Ask an expert - neuro and psycho logical

222 questions

We are very sorry to hear of your daughter's problems; that is a very long time to be carrying the burden of an undiagnosed complaint in one so young.

The question of whether pain or anxiety came first is very difficult to settle. In most cases there is a very unpleasant circularity about these kinds of problems, and both conventional and Chinese medicine look for ways to break the cycle. As far as treatment of both is concerned, there is a pretty good amount of evidence suggesting that acupuncture treatment can be helpful. As we wrote recently in response to a question about depression and anxietyThere is some increasingly good evidence for the use of acupuncture in the treatment of depression, as out factsheet showshttp://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/depression.html

as does a heavily publicised research trial by BAcC member Hugh Macpherson and colleagues published very recentlyhttp://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001518


Where the depression is linked to a continuing health problem, however, the situation becomes a little more complex. We find that when someone has a chronic condition it can become a great deal more difficult to deal with the depression that this causes and the underlying depression to which this has added.The great strength of Chinese medicine, however, is not that it treats this or that condition, but that it treats the person. This is why twenty people with headaches may be treated twenty different ways. Clearly some points will have a direct effect, but treatment is not the equivalent of an aspirin, and the practitioner will be at pains to discover why this symptom appears in you and not in someone experiencing similar external stresses. The best treatment always combines treating the symptoms within the context of their overall pattern, and the pattern is the primary factor. Indeed, in ancient times some of the older systems used to treat the people without necessarily taking any notice of individual symptoms, in the simple but effective belief that a system in balance took care of its own problems.The best advice we can offer is that you visit a BAcC member local to you, and see if they are prepared to give up a little time without charge to discuss whether your specific presentation. Anxiety and depression are rather broad labels which cover a huge range of possibilities, and sometimes we have to say to patients that what they are dealing with requires more of a talking therapy approach than we can offer. Given that it is rare for mental and emotional issues to arise without accompanying physical changes, even where these do now generate symptoms, a practitioner of Chinese medicine may well be able to see overall patterns which give them confidence that they may be able to help.The issue of chronic pain is also one on which a great deal has been written, but most practitioners would be trying to get as much information as possible about her life at the time when the chest pains started. Chinese medicine has some very broad brush principles about the flow of energy in the body which underpin an understanding of pain which arises from blockage or poor flow. It would be interesting to find out whether something had impaired the overall flow We think that this still represents very good advice, and we are sure that you will be able to find someone locally who will sit down with your daughter and see whether they think they can  help her. As follows from above, Chinese medicine is an inherently generalist practice, and all of our members are equally well qualified to provide the same level of exemplary care. Using our postcode search facility on the home page will identify your nearest BAcC members.The only caveat we have is the issue of self-harming, and the extent to which it is happening. It can sometimes be helpful to have had experience of working with people who have self-harmed, and it may be worth asking local practitioners if they know of someone locally who has developed a reputation for addressing complex mental and emotional issues. Most practitioner networks are a very efficient grapevine for directing prospective patients to the best practitioner for them. We hope that you manage to find someone who can help your daughter and lift the burden your family is carrying.

This is a very good question. It is the received wisdom inside the profession that treatment should be started as soon as possible after a stroke, and that the potential for change and improvement diminishes over time. This is driven in part by the fact that in China it is not at all unusual for someone to start having treatment on the day of a stroke, the logic being that the energy of the body has been disturbed and the sooner that it is corrected, the less likely the disturbance is to be 'set' in the system. 

We have some sympathy with this view. There have been several books published in the last couple of decades which have explored the possibility that once an energetic pattern has become established it is no longer seen as a pathological factor but becomes the essence of the person. This means that someone can in a rather peculiar way become invested in the post-illness state as their reality, with the attendant difficulty in getting things to change. If you talk to people who teach the Alexander Technique you find the same model; once the body has  a set pattern it takes a long time to re-train it.

