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Ask an expert - muscles and bones - arthritis

34 questions

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.


Q:  I have pain in my right hip / inner thigh. I have had X-Rays with results showing  I have arthritis  and have been advised by my GP  to try pain management and physio.  Would  acupuncture help me ?

A:  There is certainly evidence that acupuncture can help with both arthritis and with pain control, as our two factsheets

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

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

show. The evidence is not quite at the level where we can give an unqualified recommendation but is certainly nearing the point where we can make a stronger case to NICE for acupuncture to be considered as a legitimate intervention for GP choice and referral. The trials of osteoarthritis for the knee have nearly reached this point, and the issue is not really about whether the trials will show positive results as much as when and whether the trials will take place. Acupuncture research is expensive and
not funded by any major national organisations, so trials are not easy to set up.

As far as pain management is concerned, there are two aspects to this. From a Chinese medicine perspective pain usually arises from blockage and deficiency of energy in the body which may in your case have been caused by the degeneration of the joint or may have been causally implicated in the deterioration having happened. Using acupuncture to reverse the blockage or weakness will probably have a lasting impact on the energetic flow, and may well take care of some of the pain. The fact that the pain manifests on the inner thigh suggests that there may be an aspect of what is going on which reflects this.

However, the deterioration in the joint and the inflammation which this will continue to cause is not something which is going to go away, and the usual pathway is for the deterioration ultimately to call for a hip replacement, an operation which these days appears to be being done with immense speed and rapid recovery. If this is the case, and this pathway is by no means inevitable, then the amount of pain relief and its sustainability may come down to a simple financial question: does the amount of relief and how long it lasts warrant the cost? For people with deep pockets and a powerful need to keep going for work, this is not an issue, but for most of us it is. This is something which people usually discuss with their practitioners but ultimately it is the patient's call.

On balance, though, our experience is that it is possible to help to contain the rate of deterioration and to remove some of the secondary pain caused by energetic blockage, and we would be happy to suggest that you could visit one of our members local to you for a brief face to face assessment of what may be possible. We have also found that where someone has a hip problem on one side there is often a consequent disturbance which develops on the other side, especially in the knee, as someone shifts the balance of their weight off the painful side. This often causes a rotation of the pelvis which can then generate fresh problems. We advise many of our patients also to
have an assessment by an osteopath because there are often patters which have developed gradually as the hip has deteriorated which have not yet generated
symptoms but may well do so. If this has become a structural issue, it is often quicker to have a session or two to re-establish good 'shape' in order for the
acupuncture to encourage better function in the muscles and tendons which have been working at a mechanical disadvantage.

From a Chinese medicine perspective, however, not only is each patient unique but the presenting problem which they have is rarely the only issue they have. The patterns into which these problems all fall usually point to systemic weaknesses which treatment can help to correct and which helps in turn to sustain and maintain local improvements. This is why a face to face assessment can be so valuable.

Q:  Could acupuncture prevent further deterioration of joints affected by osteoarthritis, specifically joints between base of thumb and wrist, where an osteophyte is forming. Might the area even restore itself with treatment?

A:  We are always a little cautious about appearing to offer over-positive outcomes in giving advice here. The frequently used line in modern sales advertising, that 'once it's gone it's gone', seems to us appropriate when talking about actual physical change in the body. We have come across cases where there appears to have been some reversal in the growth of osteophytes, but when this has happened there have often been two or three treatments in use at the same time, making it rather difficult to assess whether one of them worked or whether there was some kind of synergistic response to using all three. We take the safer view that once osteophytes have become established the best that one can hope for is that the rate of growth slows down or stops altogether, the 'getting worse slower' option.

There is considerable evidence accumulating that acupuncture can be effective in treating osteoarthritis, as our factsheet

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

shows. The majority of this evidence, which is not yet quite enough to give a blanket assertion of efficacy, is centred on treatment of the larger joints (hips, knees, etc) but the general principles employed are the same.

One aspect of your condition which you have not mentioned in the question is any specific form of work or leisure activity which may have contributed to the condition. It may be that this 'just happened' but we very often find that there is a background of injury, perhaps even twenty or more years ago, against which backdrop the current condition developed and which an otherwise innocuous activity has exacerbated. This writer broke his scaphoid bone in the wrist as a 15-year old without realising it until his whole wrist seized up as a 29-year writing his PhD longhand (those were the days!) and the radiologist found the fracture lines. Without the constant pen in hand day after day this may never have developed.Once it had been identified, however, it did mean a more careful management of repetitive activity of this kind, and there may be some practical management which a practitioner may have to consider.

In Chinese medicine each patient is unique and different. Twenty different people may have the same problem, but each will have a different overall setting against which the problem developed and which condition the response in such a way that there would be twenty different treatment approaches. The best advice we can give you for the best assessment of what acupuncture treatment may be able to offer you is to contact a BAcC member local to you and see if they can offer you a few moments without charge to take a look at what is going on and offer a slightly more precise assessment of what might be possible.

Q:  I have had an MRI and been  diagnosed with arthritis in neck and lower back. Nothing can be done except to take pain killers. Could acupuncture help?

