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Acupuncture and chronic pain

Q:  My son has a diagnosis of CPRS due to presumed ( imaging shows no other damage) nerve damage around the left ankle area following a football tackle. 10 months on the pain has not responded to NSAIDs, gabapentin or amitriptyline and a nerve block seems to have resolved little. Mobility remains impaired despite daily physio which is limited by the pain. Any thoughts or suggestions as to potential from accupuncture. His pain team say there is little positive experience in this area and given his localised neuropathic type pain, the chances of getting near him with needles makes it probably a non starter. I wondered whether local anaesthetic prior to needle insertion is possible?

A: If we can unpick your question accurately, against a backdrop of severe chronic pain for which no visible damage can be found and which does not respond to conventional treatment, the questions are first, whether acupuncture is worth trying, i.e. what level of evidence, if any, is there that it might work, and second, would the fact that your son is now hyper-sensitised, whether anyone could actually get needles in or near the affected area.

As far as the first question is concerned, there has been a long history into the use of acupuncture for chronic pain. Our website is down at the moment, or we would have posted an up to date reference to a fact sheet which can be found on the home page by following buttons to research and beyond. This identifies many studies which have been conducted over the years. The measures both for pain and natural pain relievers in the form of neurotransmitters are easily measured, and there have been dozens of studies which show that acupuncture can have an effect on pain. The usual question is not whether but how much and how sustainable the effect.

However, this takes us down a very western-medical route. Chinese medicine understood pain as the consequence of changes in the flows of energy through an area, either through injury or blockage or through systemic weakness. Often there is an overlay, where a systemic weakness predisposes to injury, but in the case of injury it is not uncommon for us to find a weakness in the flow which has no specific correlate in conventional medicine. This is why, often as the treatment of last resort, we have successes where the problem has not even been properly identified. However, each person is unique and different, and your best option would be to take your son to a BAcC member local to you for an informal assessment of what may be possible. Most of our colleagues are happy to give up a little time without charge to establish whether treatment would be advisable or beneficial.

As far as the needles are concerned, they are minimally painful, but we have come across situations where even the gentlest insertion was too much to bear. The beauty of the Chinese medicine system is that the complex interconnections mean that we have strategies for dealing with situations just like this. Received wisdom, for example, is that you never treat a limb where lymph nodes have been stripped, and it is not uncommon to treat the opposite limb or in some cases, the opposite lower limb. This can be very handy where someone is in a cast. The different points have resonance with each other, and even in mainstream treatment there are times when one uses points far away from the actual site of the problem. Any well trained practitioner should be versatile enough to deal with this kind of problem and provide direct treatment from a