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222 questions

Q. Can acupuncture help with pain from post herpetic neuralgia?

A. We are frequently asked about post-herpetic neuralgia, and only a couple of weeks ago we wrote an immensely long answer as follows:

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.

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.

to which we added

We have had a good look through the research databases to see what further evidence is available (the factsheet seems to stop around 2008) and we have found a few which are positively encouraging, such as:

https://www.ncbi.nlm.nih.gov/pubmed/21639941

https://www.ncbi.nlm.nih.gov/pubmed/22502623

but the systematic review proposed in 2014 has still to be completed (at least we can find no trace of a publication by the principal author).

and then added to the answer
We have undertaken further searches to see if the systematic review has been completed (no!), and to see if anything new has emerged. Nothing has, but we are always a little cautious about the results of trials because they rarely use acupuncture in the way that we would, rather instead they use the same points over and over again. This is not really a traditional way of treating but is unfortunately required to meet standard trial designs. From our perspective there are more variables which cannot be removed from the equation, the most significant of which is the individual patient. No two presentations are the same because no two contexts are the same.

This means that while there may be some similarities between aspects of a condition's appearance it will always be essential to look at them in the context of the patient's overall health, hence our recommendation to have a brief face to face chat with a local BAcC member to see what may be possible for your specific case.


We hope that this leviathan gives you an idea of what may be possible. We have addressed the problem of post-herpetic pain here, but in general acupuncture treatment has a reputation for pain management which dates back to the 1970s after Nixon's visit to China. When people saw operations performed with acupuncture anaesthesia it prompted a great many trials which showed the effects of acupuncture on the release of pain-killing neurotransmitters.

The question is not will it work, but usually how much will it work and for how long. What we try to avoid is a regular habit of treatment without much change, although some patients with deep pockets are happy to come very regularly for even a day or so of relief.

As above, though, talking to a local BAcC member about what may be possible is always the best step.

Q. i'm trying to find help with my (central post-stroke pain syndrome) I've had for 28 years after a stroke hemorrhage in 1990.
i have tried everything from oramorph , Trans cranial magnetic stimulation, deep brain stimulation, spinal cord stimulation HF10 and other interventions all with no benefit so would acupuncture help?

A. We have to be honest and say that if all of the other therapies you have tried over the last 28 years have failed to effect a change it would be a very considerable surprise if acupuncture treatment suddenly proved to be the answer. However, we are not entirely sure what the CVA has caused by way of continuing symptoms under the generic title of CPSP, and there are aspects of post stroke treatment where the blockages which arise at the time of the event will stay blocked until someone clears them. We do occasionally hear of people having dramatic changes twenty or thirty years after a problem began but this is quite a rare event, and we would never use examples like that as the basis for a recommendation.

We have gathered a considerable amount of information about the treatment of strokes in a rather dense review paper which can be found here

https://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html
but the short answer to questions about efficacy is that in China acupuncture treatment, when used, commences almost immediately before the system has become 'fixed' in a state of disrepair, and the evidence suggests that this maximises the chances of regaining residual function quickly. The longer people wait for acupuncture treatment, the less well it seems to work and the less overall effect it seems to have.

Pain management is something for which acupuncture has developed something of a reputation since Nixon's visit to China in the 1970s and the sight of people having operations under acupuncture anaethesia. This led to a proliferation of trials and because neurotransmitter levels are easily measured a great deal of good evidence about the use of acupuncture to stimulate their release. Many Pain Management clinics base their work on this. The central question is how much relief and how sustainable, and it may be a matter of weighing up the cost and inconvenience against the amount of relief treatment can offer, it indeed it does work a little.

The best advice that we can give is that you visit a local BAcC member to seek their view in a brief face to face assessment of what may be possible, depending in the exact presentation it is that you need help with. We also think that cranial osteopathy might be another pathway which might offer some potential for change, but we don't have a central referral point to which we can direct you. Many osteopaths use cranial techniques, but some spend a great deal of time on this work and are often the local 'go to' people for difficult cases. we would hope that any you might contact direct you to the most experienced, just as we imagine that our members might have a local 'hero' to whom they send the more challenging cases.

