Ask an expert - muscles and bones - arthritis

34 questions

Q:  My husband has oesteoarthritis in the hips with intractible pain left hip. Cannot find a painkiller he can tolerate. Cannot have hip replacement untiL investigations for recent TIA are completed with any neccessary treatment. Would acupuncture help for the pain?

A: As our factsheet on osteoarthritis shows.  Please click here

 

 

there is a some evidence that acupuncture can provide relief. The evidence is not sufficiently clear nor in sufficient quantity to allow us to make any formal claims for efficacy, but this is an area where we feel that there is likely to be a growing body of evidence, as there was with back pain and migraines, which will enable us to say with confidence that treatment may be beneficial.

 

The crucial aspect of treating conditions like osteoarthritis of the hip, however, is not whether or not it 'works', because ultimately many sufferers will have a hip replacement, but the extent to which treatment relieves the pain and for how long. We tend to take the view that acupuncture treatment will provide some relief from pain, whether this is through needling or simply through a form of placebo effect, as our critics claims, but for us the issue is how much relief and how sustainable it is. If treatment buys 48 hours of rest after which the pains return, then to put it crudely a great deal will depend on the resources one has or the generosity and flexibility of the practitioner. We have heard of people being happy to pay for bi-weekly or even tri-weekly treatment, but more common is for a practitioner to offer a number of shorter consultations within a week in order to keep the costs down. If treatment does have a measurable effect, this is a route worth pursuing. If any effect is very short-lived, however, then it may not be worth the time and expense.

 

The best advice, as always, is to visit a BAcC member local to you for a brief face to face assessment of what they believe they can do. If you do decide to go ahead, it will be extremely important to set measurable outcomes and to have a fixed review period agreed from the start. If nothing is happening after four or five sessions it may be wise to call it quits; our experience is that by this stage there should be some tangible change, even if short-lived.   

A: The evidence for the benefits of acupuncture treatment for arthritic pain, as witnessed by our fact sheet
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/osteoarthritis.html
 

is relatively encouraging. Not surprisingly the research has focused on the major joints like the hip and knee, but the problem, from a Chinese medicine perspective, is the same whichever joint the pain manifests is, and the fact that treatment of knee can bring relief means that in principle the same may apply to the toes.
 
There are obviously confounding factors. A great deal depends on your age and general health. In the elderly or in the diabetic some of the pains may be attributable to a number of other factors where the value of acupuncture treatment may be less, but the question is not really 'does it work?' as much as 'how much does it work and how sustainable is the improvement one can achieve?' It is a difficult truth to acknowledge that the depth of someone's pocket can make a difference. We have come across patients with almost limitless funds who can afford to have treatment every three days in perpetuity because the treatment lasts that long before wearing off. Most people, however, are not so blessed, and the question which has to be answered, if the treatment does bring short term relief but is not incremental, is how long one should reasonably carry on and at what cost. We know of practitioners who do deals with patients to provide frequent short treatments within their purse, but we do not tell our members how they should work, and many find this kind of treatment, which is often quite formulaic, not to their taste.

 There is also the possibility that there are other interventions which may offer good results. A significant minority of BAcC members also belong to the RCHM and practise Chinese herbal medicine. This can be a very powerful force for recovery, especially since the treatment can be delivered daily and supplemented by regular acupuncture treatment. We have also found that reflexology is often cited by older patients as a very effective way of obtaining relief from some of the more nagging chronic pains.

 It may be repetitive to say the same thing with every question we receive, but our practitioners are the best resource a potential patient has to determine what benefits acupuncture treatment may provide them with. They will not sign someone up for treatment if they think it will not work, and will always cross refer to other forms of healthcare if they believe that these will get to the point quicker. We advise you to seek out a BAcC member local to you and ask for their opinion based on a brief face to face assessment.
 
 

Q:  My daughter (age 22) suffers from psiorasis of the scalp and around 5 years ago developed psioratic arthritis, which affects her fingers, toes and is now giving her pain in her knees.

A:  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

Please click here 

Please click here
  
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.
 
This advice still holds. We think that it would be best if your daughter could speak face to face with a BAcC member to get the best possible advice on how or whether acupuncture may be of benefit to her.
 

Q:  I suffer from osteoarthritis in all my finger joints making daily tasks almost impossible. I am unable to take any anti inflammatories so things get very difficult for me. would i get any benefit from accupuncture for the pain?

