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219 questions

Q :I have a patient who has trigeminal neuralgia and we are looking for a practitioner in the Midlands who has experience in treating this condition.

A:  It sounds rather trite when we say it but in essence all of our practitioners are equally capable of dealing with a condition like trigeminal neuralgia. This is because the nature of Chinese medicine is to be generalist, treating the person rather than simply the condition, and a symptom such as trigeminal neuralgia would be understood within the wider context of someone's overall balance. This could mean, in theory, that each patient presenting with the problem would be treated differently.

In reality, especially in modern Chinese acupuncture where a kind of 'best of both' attitude is starting to prevail, differentiation by named condition is starting to make more of an appearance, and certainly in outpatient departments in Chinese hospitals there are now protocols for problems such as this and also aggregations of patients with the condition. Research is often based on these kinds of formula treatments, and as our facsheet shows

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

the results are fairly encouraging. We tend to take a 'two legs good, four legs better' approach with a view that personalising the treatment would make the results better still but models for multivariate research are thin on the ground and not attractive to funders.

In the UK, however, most practitioners will have seen some cases of trigeminal neuralgia, but not in the sort of quantity where anyone could claim expertise. The received wisdom in the profession is that it is one of the more intractable problems which either responds well or not at all, and most of our colleagues will be very cautious about letting hope triumph over experience when patients want to chase results when clearly nothing is happening.

The best advice we can offer is that the patient uses our postcode search facility to find someone close to where they live, and then arranges a brief face to face chat so that the practitioner can offer a slightly better view of what may be possible in their unique case. Sometimes there are more 'obvious' cases where a practitioner can see pathologies which would realistically fuel some hope of success. Most BAcC members are happy to give up a small amount of time without charge to see whether acupuncture is the best fit or whether options like cranial osteopathy may offer a realistic alternative.


Q:  Can acupuncture relieve the symptoms of psychosis. My wife is Chinese, has been sectioned under Part 2 of the Mental Health Act and will not take any western drugs as she does not trust them.

A:  We have to say that although the World Health Organisation's list of treatable conditions does include schizophrenia as a condition for which some evidence of efficacy exists, the overall position is that there is nowhere enough evidence to suggest that acupuncture would be able to deliver a solution to this problem.

However, when we talk about evidence in this context, we are talking about the kind of randomised control trials beloved of drug testing regimes, which are not the most suitable way of testing a complex multivariate process like traditional acupuncture. Is there a history of acupuncture and herbal medicine for serious mental disorder? Well, the answer would be a qualified yes. There are a number of presentations for groups of symptoms which could well be characterised as psychosis which are recognised syndromes in Chinese medicine with clear treatment protocols. This is even more the case with Tibetan medicine which uniquely in Far Eastern medicine has a very complex and enduring tradition of using herbal medicines to treat a number of what we regard as sectionable mental disorders. However, this tradition has barely travelled to the West, and few practitioners have the necessary skills to offer solutions.

Our dilemma in offering advice in situations like this is not to appear to be subverting what are the accepted protocols for treating mental disorder by offering treatment which many experts in this field might regard as quackery. Should your wife's condition deteriorate because of time spent trying alternative systems of medicine, there would be a strong likelihood that the practitioner would be held to account for delaying necessary treatment. That said, if you can convince the administration where she is that it would do no harm and may do some good, and if they are assured that she can come to no harm, it might be possible to give her treatment. It would certainly be unlikely to cause harm.

The next major issue would be to locate someone with the requisite skills and experience. Although we have few recognised specialisms in traditional acupuncture we have been developing areas like paediatrics, obstetrics and mental health issues where we believe the special nature of the client group may require additional skills which we would recognise as expert practice. Although in theory, as generalists we should all be able to help any patient we take the view that serious mental disease needs some familiarity with the field and some experience of how to work with people in extremely distressed states. Not everyone has this experience or skill, and it would not help your wife is someone is out of their depth. With that caveat it may be possible to locate someone through our searchable database who is skilled in this area and willing to have a try. The chances are that anyone working in an area will know which of their colleagues is most likely to be able to help.