As you might imagine we have been asked this question on several occasions and our answers have tended to be rather upbeat, as for example:

The evidence for the use of acupuncture to treat migraines and tension type headaches is encouraging enough that NICE, the National Institute for Health and Clinical Excellence has recommended it as a treatment for many types of headache. Our factsheet

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

provides details of a great deal of the research which has been undertaken. 

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 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.

We think that it is important to add riders like this. Research very often uses formula treatments, and this goes against our ethos of treating the person, not the condition, of seeing symptoms in their overall context. Just as there are occasions when an individualised treatment will exceed formula treatment in effect, there are equally occasions when formula treatment will not be appropriate, nor will individualised treatment be much better. Talking to a practitioner before committing to treatment is a wise move.

The reply should probably point out that the evidence for cluster headaches per se is not quite as compelling, although the one study cited in the factsheet

https://www.ncbi.nlm.nih.gov/pubmed/16643558

comes from the GERAC trials in Germany in 2006 which are particularly interesting because the figures were gleaned from German medical doctors and were statistically significant by virtue of the sheer size of the trial.

Our advice from the earlier answers remains very apposite on one main point, though, and that is the fact that each person is unique and individual in their balance of energies, and for problems like cluster headaches which can arise from a number of systemic problems it is essential that someone has sight of a patient before blithely making any prognostications about what may be possible. Most members are happy to give up a little time without charge to prospective patients to enable them to make properly informed decisions about having treatment.


Over the years we have had a number of questions about phobias, and the most recent composite answer we gave about a fear of flying was:

It was always said that if you wanted to get a straight answer from a doctor, you should ask them, 'would you be happy for your wife to have this treatment?' So, I suppose if you said to us, 'would you recommend acupuncture to your family to overcome a fear of flying?', the answer would probably be 'no'. This is not to say that it might not work; over many years of practice we have heard of a number of almost incredible stories about changes which people have managed to make thanks to treatment, and quite often by the practitioner simply sticking to very basic traditional acupuncture. Extreme reactions of any kind are, from a traditional acupuncture perspective, indications that a part of the system is out of balance and generating inappropriate emotional or mental responses. It is sensible to be mildly apprehensive about flying, just as it is to be mildly scared of heights. If the faculty of sensible fear is out of balance, then extreme reactions abound.However, with a problem such as this there are other possibilities which seem to us to go to the heart of the problem much more directly. Hypnotherapy or CBT (Cognitive Behavioural Therapy) are both well tried approaches for phobias, with the added advantage in the case of hypnotherapy of being able to do trial runs under the power of suggestion. There are a great many forms of hypnotherapy, all of which have their strengths, but those based around NLP and the work of hypnotherapist Milton Erickson seem to have the most well attested handle on treating phobias.There is no doubt that you would probably derive some benefit from acupuncture treatment in terms of a reduction in anxiety, as our factsheets show, and always the possibility that a skilled practitioner might look at your overall balance and get that feeling that there is something obvious to be done which may help. It is more probable, though, that they would do as this expert would, refer you to a trusted colleague who does hypnotherapy or CBT to ensure that your needs were skillfully and professionally met.Because traditional acupuncture treats the person, not necessarily the condition they have, there is a danger that this can be re-framed as 'acupuncture can treat anything', and occasionally incautious practitioners let patients' expectations run away with them. From a Chinese medicine perspective every aspect of the human being, every inappropriate mental, physical, emotional or spiritual state, is theoretically amenable to change by treating the person as a whole. However, our clinical experience is that there are many problems, such as terminal illnesses or serious psychotic states, where expectation of recovery is virtually nil, and it is highly risky to feed the desperate need of patients with statements which might lead them to have hope where there is none. Cases like yours, although not quite as serious, nonetheless can represent entrenched patterns of thought and behaviour which require specialist skills to unravel.We think that this still represents the best advice that we can give, especially given the timescales involved. If you are London based, and your friend is also London based this is probably the best place to be in terms of finding someone who could possibly help. Your friend may even be able to get CBT sessions through the NHS if she has a sympathetic GP who understands both the urgency and importance of the situation. If not it can be a bit of a minefield finding someone who is appropriately qualified and appropriately skilled. The challenge is finding someone who does what your friend needs.If you want to see what we mean you could do worse than look at this brief video presentation by Richard Bandler, who along with John Grinder first set down the principles and practice of Neuro-Linguistic Programming (NLP). http://www.nlplifetraining.com/Spider-phobia-Overcome-yours-with-NLP-and-Richard-Bandler