 

A:  Although the BAcC factsheets for both osteoarthritis and pain management show some very encouraging results for the use of acupuncture treatment

 

please click here
 
and please click here
 
the majority of the research studies tend to cover the use of acupuncture for the major joints, such as the hip or the knee. The use of acupuncture treatment for the smaller joint pains, especially the fingers, is not as well researched, and the reported clinical experience of dealing with them is often not as encouraging. Once the small bones start to deform and cause inflammation and pain it is not that easy to reduce the swelling or discomfort on a more than temporary basis.
 
That said, the equation, how much relief lasting for how long and at what cost, is a very fluid one. There are patients for whom the relief they get, while not permanent, is sufficient to justify the expense of treatment. Although traditional acupuncture is, to use the over-used word, holistic and looks at symptoms within the context of the whole person's balance of energies, there is often a great deal that can be done with local treatment to encourage flow and to reduce the inflammation. Equations such as this, however - extent, sustaiability and cost - are very much within the area of professional judgement which our members make all the time, and they are by our Codes to be as transparent and helpful as they can be to let you make an informed decision about whether the treatment may be worth pursuing.
 
Our experience is that most members are happy to give up a small amount of time without charge to discuss the advisability of treatment with prospective patients, and if they take someone on they will usually set a review target of four or five sessions to see how things have gone and to discuss whether it is worth continuing with treatment.
 
Our advice to you, therefore, is to seek the advice of a BAcC member local to you. We are interested in the fact that you cannot take anti-inflammatories, and wonder whether there are other aspects of your health with which acupuncture treatment may help which may, for example, help you to take medications which would be of benefit. A short face to face discussion may be able to clarify this.

We were asked this question very recently, and we replied:
 

Can acupuncture help with osteoarthritis of the knee?

It greatly depends on what counts as a 'bad knee'. There is considerable evidence that acupuncture treatment can be highly beneficial in the treatment of osteoarthritis of the knee, as our factsheetplease click here

  

shows, and serious consideration was given in the NICE discussions on knee treatment to the recommendation for acupuncture as a treatment option within the NHS. Certainly the major German trials, of which you can find a good overview athttp://en.wikipedia.org/wiki/German_Acupuncture_Trials reported some very good outcomes. The problem for NICE was that the difference between real acupuncture and 'sham' acupuncture (a device that gives a sensation of being needled without actually doing so) was small, and so in the strict terms of the trial it is impossible to say that acupuncture works if a 'pretend' treatment works just as well. However, as one of our medical colleagues pointed out, both forms of acupuncture were far better than conventional treatment, and rather than dismissing acupuncture as no better than sham, people may just as well have been given the treatment anyway and while researchers kept on investigating why both treatments seemed to work.

 

If the problem is more to do with the muscles and tendons of the knee, there is again a considerable body of evidence which suggests that acupuncture can aid the recovery of function. Many western medical practitioners and physiotherapists use acupuncture as one of the treatment options for treating various knee strains, and Chinese medical theory, while it uses different terminology to describe the restrictions on function, has a similar strategy for local treatment. The great strength of Chinese medicine, however, is that is sees the individual symptom in the context of the way the whole system functions, and a practitioner will try to determine whether this is a local issue and can be treated as such, or whether this is the tip of a larger iceberg.

 

In any event, they might want to establish why the system was not healing itself. In many cases this is simply to do with people's work, and although some adjustments can be made to how people go about their jobs, it is not always that easy. Modern times have also seen a great burst of jogging and training which both put huge strain on the joints, and there may be a need to ease back on voluntary activities.

 

In any event, it is worth seeking the advice of a BAcC member local to you so see what they think about the problem. It would be helpful if you can explain what conventional medical tests and treatments have been done to give them a good idea of where the problem appears in investigations like arthroscopy, and so on.   


The question was a little more vague than the one you asked, but the core information in our answer remains the same. You ask, though, 'how helpful?', and this is more difficult to quantify. In many cases of osteoarthritis of the knee and also of the hip, the deterioration has been significant before people seek treatment, and if there has been considerable damage to the joint it is unlikely to respond as well as to treatment in the early stages. The balance which has to be struck is that between the extent to which treatment may bring some relief and the frequency necessary to maintain it. We have been aware of people with unlimited funds who have had treatment weekly for years in order to keep pain and discomfort from inflammation at bay, but the majority of us do not have the same level of financial freedom. Your practitioner, if you did decide to have acupuncture treatment, would be very clear in reviewing with you the cost effectiveness as well as effectiveness of any treatment you had, and ensuring that you were in charge of the process and not feeling drawn into an open-ended drain on your resources.
 
 

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