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Is there much evidence for treating CRPS with acupuncture?

Q: Is there much evidence for treating CRPS with acupuncture? My 15 year old daughter has it in her ankle/foot.

A:

We were asked a similar question a year ago and our response then was:

Diagnosing the pain as CRPS (we normally call this Complex Regional Pain Syndrome rather than Chronic, but it's only a name) doesn't really refine the diagnosis a great deal. If you look at the wikipedia entry on CRPS, as we are sure that you have, there is no clear-cut cause, the term mainly being used to describe a complex array of neuropathic and sensory pains of great severity. From an acupuncture treatment point of view, both in traditional Chinese and western medical versions, chronic pain was one of the main focuses of research in the 1970s and onwards following Nixon's visit to China and the film footage of people having operations without anaesthetic. There has been a great deal of research, as our factsheets on chronic pain and neuropathic pain show http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html & http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html When we are asked about the value of treatment all we can say is that it is worth trying, and that the major issue will not be whether it works but the extent to which it works and how sustainable the improvements are. Generally speaking we do not like to continue treating someone where there is no overall improvement but simply respite from pain which always lasts only for a short while. However, patients over the years have told us emphatically that if the trade off for a little regular cost is the ability to maintain a valuable and valued lifestyle then it's their call, not ours. However, from a Chinese medicine perspective there is often a great deal more hope than simply symptom suppression. The system of medicine is predicated on the balanced and effective flow of energies in the body, and if for any reason this flow becomes imbalanced - overflowing, weak or blocked - then pain will result. The re-establishment of proper flow will restore balance and in theory the pain should go. The major task the practitioner faces is determining how much the problem is simply local and how much it depends on underlying systemic weaknesses for its enduring nature. In your daughter's case her youth probably means that she's in good health, and twelve year olds tend to respond well to treatment, as do most children. Undoubtedly, though, the pain and trauma will have taken some toll. It would be well worth while contacting a BAcC member local to you for advice based on a brief face to face assessment of what is happening in your daughter's case. Although we have not yet finalised our discussions on expert practice in relation to paediatrics, it is likely that in the next few years we shall recognise the postgraduate training that many members undertake in treating children. They are not simply small adults, and it may well be worthwhile using google searches for 'acupuncture' and 'children' to see if there are, as is likely, BAcC members who have followed this path. We are not quite yet in a position to identify them directly. That said, any practitioner worth their salt will be more than adequately able to help and offer their advice.

We don't think there's a great deal we can add to this answer. We have conducted a search of the databases and found case reports like this one https://www.ncbi.nlm.nih.gov/pubmed/23113454, although you are not going to find it easy to locate a Chinese scalp acupuncturist in your area, this being a modern development for which there are as yet no agreed standards. There are also studies like this one https://www.ncbi.nlm.nih.gov/pubmed/21208130.

But single case studies are far too unreliable for drawing useful conclusions. They may prompt further research, but there are too many confounding factors in play to be sure what has effected the change. Many people who become the subject of a study improve by virtue of the extra attention they are getting.

We always find that going back to basic principles is the best answer. From a Chinese medicine perspective pain arises where there is a blockage in energy flow, an excess of a deficiency in the system as a whole, and usually a combination of local and systemic issues. Since each patient is unique and different it is really only possible to say whether a treatment for one of the less common presenting problems will work through actually seeing what is happening.

The advice we gave in the previous answer is your best bet. If a local practitioner can spare a few minutes to see your daughter to assess the situation you will get an honest appraisal of what acupuncture may do and also recommendations for other forms of treatment if the practitioner thinks these might be better.

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