Ask an expert - muscles and bones - arthritis

34 questions

Q: I have osteoarthritis in my knees. I don't get pain, but get swelling, stiffness and a burning feeling. One knee gives way at times. Would acupuncture help with any of this?

A: As you can imagine we have been asked this question on a number of occasions, and a recent answer contained the following extracts:

 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.

https://en.wikipedia.org/wiki/German_acupuncture_trials

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.

Clearly in your case the inflammation is quite severe to bring about a burning feeling, and while we have extracted parts of the answer which dealt with pain relief they may still have been relevant; one person's burning feeling is another person's pain.

 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.'


A: We have received relatively few enquiries about the treatment of psoriatic arthritis and the most recent, three years ago said:

  We have to be honest and say that the research studies which exist for both rheumatoid arthritis (which from a Chinese medicine perspective is very similar to psoriatic arthritis) and psoriasis are not that helpful. Our factsheets

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

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/eczema-and-psoriasis.html

point out that studies are few and far between, and often methodologically weak. 
 
This does not mean that acupuncture may not be able to help at all. Many patients with auto-immune arthritic conditions often use acupuncture for relieving specific symptoms, such as pains in a particular joint, and we do hear of people deriving considerable benefit. This is principally about limitation of discomfort and pain relief, however, not about reversing the main condition.
 
When people have enquired about psoriasis in the past, we have also offered very cautious advice. The last response we gave in October said:
 
There hasn't been a great deal of research in the use of acupuncture for the treatment of psoriasis, and where small studies have been done there has not been a great deal of success on which one could base a positive recommendation.
 
This is not to say that acupuncture treatment may not be of benefit. Skins problems such as eczema and psoriasis can have a variety of causes, some of them mental and emotional as well as environmental and the universal 'idiopathic', which is western medical speak for 'it just happens', or 'we don't know what causes it'. Traditional Chinese medicine was initially premise on the simple but profound belief that symptoms were merely alarm bells that the system as a whole was out of balance, and that a skilled physician would be able to assess what was needed to restore balance and by doing so eradicate the symptoms. There is no doubt that each year many people have acupuncture on this more general basis and experience some very encouraging results.
 
However, we have to say that the received wisdom in the acupuncture profession is that Chinese herbal medicine often generates better results for skin conditions, possibly because the regular daily or twice daily treatment is better suited to dealing with the problem or possibly because the precise adjustments of the prescription achieve what broader techniques may not. In any event, it may well be worth your while contacting a member of the Register of Chinese Herbal Medicine (RCHM) for advice. You will probably find that the person you speak to is also a BAcC member, since more than 90% of the RCHM membership is dual-registered.
 
This does not mean that we would entirely rule out acupuncture as your first option, and you may still find it valuable to discuss your own unique presentation with a BAcC member local to you. He or she will be able to give you a better face to face assessment depending on the spread and location of the condition than we could do here.

Looking back at this we think it might be a little over-cautious. While it would be foolhardy to suggest that there is a cure we have seen a number of cases where someone's rate of deterioration has slowed down, or at least they have perceived it as such, or where symptoms which were assumed to have been a part of the overall picture have been considerably lessened because they were not as closely connected with the 'headline' problem as was believed to be the case.

 On that basis it would certainly do no harm to see what acupuncture treatment can offer. The key concern is of running up a large bill for treatment which really has not achieved very much. It is really important to set regular review periods and, difficult as it may be, to set measurable outcome targets, things which would let you know without doubt whether things were improving or not. Greater endurance, better grip, etc etc - something which can be measured and not simply be a reflection of how you feel on the day.

 There is no set cost for treatment. We tend to distinguish between London, where first sessions can cost between £50 and £75 and subsequent sessions £40-£60, and the rest of the UK where first sessions are often a little less £40-£60 and subsequent sessions £35-£50. In reality, though, there is a difference in the overheads of working from home and working from a Grade 2 Listed building in a city centre, and this is often reflected in the cost of treatment. There is also a growing number of members offering treatment in multi-bed clinics where the aim is to reduce the cost of treatment by working in a group setting. For someone with long term treatment in prospect this can be a welcome development.