A:  Acupuncture treatment certainly has a good track record for treating chronic back pain, to the extent that it is one of the treatments recommended by NICE, the body which sets out recommendations for the NHS. Our factsheet on back pain mentions this and other research:

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

However, in all cases of arthritis of the neck and back, the question of much help acupuncture can offer depends on the extent of the deterioration of the spine, and especially the neck. If there is a great deal of degeneration of the bone and also the inter-vertebral discs, the chances are that acupuncture may offer only limited pain relief. This is not to be under-valued; someone who is in chronic pain may well think that two or three days of relative ease are well worth the expenses. In the end it may come down to affordability, the balance between the expense and the level of relief.

On a brighter note, however, the pains not be entirely related to physical structure. We have come across many patients whose X-rays have shown significant deterioration of the lower spine, yet whose back pains have been brought under control by the use of acupuncture. This can sometimes be because the treatment can reduce the inflammation, breaking the cycle of discontent which means that inflammation cause swelling causes more inflammation. This cycle is what doctors try to break with anti-inflammatory medication. It can sometimes be the case, however, that the back pain and the deterioration of the spine are unrelated, and that there are reasons which can be understood within the Chinese Medicine system which are the cause of the discomfort.

Each person is different in Chinese medicine terms, and so there is a limit to the specific advice which we can give.The best advice is to visit a BAcC member local to you and see if they will offer you a brief face to face assessment of your specific problem. This will be much more informative than anything we can offer here, and they should be able to offer some advice on how much treatment may be necessary, if indeed they think it is worthwhile.

The key thing with conditions like this is that you set measurable outcomes and review progress on a regular basis. It is very easy to get into a long-term treatment pattern without realising, and suddenly find that fifteen or twenty treatments later nothing much has changed. This is why we often use outcome measures which can be measured (time between medications, distance walked) to avoid the good day/bad day problem of it depending on what happens on the day someone is asked. 

Q: My mother,  who is now almost 80,  is suffering from arthritis in her foot but also a condition known as menieres disease - like an intense sea sickness where she will vomit and almost pass out. Sometimes it wakes her up too and the only thing she can do is to try and sleep it off. Can accupuncture help with both of these and is there a practitioner in the S Wales area you would recommend?

A:  We were asked about arthritis in the foot some time ago and we responded:

We have produced a fact sheet on osteoarthritis

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

and as you can see, research into the treatment of arthritis in the feet is not that common. There are many hundreds, if not thousands, of studies published in Chinese every year, but only a small percentage are translated, and we are sure that there has probably been research but we are unlikely to see it.

Although acupuncture has a reasonably good record for offering relief in cases of osteoarthritis, it would be fair to say that arthritis in the feet can be much more difficult to treat. The very tight 'fit' of the foot bones means that where osteoarthritis starts to develop it can be very difficult to overcome the constant rubbing and inflammation which this causes in order to break the cycle of pain - inflammation leads to pain leads to more inflammation and more pain, and so on.

However, one of the great strengths of Chinese medicine is that it looks at symptoms as a part of a much wider pattern of energy flow in the body, and can sometimes make sense of systemic conditions which manifest in specific areas. Treatment may involve not just the affected area, but also points elsewhere on the body which can begin to put right the underlying imbalances which are the true cause of the problems. Arthritis has been around as long as men have walked upright, and the ancient Chinese had their own ways of differentiating the various types based on the nature of the symptoms - better with heat or cold, movement or rest, etc etc. This has led to some well-established protocols which may offer some benefit.

However, each person is as unique and different as their symptoms, and in some cases the deterioration will have gone beyond the point where treatment will be of benefit other than as short term pain relief. The best advice we can give is that you visit a BAcC member local to you for an informal chat and brief face to face assessment of what they think might be possible. We are confident that they will give you an honest and realistic assessment of what they think acupuncture treatment might offer.

We think that this is still sound advice. It would be fair to say that treating arthritis in the elderly means that progress can sometimes be a little slower, but it is impossible to generalise; this expert has seen young people in whom it has been impossible to help and a ninety-year old whose life was transformed. In Chinese medicine, though, each patient is unique and different, and it would be best to see someone who can offer a better view based on a face to face assessment.

As far as Meniere's disease is concerned, there is a slightly better evidence trail. Our factsheet on vertigo, which scoops up all problems in balance in the ear and nearby

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

offers some encouraging evidence that acupuncture treatment can help, although we have to qualify this by saying that it probably falls short of the standards required for us to make definite statements. This, however, is more to do with the application of an appropriate standard against which research is measured in the West as it is about the research itself. There are many Chinese studies which start from the premise that acupuncture works and try to establish what works best, but in the West there is still scepticism about acupuncture working and these studies are ruled out.

From a Chinese medicine perspective there are some clearly defined syndromes in which nausea, vomiting, loss of balance and tinnitus play a part, and a skilled practitioner can quickly gather evidence from other signs and symptoms to see if there is a clear pathway which offers immediate treatment options. It is not essential that this is the case; Chinese medicine treats the person., not the condition, and many of the more traditional systems are asymptomatic, i.e. symptoms are seen as a general indicator that the whole system is not working well, and treatment is directed at getting the overall balance back in the belief that this will correct symptoms. 2000 years of treatment history suggests that this might have some success!

Finding a practitioner could not be easier: simply use the 'find a practitioner' function on our home page, and a list of members near you will appear. We do not make individual recommendations, partly because we treat all members equally and can't be seen to have favourites, but mainly because we believe all have trained to an exemplary standard even to become members and are all capable of delivering first rate care.

We hope that you find someone who can help your mother and have every confidence that you will.

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