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Ask an expert - general

183 questions

Q: For over a year now I've been suffering with a frozen shoulder. I went to see a specialist who said I had a nerve problem because the pain moves around my neck, arm and shoulder. The pain was really bad and I couldn't move my arm. I was given Morphine for the pain and a steroid injection into a different part of my shoulder. I also have Type 1 diabetes and thyroid problems. After the injections the pain went but after a few months it's back but not as bad as the first time. The doctor has now told me that because I have Type 1 diabetes I cannot have any more steroid injections, so has prescribed me ibuprofen and advised me to go back and see a physio. But the physio said he can't treat me if I'm in pain and the ibuprofen doesn't work, so I was wondering if I could have acupuncture?

A: The very simple answer is that there is no reason why you cannot have acupuncture as a Type 1 diabetic. The only caution which a practitioner will have is that with Type 1 diabetes there can sometimes be reduced sensitivity to the extremities. In our Guide, which we publish for our members, we say:

Diabetes mellitus It is recommended to ask diabetic patients about neuropathies they may have developed. In severe neuropathies the patient may experience loss of sensation. Due to impaired blood circulation to the affected area the patient may also be at a greater risk of developing a localised infection.  

Needling into the affected area should be done with particular care and strong manipulation of the needle avoided. Patients with poorly controlled diabetes, especially if insulin-dependent, may experience greater than normal fluctuations in blood sugar levels.

As strong acupuncture treatment can lower the blood sugar levels and occasionally induce some drowsiness, it is recommended that you treat such patients with particular care, especially on their first acupuncture treatment, and ensure that they have had something to eat before the treatment.

This just about says it all, really. We have come across the very occasional patient in whom the treatment triggers a release of additional insulin and can steer them towards a hypo, but most long term diabetes patients are usually very much on top of maintaining their sugar balance.

The reason for stopping steroid injections may also be that there is an upper limit beyond which most doctors will not go anyway. Three or perhaps four usually represents the safe number, after which there is an increasing risk of local damage to tissue in the area.

As far as frozen shoulder itself is concerned, as our factsheet shows https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1133-frozen-shoulder.html there is some fairly good evidence that acupuncture can be helpful. This is far from conclusive, so we can't make specific claims, but the evidence does suggest some benefit as well as some reduction in pain. The only problem is that it is difficult to stop someone using the shoulder while it improves, so progress can often be hampered by unintended setbacks when people reach out automatically and trigger pain and discomfort.

The best advice that we can give is for you to visit a local BAcC member for an informal chat. Most are more than happy to give prospective patients some time without charge to take a look at what is going on and will be able to give a better informed answer than we can about what prospects there are for benefit from treatment.

Q: My doctor advised me to contact a physio as I was experiencing joint pain in my knees. I had acupuncture on my first visit and after three days my shoulder blades and upper neck are in excruciating pain. Painkillers are not even helping and I don't know what to do. I can't deal with this any longer. Why Am I experiencing this and will it ever stop?

A: We would probably need a little more information before we could give a definitive view. The first question we would ask would be where the needles were inserted. Acupuncture is a very safe treatment with very few serious adverse effects, and most, when they do rarely occur, are the result of damage caused by the needles themselves, hitting nerves, causing deep bruising, etc etc. If someone throws a very specific pain then the first thing to check is whether the treatment as a physical act of needle insertion could have caused it.

The second thing to check is whether the treatment has caused a change in your posture, especially if needles have been applied to the lower back as well as the knees. The physios pay particular attention to this, often because they use slightly more vigorous techniques than we do as traditional acupuncturists. Occasionally a muscle might be tense and 'guarding' because it is supporting an inherently unstable spine. If this relaxes then it can generate problems locally or even higher up. It can even be the case that the correction of gait problems can affect the spine which in turn can make a change higher up for which the muscles are not yet prepared. The physio may well be able to recommend some exercises if this is the case.

Of course, a third possibility is that by using  acupuncture from a physical/medical perspective only the treatment has caused systemic effects in a wider way of which the practitioner may be unaware. It has been one of our constant themes with western medical acupuncturists that using points within a medical context does not mean that you can switch off the effects they have from our perspective in Chinese medicine. Why this might have resulted in neck and shoulder pain would very much depend on the nature of your energetic balances from a Chinese medicine perspective.