 

Q:  I am currently in a significant amount of pain in my back, shoulders and neck due to arthritis. I was going to book an appointment for a session of acupuncture today but don't think I would be able to bear it at the moment. Is it best to wait for the flare up to subside slightly before trying acupuncture or be brave and do it whilst in this amount of discomfort? 

A: This is quite a difficult question to answer. We would probably say that if you think you couldn't bear the treatment at the moment, the best course of action is to wait until you feel that you can. There is a very strong feeling in many patients that letting the practitioner see things at their worse is a good thing, and they struggle into clinics when they are feeling very unwell. This expert tends to take the view that if getting to treatment becomes an ordeal on top of the pains which are already bad, it is not a sensible thing to do.

There is, of course, the counter-argument that the treatment may well be ofimmediate benefit in reducing the pain. Our experience, however, is that with long term conditions like this such changes are short-lived, and it is far better to wait until the pain has become more manageable so that the whole experience is a pleasant and upward moving one.

There is no doubt that from our experience when the pain of arthritis is very severe any kind of intervention can become immensely painful in itself. Oddly enough, the one thing which always seems to be helpful in these sorts of situations is reflexology. It has been a common experience in those patients with severe arthritis, especially those of mature years, that they report that as a short term palliative this treatment works very well. For the long term, however, Chinese medicine has an increasingly impressive track record of helping people with arthritic pains, and a growing body of research to underpin it.

Q:  I am currently in a significant amount of pain in my back, shoulders and neck due to arthritis. I was going to book an appointment for a session of acupuncture today but don't think I would be able to bear it at the moment. Is it best to wait for the flare up to subside slightly before trying acupuncture or be brave and do it whilst in this amount of discomfort?

A: This is quite a difficult question to answer. We would probably say that if you think you couldn't bear the treatment at the moment, the best course of action is to wait until you feel that you can. There is a very strong feeling in many patients that letting the practitioner see things at their worse is a good thing, and they struggle into clinics when they are feeling very unwell. This expert tends to take the view that if getting to treatment becomes an ordeal on top of the pains which are already bad, it is not a sensible thing to do.

There is, of course, the counter-argument that the treatment may well be of immediate benefit in reducing the pain. Our experience, however, is that with long term conditions like this such changes are short-lived, and it is far better to wait until the pain has become more manageable so that the whole experience is a pleasant and upward moving one.

There is no doubt that from our experience when the pain of arthritis is very severe any kind of intervention can become immensely painful in itself. Oddly enough, the one thing which always seems to be helpful in these sorts of situations is reflexology. It has been a common experience in those patients with severe arthritis, especially those of mature years, that they report that as a short term palliative this treatment works very well. For the long term, however, Chinese medicine has an increasingly impressive track record of helping people with arthritic pains, and a growing body of research to underpin it.

 

Q:  I have arthritis  in my hip.  I had accupuncture yesterday for the firs time  which was fine.  Today the pain in the affected leg is worse than before.  Is this normal as I have more booked next week.  How long should this pain last? 

A:  There are no hard and fast rules but we would be surprised if the pain lasted for more than 48 hours. It is not at all uncommon for pain to increase slightly after a first treatment for musculo-skeletal problems, and most of us tell our patients to expect a slight increase for the next day or two. If the pain continues for longer than that at the same level of intensity then it is certainly worthwhile giving the practitioner a ring to see what they make of it. They will know your case history well and also know what they did, which will make them best placed to tell you what is going on.

Aside from the energetic effects of treatment there is also the possibility of a slight bruise deep within the tissue which can sometimes occur if the needling is slightly deeper. There may be no external signs, but these can cause nerve impingement which can last for a few days.

Most likely, though, is a treatment effect. This can either be because of the restoring of energy to an area, and equally to the effects of the treatment encouraging better structure. This can often cause a re-alignment of muscles and their relative tensions, which can result in discomfort as the body starts to find its correct position.


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