was 28. He is now 61 and is suffering with severe hip pain. His hip joint is completely worn. Is acupuncture a suitable treatment for him?

A: This is, we think, really two questions: is it OK for your father as a paraplegic to have treatment, and if so, what are the possible benefits for the problems that he has.

As far as the first is concerned there is absolutely no reason for a person with paraplegia or quadriplegia not to have treatment. Although someone may have lost conscious and voluntary nerve control of the limbs which have been affected all of the autonomic functions continue, and from a Chinese medicine perspective this means that there is energy flow which can be enhanced or corrected by suitable treatment. The main caution with problems like your father's is that there can often be a sensory deficit, so practitioners are always very careful in how they treat. If someone can't say 'stop it, that hurts' there is an increased chance of bruising, and in the case of moxibustion, an increased risk of burns. All professional acupuncturists are trained at undergraduate level in what to do with cases like this.

As far as treating hip problems themselves are concerned, a great deal depends on the level of deterioration in the joint. If the wear is great enough to warrant or nearly warrant a replacement, then we would have to be honest and say that short term pain relief would be the most we would expect to be able to offer. The question would be how much relief and how sustainable it was, and again, to be honest, this may become a question of how affordable treatment is. For people with deep pockets three or four days relief from indefinite weekly treatment may be a good deal. Most of us couldn't afford this, though, and we trust that members do their best in these circumstances to direct people to the most effective and cost-effective means of getting relief, be this herbal medicine or reflexology or any one of dozens of possible complementary medicine solutions.

The best advice that we can give is that your father visits a local BAcC member for advice about what may be possible. Nothing beats actually seeing the problems first hand in order to be able to give an accurate assessment of what may be possible, and most of our colleagues are only to happy to see prospective patients without charge to give them a good idea of what can be done.

We suspect, though, that if the wear is very considerable the amount of relief may be limited, and if someone does think treatment is worthwhile it would be advisable if they offered realistic expectations.

Q: I have athritis in my hand and thumb. Will acupuncture help me?

A: As you can read from our factsheet on arthritis there is a fair bit of evidence that arthritis can be helped by acupuncture treatment, and the usual response we give says that it is more a matter of how much help and how sustainable the results are. Clearly if treatment only gives a couple of hours of reduction in pain and stiffness then acupuncture may not be the best option, but if the improvement lasts a few days there might be better prospects. The question really is whether the improvement always drops away back to the original baseline or whether there is a gradual overall improvement. There is nothing wrong with knowing that something will only work for a week if the week in question is one where additional mobility is necessary, and of course the joker in the pack is how much treatment may be doing to reduce further deterioration, or 'getting worse slower' as one waggish patient remarked.

However, with arthritis in particular it is really good to get a handle on the possible causes. Although the symptoms are universal, the causes, even in western medicine, can be very varied - repetitive use, diet, heredity, and so on. In Chinese medicine this difference can be crucial because each person will be a unique combination of factors, and treatment can address this unique quality better, we believe, in many cases than western medicine which has clearly defined clinical pathways for all named conditions.

The best advice we can give is that you visit a local BAcC member for advice, and for them to have a look at the exact nature of your symptom in the context of your overall health. There may well be other factors in play which would enable them to determine whether this is simply a local problem or the tip of a systemic iceberg. Most of our colleagues are more than happy to give up a little time without charge to prospective patients to enable them to assess the potential benefits of treatment. We are confident that they will give you honest impartial advice.

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