There are many hundreds of practitioners in and around London, as there are throughout the UK, who use the same techniques, and we would assume may be able to offer the same effective process. Of course, as practitioners we would always be interested to see how the energy of the person had been affected for such an inappropriate response take such a strong hold, and perhaps when she returns from a successful and wonderful trip she might choose to explore this. Howe ever, first things first, and with only three weeks to spare, what we have suggested is probably the most likely way to get her to Australia.
We have repeated below a 'nested' response (two responses, one inside the other) which we gave some time ago;

We tend to be a little tentative in offering advice on conditions like Parkinsons which are often chronic and degenerative. A typical response that we have given in the past reads:
 From the perspective of research studies alone it would be difficult to give any firm recommendations for acupuncture as a treatment of Parkinson's Disease. There are a number of studies, some undertaken in the US but the vast majority in China, which show some positive signs, but not of sufficient change in a significant number of patients under study to draw any firm conclusions. You can see some of the studies if you google 'ncbi acupuncture parkinson's disease' - the National Centre for Biotechnical Information in the States is a convenient way to find many of the the more significant papers. There is also a Cochrane Review of a protocol for assessing the value of acupuncture, but as far as we are aware this has not been put into action yet.With all chronic degenerative conditions the extent to which acupuncture can help has to be carefully explained. It is often, as one rather ironic patient said, a case of 'getting worse slower', and this is extremely difficult to quantify in a condition like Parkinson's where the disease progression is neither smooth nor predictable. Anecdotally there are many accounts of patients finding that treatment helps with some of the manifestations of the disease, such as the periods of rigidity and freezing, and a general sense of well-being, but these are not documented sufficiently well to be able to claim any undisputed levels of efficacy.The best course of action is to see whether a BAcC member local to you will give you an honest assessment from an eastern perspective of what they might be able to achieve for your own unique patterns. There may be elements of how the condition manifests which they may feel that they can help.As you can see, we are very cautious in our choice of words. The shaking of the arm with Parkinsons has been tested in some small studies, as in this onehttp://www.ncbi.nlm.nih.gov/pubmed/12210879and there is some optimism in the write-up but it is a very small study.From a Chinese medicine perspective there are a number of syndromes which describe the shaking of the limbs, and which provide explanations of them in the terms which we use as practitioners. This can sometimes cause a little confusion because it gives an impression that a symptom which is treatable in Chinese medicine may mean that the same symptom might be easily treatable from a western perspective. Where there is a physical change in the brain, however, it would be unwise to get too excited about the possibilities.In any situation like this, though, we find that it does not help to be negative because there may be multiple reasons why someone's tremor might be quite bad, not least in the fact that stress itself can make the symptoms of Parkinsons more noticeable. We have found in clinical practice that reducing stress can sometimes make the frequency and severity of symptoms reduce, and it would certainly be worthwhile talking to a BAcC member local you you about what may be possible.We are not quite sure why we did not refer to our factsheethttps://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/parkinsons-disease.htmlwhich has some quite encouraging information under the 'evidence' button.We always add the observation that we often find that once someone has a 'headline' condition everything in their overall healthcare picture is assumed to be a secondary symptom of it. This expert has a patient with Parkinsons in whom several minor symptoms which have been declared to be a consequence of the disease have disappeared.  It may be that from a Chinese medicine perspective there are a number of your problems which are not directly related to the Parkinsons. We are not in the business of giving people false hope, simply recording what we have seen over the years.We also always check the current research, and since our factsheet was assembled there has been another very comprehensive systematic review https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5279085/which while not conclusive certainly would encourage us to say that while we could not guarantee results the available evidence for amelioration of some of the symptoms is certainly stacking up.As always, a brief visit to a local BAcC member is worthwhile to discuss how acupuncture treatment might help your specific presentation.

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