However, our clinical experience with post-stroke patients is rather more mixed than this. Whilst we have always warned patients who come in many months or years after the initial stroke that progress may be slow or in some cases non-existent, we have found that some people do have a marked and immediate response to treatment, often in direct proportion to their underlying constitutional health. A person who was strong and energetically in good shape before the CVA often has a greater power to recover.

There has been a mountain of research into this area, as you can see from the rather long review paper which we have on our website

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


but which may be a little technical for many readers. It has long been our hope that the evidence will reach a critical mass where we can argue a case for early intervention within the NHS with acupuncture treatment, if for no other reason than the fact that increasing the speed of recovery would save the NHS millions of pounds in rehabilitation costs. We have some hope that familiarity with the Chinese system will encourage some trials in the UK.

As far as your brother is concerned, however, it is rather difficult to say what might be possible without a face to face assessment. What you and he will find, however, is that most of our members are very happy to give up a little time without charge to prospective patients to see whether acupuncture treatment would be a good option. Most of us are very frank about someone's chances because the disappointment of achieving nothing or very little is just as palpable by the practitioner as the patient. We get it wrong - some people we think we can't help recover amazingly and we think we can help don't. In the main, however, we tend to recognise those people for whom acupuncture is well worth a try.

The crucial thing is to try to set measurable outcomes so that improvements are not just a matter of feeling better in oneself, good as this is, but visible through verifiable markers - better range of movement, greater endurance in in walking, and so on. This avoids the problem of running up a large bill without really getting anything back. If it isn't working after five to ten sessions it is better to draw a line unless there are secondary improvements which render the treatment worthwhile.

Although there is an increasing amount of research into the use of acupuncture treatment after radiotherapy the majority of studies are aimed at specific symptoms which often accompany treatment - nausea, dry mouth, fatigue etc. Unfortunately nerve pain or generalised pain in the pelvic region is not amongst them, and we suspect that this is because the generality of the symptoms makes it difficult to assemble meaningful trial groups. The results of the research show some quite positive outcomes for dry mouth and nausea, but as always is the case with acupuncture research the conclusion is that larger and better designed trials are needed. Even if someone had researched nerve pain specifically, the chances are that this is what the conclusion would be. The bar is set very high, and not always appropriately, for the work we do.

That said, there is a substantial and growing body of evidence for the treatment of neuralgia with acupuncture, even in the strange limiting cases like phantom limb pain, so it would not be a bad idea to see if treatment could alleviate some of the discomfort. The effects of radiotherapy in terms of the heat and scarring of tissue are outcomes which can clearly be translated into the diagnostic systems of Chinese medicine, and a practitioner can hope to address some of these within the overall constitutional setting within which they have had an effect.

The idea of context is central to Chinese medicine. Every is a unique blend of energies, so even when two people have the same symptoms they might arise from different internal disturbances. The skill of the practitioner of traditional acupuncture lies in treating not the symptom but the person as a whole. This means that the kinds of damage which radiotherapy can do will differ from person to person, both in terms of severity and in terms of potential for recovery.

The best advice that we can give is that you visit a local BAcC member for an informal chat about what may be possible. Most of our colleagues are happy to give up a little time without charge to establish whether acupuncture treatment might be worthwhile, and this gives you a chance to meet them and see where they work before committing to treatment. There is nothing to lose from trying treatment. Not only is acupuncture a very safe therapy but it does not have any major side effects. Even if the treatment managed to help you to deal with the discomfort it may be worthwhile.

The key thing is to set measurable outcomes from the beginning so that you can judge how well the treatment is working. Amounts of painkillers, sleep disturbance and general energy levels are the usual markers, and using them sidesteps the problem that people can feel good on some days, bad on others, and are not always able to say on any given day whether they are feeling better overall. 

We were asked about foot drop some time ago and we responded:

There are a number of case studies, relatively small in terms of the numbers of participants, which seem to show positive and encouraging results for the use of acupuncture for foot drop after strokes. However, the evidence is by no means comprehensive or conclusive enough for us to give a positive recommendation for treatment.

