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Can acupuncture help with pain from post herpetic neuralgia?

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

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:

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.

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