All that we can say, though, is that we would be reluctant to support the use of traditional acupuncture if your wife's health and well-being depended on the administration of medication with known provenance for helping her symptoms.

Q:  I suffer from very  bad headaches, have done for years but since having my total hysterectomy at the end of 2012 they are worse  on HRT. I tried Amitrypline but it is horrrible, made me like a zombie, can only use paracetamol but it doesn't  help much. I have  been looking on the internet and found out about acupuncture - can it help me? #

A: We tend to be very upbeat about treating migraines, cluster headaches and persistent headaches, and with good reason. The evidence for successful treatment is very encouraging, as our factsheets show


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

and 

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

and when we conduct online surveys of the main reasons why people consult a BAcC member headaches in one form or another appear in the top ten reasons. The evidence has been good enough for NICE to recommend acupuncture for the treatment of cluster headaches.

However, we have to be a little cautious. The great strength of Chinese medicine is that it understands the symptom within its overall context, and that does mean that while the majority of people will experience some benefit there will always be those whose overall balance means that short term success is less likely. On the other hand, the majority of research trials tend to be undertaken with formula acupuncture in order to meet the criteria espouse in the West, where the outcome is the only variable, and we have long argued that this is not the best way to test a system which is geared to the individual and where treatment evolves as the patient progresses. In many cases this refinement of treatment generates much better results than the orthodox trials suggest are likely, but until we come up with ways of preserving the integrity of what we do in a research setting we are where we are.

The best advice we can give you, based on what you describe, is to visit a BAcC member local to you for a short face to face assessment. Most of us are happy to give up a few minutes without charge to assess whether acupuncture is the best treatment for what troubles you, and this will also give you a better idea of what we do, who you might see and the surroundings in which they work. We find that this means prospective patients feel more empowered in making their choices rather than simply being booked in sight unseen.

A: A great deal depends on the time that has lapsed since he has had the stroke.

We have produced a fairly hefty review paper on the use of acupuncture for the treatment of post-stroke problems

http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which  is a bit of dense document, but basically concludes that there is growing evidence that acupuncture treatment speeds up recovery.

In China, acupuncture is amongst the first interventions after a stroke, and it is not uncommon for someone to have treatment within hours  of the episode. The underlying logic is that the stroke, often called a 'windstroke' in Chinese medicine, disrupts the flow of energy, called 'qi'. The sooner this can be restored to its normal flow, the better, and daily or even twice daily treatment is often used to try to restore function as quickly as possible.

This is not an unusual concept. There was some fascinating research some years ago suggesting that people with artificial limbs fared much better if they had them fitted within days of the amputation. Stumps healed quicker, and movement was better. It seems like the body has a kind of habit energy which if tapped into can recover quickly, whereas if someone develops a new 'habit' this can take a while to shift.

That is not to say that acupuncture treatment cannot have an impact when started a little later, simply that it can take a little longer to achieve the same results. We are always very cautious in offering a prognosis since we have found that the extent of the initial symptoms is not a reliable indicator or future progress, and mild strokes can sometimes cause permanent changes which defy the best efforts at treatment. However, each person is unique and different, and their underlying pre-stroke constitution will have an impact on recovery. This is why acupuncture treatment, which is aimed at treating the whole person and not simply the presenting problem, is such a valuable intervention. It may be able to improve basic functioning and hasten what recovery may be possible over and above getting better movement in a limb.

The advice we invariably give is to contact a BAcC member local to your father and arrange for a brief face to face assessment. This will give them a much clearer idea of what may be possible that we can do at a distance. 

A: We fully sympathise with you; along with gallstones and kidney stones, post-herpetic neuralgia is amongst the most debilitating and unrelenting pains that anyone can have to deal with. We have been asked this question before, and a recent answer was:

Q:  I had shingles which left me with severe post herpatic neuralgia.  Please can you tell me if acupuncture would benefit me? 

A:  As you might imagine we have been asked about this many times over the years; shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet

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

says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

We believe that this is still sound advice, and we hope that it is of benefit. The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

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