However, a great deal depends on what else is going on in your system. Foot drop as an isolated symptom is unusual, and very often there is a more complex neurological picture within which this sits.  If there isn't, then from a Chinese medicine perspective the weakness would be understood in terms of a blockage or weakness in the flow of energy, or 'qi' as it is called. The  practitioner would probably use a combination of local and distal points to try to restore proper function in the tendons and muscles affected by or causing the condition.

If there is a wider pattern of dysfunction, however, then the chances are that this will be a neurological problem whose treatment with acupuncture would be less likely to be successful.

However, there is no substitute for a face to face assessment in cases like yours and we believe that it would be worthwhile visiting a BAcCc member local to you to benefit from their advice. If they feel that acupuncture will not be of use, we are confident that they may have other suggestions about what forms of treatment may be best for you.

We have gone back to the research databases to see what, if anything, has happened since we gave this response, and not surprisingly the few studies which we found are pretty much the same of what can still be found. You might find this interesting

https://www.slideshare.net/JudithMiller3/acupuncture-for-the-treatment-of-foot-drop-a-case-report

and also this

http://www.healthcmi.com/Acupuncture-Continuing-Education-News/564-acupunctureceusfootdropstroke

but not for the faint-hearted is this Youtube video

https://www.youtube.com/watch?v=xnITeO-8Dt0

As far as the nerve pain is concerned, again it very much depends on what is causing it. There are so many possibilities that it would be unwise for us to speculate on what it may be. Some cases are amenable to treatment, like the neuropathy which arises after chemotherapy, and some less so, like peripheral neuropathy arising from diabetes which  can often prove intractable. However, each case is unique and individual, so you are well advised to follow the route suggested in our previous response and contact a local BAcC member for a chat about your own individual presentation.

Restless leg syndrome is awful, as this 'expert' knows from personal experience back in the 80s when nothing, but nothing, would make the problem relent. It is nowgaining recognition as a diagnosable problem, with a new name(!), and there are a number of treatment options which are being explored. A review article http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101885/ cites several of these, and the one acupuncture review this in turn cites

http://www.ncbi.nlm.nih.gov/pubmed/18843716

mentions two to three studies which are interesting but generally concludes that the majority of studies are too small and not methodologically sound enough to draw firm conclusions.

From a Chinese medicine perspective, however, there are entirely different ways of looking at the balance of energies within the body which can sometimes make sense of problems such as these within a theoretical structure which is quite different from western medicine. Problems like restless legs syndrome, where the leg feels as though it is 'over-energised' can sometimes make sense in a system of thought which looks at the free flow of energy within the system, and tries to understand the pathologies which arise in terms of excesses and deficiencies, and especially blockages. A skilled practitioner should very quickly be able to make sense of the energy flows within the system, and be able to offer you some sense of whether there is something which is treatable.

Even where this is not the case it is important to mention that the older theories of Chinese medicine were primarily aimed at balancing the whole system, seeing symptoms only as alarm bells, not the problem itself. Working in this kind of way our members very often have an effect on problems without necessarily being able to give a highly specific audit trail of what is causing something to go wrong.

We have not come across much in the way of new research, although another small study published early this year (2015)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4339862/

repeats the general pattern of significant effects but small study sizes which means that we cannot give a more unqualified recommendation.

As far as motor axonal neuropathy is concerned, there is very little focused research on this specific presentation of peripheral neuropathy. There is a systematic review published earlier this year

https://www.ncbi.nlm.nih.gov/pubmed/28112552

which embraces a number of papers about neuropathies very similar to axonal neuropathy, but nothing specifically about it. Most studies of this kind tend to be very small, and inevitably the conclusion is that more studies on a larger scale would be necessary. The main question which is left unanswered is 'who will pay for them?'

If you are considering acupuncture treatment for the problem the best advice we can give is that you visit a local BAcC member to ask for a brief face to face chat about what may be possible. It follows from what we have said before that each case is unique and different, and a face to face assessment is the only way to get a specific answer about what you might expect. Many practitioners are happy to give up a small amount of time without charge to prospective patients to make this kind of assessment.

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