What we think is very likely, however, is that unless a needle has caused physical damage in the area where your pains are they are very likely to subside within the next few days. You would be well advised to contact the physio anyway to ask what it going on, and any of our members would in the same circumstances be only too happy to discuss the problem and perhaps invite you back to take a look at what is happening. Nobody wants a patient to be in pain after treatment. It may well be that further discussion reveals why this is happening and also go a long way to ensuring that the same thing does not re-occur.

The other thing we should say, though, is that although it looks fairly likely that the treatment was causally implicated in the pains it may not be the case. If by the time you get this response the pains continue and are beyond simple pain control you would be well advised to see your GP in case this is something different which has by pure coincidence happened at the same time. With over four million treatments in the UK each year there are bound to be occasional coincidences, and the key thing is to get problems checked out first before getting engaged in discussions about what caused what.

Q: I am an oncology pain specialist nurse and I am currently doing a Masters in nursing. My question relates to 'self Acupuncture for chronic Cancer pain'. I appear to be struggling for published data on this topic so wanted to ask if there are any trials in this area or who I could ask?

A:To be honest there isn't a great deal of information about self-needling, although there have been some interesting articles over the years. A relatively recent one http://aim.bmj.com/content/33/3/210 discusses the use of self needling in research trials for breast cancer treatment. You will need to find someone in your section with access to research databases to download this, but it looks like interesting reading.

We came across a hospital In Truro many years ago where patients were being trained in the use of a specific point (Nei Guan) to reduce post-chemotherapy nausea, for which there is considerable positive research evidence, and they did have some very well laid out and clear instructions.

However, it would be fair to say that we are still very much on the side of the view expressed by Val Hopwood in the article on self-needling to be found in this journal https://www.aacp.org.uk/journal/download/4 where she says that the risks outweigh the benefits.

We have not tended to encourage people to needle themselves. There are two main reasons. First, acupuncture involves piercing the skin and safely disposing of needles, and a professional practitioner spends a considerable time learning the skills and knowledge necessary to remove any risk of infection or cross-infection from the process. Our main complaint about very short training courses is that while they may train people in useful adjunctive skills they cannot hope to ensure that the person taking them is sufficiently well trained in safe needle practice and all the cautions that go with being a professional acupuncturist.

Second, although the treatment of symptoms has its place in Chinese medicine, symptoms are regarded as only a part of the picture, and are usually indicators of imbalances within the system which need attention. The risk is that using acupuncture in a first aid way, the underlying pattern is deteriorating, but the alarm bell which the symptom represents keeps getting turned off. This is less likely in a controlled setting like continuing treatment under supervision. However, we have to be realistic; for most patients in continuing care this can mean quarterly or half yearly check-ups, and a great deal could happen in between without necessarily being picked up or seen as being masked by a treatment intended for another purpose.

That said, you can find some data by chasing the references in these two papers. There are also a number of recent studies which are well worth looking at. Jacqueline Filshie is one of the UK's experts in acupuncture and cancer treatment, and her paper

https://www.ncbi.nlm.nih.gov/pubmed/16430125 is as always enlightening and solidly grounded in experience. There is also a useful paper here https://www.ncbi.nlm.nih.gov/pubmed/23436910 for a study in which Jacqueline also took part.

We hope that these give you enough to start with and wish you well with your studies.

Q: Can GCT be treated with acupuncture?

A:There are a number of acronyms in medicine which have multiple meanings, and we are assuming with this one that you mean giant cell tumour. If it is something different do let us know.

If it is giant cell there is not a great deal that we could imagine to be gained from acupuncture treatment save relief from the pain of the secondary effects. We have checked the databases and found no evidence of formal research into acupuncture treatment of GCT, although there are a few websites which promote the idea of using Chinese herbal medicine to ameliorate the symptoms.

From a Chinese medicine perspective there are a number of points which have a direct impact on the bones of the body, and we have seen some very interesting results when it comes to fracture healing. However, although there is some research into problems like osteoporosis, there is nothing we can find which suggests that acupuncture can address the problem you have. The ancient Chinese would not have benefited from X-rays and scans, and would have diagnosed the problems according to their normal protocols for swelling of the joints and pains in the muscles and tendons. On this basis, there may be some hope that the worst of the pains can be kept at bay, but not much chance that the condition itself will be reversed or removed.

