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Q:  I have had chronic pain in my left shoulder, back, left hand for the last 2.5 years, following a broken elbow and resultant frozen shoulder.

I have seen a pain management specialist and after a number of diagnostic tests (including MRIs, XRays and nerve conduction studies) and a variety of treatments including physio, trigger point injections, NSAIDs, dorsal root steroid injections and pulsed radio frequency.
 
All the tests indicate that I have a highly sensitised nerve at C6/C7 but no entrapment. The steroid injections were really the only treatment to give me much relief - but unfortunately this only lasted about 6 weeks. After the PRF lack of success, I have really been advised to take NSAIDs and/or start SNRIs. I don't really want to take either of these medications on a long term basis and was wondering if acupuncture is likely to provide any pain relief, since this has never been mentioned as an option.
 
I would appreciate your views on the likelihood of success.
 

A:  There is no doubt that acupuncture is an option for the kind of problem which you have, and many patients attend clinics throughout the UK with exactly this kind of problem. The research evidence for the success of your specific problem is not very plentiful, not because none is performed but because many studies conducted in China are methodologically unsound. However, the fact that you derived benefit from steroid injections is a positive sign. Many patients turn to acupuncture after they have exhausted the number of injections that can be safely used in an area, and quite often the acupuncture appears to reproduce the effect which the steroid has, as far as we can tell from the anecdotal evidence which we come across.
 
Although acupuncture can be used, and often is, in dealing with the specific named problem with which the patient presents, though, the theory of Chinese medicine is underpinned by an entirely different understanding of physiology and organ function based on the flow of energies, called 'qi', in the body. The fact that you have had such extensive pain across a wide area of the body speaks of blockage in and impairment of this flow, and the practitioner will be interested to find out whether the local manifestation of pain is its focus or whether it is as a result of blockages within the general area. From a Chinese medicine perspective, pain only arises from blockage, excesses and deficiencies, and the skill of the practitioner in identifying what needs to be done and where is critical to ensure that symptoms go away and stay away.
 
Your best course of action is to visit a BAcC practitioner local to you who can offer you advice, based on a short face to face conversation, of whether they think acupuncture would benefit you. We trust that they will be honest enough to say so if they feel that this is not your best option.

Frozen shoulder can be a difficult condition to treat. Our fact sheet on the website - please click here is not overly encouraging, but the main point to note here is that there haven't been a great many studies. What counts as 'frozen shoulder' can vary considerably and creating a number of groups with identical problems for trial purposes is not that straightforward.
 
One major problem with the shoulder joint is that it's mobility means a dependence on groups of muscles and a relatively open socket into which the head of the humerus fits. It is very easy for there to be a minor displacement or small dislocation of the joint, and equally easy for a problem with one set of muscles to cause a ripple effect throughout all of the groups holding the shoulder joint stable. There are often secondary problems which may need to be addressed.
 
Chinese medicine has obviously been used to treat problems like this for thousands of years, and as well as treating locally to where the problem is on the body there are a number of functional treatments which are aimed at affecting all muscles and a couple of 'empirical points', points which have been used for centuries to help with all shoulder problems. There are also points which can be used to help reduce some of the pain and inflammation which results from the muscle and tendon strains.
 
However, there is no doubt that it really pays to have treatment with someone who fully understands the dynamics of the joint in great detail and can make an informed and careful assessment of the precise problem. There are a considerable number of BAcC members who are also trained in osteopathy and physiotherapy, and equally a number of osteopaths and physios who use acupuncture on a regular basis, and the combination of manipulation, movement and acupuncture may be the optimum package.
 
It may be helpful to seek the advice of a BAcC member local to you. Most know of colleagues within their area who specialise in this kind of condition, and many also work very closely with local osteopaths and physiotherapists, and maybe able to put together a co-ordinated package of treatment to get you back to good health and mobility.   
 
 
 
 
 
 

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