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Ask an expert - muscles and bones - neck - neuralgia

2 questions

We are really sorry to hear of your son's problem. These extremely uncomfortable but largely undiagnosable problems often create what the doctors call heartsink patients, the ones for whom they do not have an immediate answer and for whom they run out of options fairly quickly.

We were asked about a similar problem some years ago and our answer then encapsulates the general response to these sorts of problems:

We wish that we were able to say with confidence that acupuncture treatment would be of benefit. However, as far as the research goes, which is the only basis on which we are able to make claims to efficacy, there is very, very little. This probably has a great deal to do with the fact that conditions like tenesmus and anismus often spontaneously reverse, and are therefore quite difficult to research because gathering a trial and control group is hard. The other problem is that most people are trying just about everything at the same time, so a clear difference between acupuncture and acupuncture plus the normal treatment is not easy. Most people simply say 'throw everything at it.'

Clearly from a Chinese medicine perspective, based as it is on the underlying belief in an energy, called 'qi', and the understanding of its balance, flow and rhythm, there are ways of looking at conditions like this which are different from a conventional western medicine understanding. These could range from a simple consideration of what is flowing in the area, i.e. which channels might be affected, to a functional concern, i.e. which part of the system maintains good function in the end of the colon and rectum, and a broader look at what might have caused the problem to begin. The ancient Chinese, for example, had a very complex understanding of the effects of heat, cold and damp on the system, and very often attributed griping and spasmodic pain to the invasion of cold into a body orifice. For a race which was largely agricultural this kind of phenomenon was seen to be based on common sense. Although it is not as common in modern life to be exposed to extremes of climate in this way we have seen several cases where people have literally been exposed to cold breezes while inadequately dressed and suffered symptoms such as these.

From the Chinese medicine perspective, however, there would also be other signs and symptoms in the patient's presentation which would guide the practitioner's strategy, and these might just as easily point to a systemic problem of which your husband's symptom was a small manifestation.

Our only advice in cases like this is to visit a BAcC member local to you and seek their advice in person. This is the sort of case where there is no effective substitute for discussing with the patient what is happening, and offering a more rounded judgement on the potential benefit of acupuncture treatment.     

We have checked again for any research trials which might have surfaced since we gave this advice, but have found none. There are occasional sites like this one,

whose provenance we cannot check and which is riddled with advertisements and referrals on which we cannot comment, but what it does do is to offer some very real interpretations in Chinese medicines for what is happening and the relevant treatments. This kind of 'named condition - Chinese medicine treatment' is not how we believe we work, although it is becoming increasingly common in China, but it has to be said that for cases of acute pain it is often an approach that will bear fruit. 

The advice we gave in the earlier response holds good, though. If your son visits a BAcC member local to him for a brief chat about what may be possible we are confident that the practitioner will be able to make some sense in Chinese medicine terms of what is going on and give a balanced view of whether acupuncture treatment may be able to help him. 


We have been asked this self same question this morning, and our response was:



We have been asked about it a number of times, and  we have factsheets about both facial pain and neuropathic pain


There evidence underpinning a recommendation for acupuncture treatment is limited, but as you can see from the evidence button on the neuropathic pain sheet acupuncture has on several occasions been shown to be superior to the standard drug treatment, which suggests that it is worth trying. 


In a previous response on the same question we said:


If you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.


We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, and subtle manipulation may offer possibilities.


We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficient to warrant making a recommendation to try to use acupuncture as a long-term pain relief option.


If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to establish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accurately bad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.


From our perspective it is always possible to achieve a certain amount of pain relief in almost any condition, whether this be because of the acupuncture treatment or as  our critics would have it some kind of placebo effect. The question is always how much pain relief and how sustainable this is. Clearly a treatment which works for twelve hours is not going to be very useful, although we have known cases where people have targeted treatment at times when they are going to need to be on top form for athletic events or important meetings. If the effects last longer but never quite increase in depth or duration then it may become a financial consideration, i.e. if someone can afford weekly treatment indefinitely because that is how long it lasts then having deep pockets is an advantage (although we have known members offer reductions for this kind of maintenance). Most of us, though, do not like to see someone remaining in pain for months, and we tend to look closely at other options if what we are doing isn't really taking off. Cranial osteopathy is one possibility, but practitioners will be aware of many other forms of treatment in their areas who might offer a useful solution.



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