In cases like yours, though, so much depends on the unique nature of the person's energy, and making general pronouncements will never be as good as the opinion of someone who has seen the problems you have in context, i.e. along with all other aspects of your health and functions. This would enable you to get a much better idea of what is possible than we can offer at this distance. Find a local practitioner who is properly trained and qualified and ask what they think. If they offer cure or full remission be very cautious indeed. This may be more than anyone could sensibly promise.

Q: A couple of time I have read on your website that acupuncture treatments are almost good for nothing and that there is no evidence that it can successfully treat conditions as Trigeminal Neuralgia and many others. Are you against acupuncture? Your website seems to advocate against this science.

A: This is a very good question, for which we think there are some very good and, we hope, informative, answers.

The first and most important point to make is that since the Advertising Standards Authority's reach was extended to cover websites and internet marketing there are much stricter conditions about what people can claim in their advertising and marketing materials. In healthcare in particular any claims to cure, treat or help in the treatment of a problem now have to be backed up by evidence that this really is the case. By'evidence' the ASA has adopted a standard with which nearly every complementary therapy has disagreed and with which they have taken issue, the randomised double blind control trial. This really only works well for drug testing, not for therapies where the nature of the intervention develops as treatment progresses.

The BAcC, along with many other bodies, has been engaged in discussion with the ASA for the last five years about the unsuitability of this as a standard, and also about the choice of experts by the ASA to review evidence. The bottom line, though, according to this criterion is that only about four or five conditions meet the required standard, and a very uninteresting group they make too unless you happen to be looking for acupuncture treatment for dental pain. The vast majority of studies are not RCTs, nor would we want them to be; the acupuncture is often formulaic and restricted, and about as far removed from day to day practice as one can imagine.

However, these are the rules, and so when we are asked about named conditions we have to be very clear that the evidence from this perspective is not conclusive. We often use terms like 'encouraging' or 'promising' when the evidence is short of conclusive but fairly robust,  but as a regulatory body which has to require its members to comply with the law we cannot ourselves bend or break the rules. If there is no conclusive evidence in the ASA's terms then we cannot claim there is, even when we know that we have treated many cases of a problem successfully.

As far as named conditions themselves are concerned we have also been backed into a corner, partly because of the nature of our own marketing over the years. As we are at pains to say in nearly every response traditional acupuncture treats the person, not the condition. Although you will find an increasing number of books and internet articles about 'acupuncture for headaches' or 'acupuncture for stomach disorders' this is not how we view our work. To some extent it is possible to treat named conditions in themselves but from a traditional acupuncture perspective it is not as satisfying or ultimately as likely to succeed long term as treating the person, i.e. tailoring the treatment to the individual and their unique imbalances. In the circumstances it is with great caution that we would say 'acupuncture treats x or y or z';. There are going to be many prospective patients for whom this will not be the case because what seems like a simple problems sits atop a pattern of overall disorder which might take months or even years to sort out.

At the same time, as practitioners we have seen many thousands of patients over the years, and we have a fairly clear idea of the conditions which, whatever the state of an individual's health, do not seem to be too tractable to treatment. Some, like severe tinnitus, can endure through many courses of treatment of all kinds, as the magazines of the tinnitus support groups attest. It would be unhelpful and misleading for us to claim to treat such problems on the basis that acupuncture treats the person, not the condition, when we know that it is one of a number of problems which do not seem to respond well to any treatment.

We take the view that as a mature profession we should be honest in assessing those problems which are more likely to be helped and those which aren't, and letting the prospective patient know this. We remember earlier times when the fact that acupuncture treated the person more than the disease led to some patients getting the very wrong end of the stick; treating a patient with cancer is not the same as treating cancer, but people will hear what they want to hear unless someone is very careful with their choice of words.

As a final point, we would probably not want to lay claim to the word 'science' for what we do. There are all sorts of definitions of scientificity, and under many of them we could probably make a case for traditional acupuncture as a science. We also, though, recognise that there is an art to what we do, skills based on experience and observation which are unique to each practitioner and which provide an infinite number of perspectives on groups of patients. We had this brought home most clearly when we were discussing National Professional Standards with doctors. For them a diagnosis was an accumulating paper or computer file which could travel from doctor to doctor without any change or modification. For us, diagnosis was an active process which depended on the individual practitioner, and evolved over time. Until we ironed out this major semantic difference there was great confusion.

We hope that this explains why we take the approach we do, and why our answers and our website in general do not claim as much as we would like or, in fact, could do based on our clinical
experience. Our strategy has always been, however, to encourage people to visit our members to find out what acupuncture can do for them as unique individuals rather than offering generic answers to individual problems. Judging by the feedback we receive this approach seems to have gone down well with a large proportion of the 2500 people to whom we have replied through this facility.

This is a very good question, for which we think there are some very good and, we hope, informative, answers.

The first and most important point to make is that since the Advertising Standards Authority's reach was extended to cover websites and internet marketing there are much stricter conditions about what people can claim in their advertising and marketing materials. In healthcare in particular any claims to cure, treat or help in the treatment of a problem now have to be backed up by evidence that this really is the case. By'evidence' the ASA has adopted a standard with which nearly every complementary therapy has disagreed and with which they have taken issue, the randomised double blind control trial. This really only works well for drug testing, not for therapies where the nature of the intervention develops as treatment progresses.

The BAcC, along with many other bodies, has been engaged in discussion with the ASA for the last five years about the unsuitability of this as a standard, and also about the choice of experts by the ASA to review evidence. The bottom line, though, according to this criterion is that only about four or five conditions meet the required standard, and a very uninteresting group they make too unless you happen to be looking for acupuncture treatment for dental pain. The vast majority of studies are not RCTs, nor would we want them to be; the acupuncture is often formulaic and restricted, and about as far removed from day to day practice as one can imagine.

However, these are the rules, and so when we are asked about named conditions we have to be very clear that the evidence from this perspective is not conclusive. We often use terms like 'encouraging' or 'promising' when the evidence is short of conclusive but fairly robust,  but as a regulatory body which has to require its members to comply with the law we cannot ourselves bend or break the rules. If there is no conclusive evidence in the ASA's terms then we cannot claim there is, even when we know that we have treated many cases of a problem successfully.

As far as named conditions themselves are concerned we have also been backed into a corner, partly because of the nature of our own marketing over the years. As we are at pains to say in nearly every response traditional acupuncture treats the person, not the condition. Although you will find an increasing number of books and internet articles about 'acupuncture for headaches' or 'acupuncture for stomach disorders' this is not how we view our work. To some extent it is possible to treat named conditions in themselves but from a traditional acupuncture perspective it is not as satisfying or ultimately as likely to succeed long term as treating the person, i.e. tailoring the treatment to the individual and their unique imbalances. In the circumstances it is with great caution that we would say 'acupuncture treats x or y or z';. There are going to be many prospective patients for whom this will not be the case because what seems like a simple problems sits atop a pattern of overall disorder which might take months or even years to sort out.

At the same time, as practitioners we have seen many thousands of patients over the years, and we have a fairly clear idea of the conditions which, whatever the state of an individual's health, do not seem to be too tractable to treatment. Some, like severe tinnitus, can endure through many courses of treatment of all kinds, as the magazines of the tinnitus support groups attest. It would be unhelpful and misleading for us to claim to treat such problems on the basis that acupuncture treats the person, not the condition, when we know that it is one of a number of problems which do not seem to respond well to any treatment. 

We take the view that as a mature profession we should be honest in assessing those problems which are more likely to be helped and those which aren't, and letting the prospective patient know this. We remember earlier times when the fact that acupuncture treated the person more than the disease led to some patients getting the very wrong end of the stick; treating a patient with cancer is not the same as treating cancer, but people will hear what they want to hear unless someone is very careful with their choice of words.

As a final point, we would probably not want to lay claim to the word 'science' for what we do. There are all sorts of definitions of scientificity, and under many of them we could probably make a case for traditional acupuncture as a science. We also, though, recognise that there is an art to what we do, skills based on experience and observation which are unique to each practitioner and which provide an infinite number of perspectives on groups of patients. We had this brought home most clearly when we were discussing National Professional Standards with doctors. For them a diagnosis was an accumulating paper or computer file which could travel from doctor to doctor without any change or modification. For us, diagnosis was an active process which depended on the individual practitioner, and evolved over time. Until we ironed out this major semantic difference there was great confusion.

We hope that this explains why we take the approach we do, and why our answers and our website in general do not claim as much as we would like or, in fact, could do based on our clinical
experience. Our strategy has always been, however, to encourage people to visit our members to find out what acupuncture can do for them as unique individuals rather than offering generic answers to individual problems. Judging by the feedback we receive this approach seems to have gone down well with a large proportion of the 2500 people to whom we have replied through this facility.

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