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Q:  Can acupuncture help treat ankylosing spondylitis and if so what treatment is required and which symptoms can it cure.  What is the likelihood of a successful cure and what is the likelihood of a relapse after treatment.

A : There isn't a great deal of research into the use of acupuncture for ankylosing spondylitis. There are many possible reasons for this, over and above the fact that in the west research into the use of acupuncture is very limited for want of funding. The most likely is that each presentation tends to be unique, and for the most common trial design, the randomised double blind control trial, it is essential to test like with like. The more variable the presentation, the less reliable the results are considered to be. There are more papers produced in China, most of which do not get translated, and a review published in 2016

suggests that most of these studies showed benefit, but needed to be followed up with larger and better designed trials.

From a Chinese medicine perspective where each presentation is addressed as unique, it is very difficult to say without seeing the patient what might be possible. If the inflammation is in the relatively early stages then interpreting the symptoms through the diagnostic categories of Chinese medicine might offer treatment options to reduce pain and reduce the inflammation. We have certainly heard anecdotal reports of people having their discomfort much improved, but it is very difficult to generalise from random cases. However, if the condition has progressed to the point where there is some fusion of the lower spine that will severely limit what may be achieved. Pain relief always remains an option, but the extent to which the pain can be reduced and how long the reduction can be maintained are not easy to predict.

As for the level of success and relapse that is impossible to say for much the same reason: each case is different. All that we can ask of our members is that they set measurable outcomes for patients so that there are real indicators of improvement, and regular review periods to ensure that treatment doesn't just carry on and on without looking at the value of continuing.

We are sorry that this is not as helpful as we are usually able to offer, but the condition is so variable that we would be remiss to offer someone false hope by being more positive than we can be.


Q. I see a sports therapist for help with aches and pains after regular gym exercise. He has also recently been carrying out accupuncture. My concern is I feel quite emotional a few hours after the session almost like a release of tension or something. Is this normal or should I mention it next time. I always sleep so much better and it helps alot with the back pain.

A. It sounds to us like the treatment is having a very beneficial effect, and yes, we do find that on occasion treatment for a specific problem can actually have a systemic effect. So, for example, treating someone for a bad back can release all sorts of blockages, some of which might be expressed in a release of 'contained' emotion. It is certainly something which any practitioner would value as feedback.

This is something of a live issue for us because of the greater use of acupuncture within a western medical context as a focused treatment for physical problems. We have made the case for many years that while we value the fact that people are getting the undoubted benefit, from our perspective any needle inserted into the body can affect body, mind and spirit. Our concern is that you can't know what you don't know so if someone treats on a musculo-skeletal basis they are not going to be aware of the possible emotional reactions this might stir up.

For us this would be valuable feedback, and our systems can interpret and work with reactions of any kind. A great deal of Chinese medicine thought uses rather general concepts like 'appropriateness' so when an emotion appears inappropriately or in inappropriate quantity it becomes diagnostically significant and helps us to restore balance in the whole system. We are all mainly trained in working with people to delve a little more deeply into what is going on, guided as we are by the belief that repressed emotions can manifest as muscular problems. If they are not properly addressed the body will simply manifest another similar problem until they are.

We always tread carefully, though, because we would not want to be seem to be staking out the territory and trying to stop people from using acupuncture in a more physical way. Many people derive huge benefit from such measures. What we would like to see is people referring patients on to us if they start eliciting reactions which they cannot explain, or at very least talk to the patient about the sorts of things that are coming up and directing them to someone who can help them.

That said, we have had many patients who experience these kinds of almost cathartic reactions to treatment without any background of problems not dealt with, and as long as the effect is short-lived and the overall problems seem to improve we don't make a big deal of it. Everyone is unique and special!

Q. Hi,

I wondered if there are any points that we should avoid using for a patient with rheumatoid arthritis for example points where there is a risk of entering the joint such as the eyes of the knee or shoulder?

Has acupuncture ever been known to trigger a reactive arthritis?

Also, should we be using anti-bacterial wipes prior to inserting the needle for someone with rheumatoid arthritis?

A. There are no contra-indications of which we are aware for the use of acupuncture in treating rheumatoid arthritis. Some traditions of acupuncture, strangely enough the modern medical versions, tend to use deeper insertion of the needle than many traditional acupuncturists would countenance, and we have found nothing on their safety forums to indicate that special care needs to be taken. The BAcC was involved with a group of several associations, including medical acupuncture bodies, to draw up safety guidelines some years ago, and this was never raised as an issue by anyone.

By the same token we have not been able to find any evidence to suggest that a reactive attack has happened as a consequence of treatment. This is a little more tricky, because as is often the case in these situations people are generally doing a great deal more just having acupuncture, so it may not have been picked up as valid causation. As we have said to colleagues many time absence of evidence is not evidence of absence. However, there have been recorded cases of which we are aware, and we do monitor adverse events carefully.

The issue of swabbing or cleaning points is a little more contentious. In the NHS there is a roughly 50/50 split between those who insist and those who don't. Our own advice to members, which we are happy to share is:

Where necessary, you should swab the skin with 70 per cent isopropyl alcohol with or without 0.5-2.0 per cent chlorhexidine. If the area of the skin to be needled is clean and free from dirt or organic matter (such as soil) then there is no requirement to swab the skin.

If areas of the body to be needled are dirty then they should be washed first with soap and water.
Swabbing is only indicated for patients who have a suppressed immune system through illness or medication and is not required in the fit and healthy.

The recommended agent to “sterilise” the needle area is 70% isopropyl alcohol usually in the form of a medi swab. Cotton wool balls soaked in alcohol solution are strongly discouraged as these can become heavily contaminated with hand and environmental bacteria. The use of 90 per cent isopropyl alcohol is unacceptable as it may preserve organisms and also because it evaporates too quickly to have an antiseptic effect. Other cleaning agents, if used, should also have adequate antiseptic properties and be safe on the skin. These preparations should contain 0.5-2.0 per cent chlorhexidine and should ideally be in an alcohol solution, as chlorhexidine is not completely effective against Pseudomonas, the main organism causing infection in the earlobe.

The misuse of swabs is very common and it is recommended that a fresh swab is used for each point. The swab should be in contact with the area to be needled for 30 seconds and allowed to dry for a further 30 seconds. It is recommended that you swab points in a way that touches the area only once so as not to re-contaminate the area and it is best to swab from one end of the area to another.

After an acupuncture point has been cleaned in this way, it must not be palpated unless it is cleaned again afterwards.

The arguments tend to focus on whether cleaning a needle site removes protective bacteria as well as killing potentially dangerous ones, so we have taken a fairly commonsense line and asked members to use professional judgement in dealing with patients who might be perceived to be slightly higher risk. Since most high risk conditions have a vast range of presentations we wanted to avoid over-reaction.

Q. Do you treat Mortons Neuroma?

A. We have certainly tried to treat Morton's Neuroma, and not always with success as a rather downbeat answer from last year indicates:

We have to be honest and say that there is not a great deal of evidence for the effective treatment of Morton's neuroma with acupuncture. We published an answer through this same section three years ago to a question from a patient who was convinced, and with some justification, that treatment with one of our colleagues has been wholly responsible for a complete improvement in his condition.

We have to say, though, that our clinical experience runs counter to this, which is why the very upbeat tone of webpages like that of this American practitioner

(informative as it is) raises a wry smile. If only..

Having said that, what he describes in the formation of the tissues which cause the condition is something with which we deal elsewhere on the body, and in theory there is no reason why treatment should not be able to reduce some of the discomfort. However, we would be very surprised if this could be done without the aid of orthotics which reduce some of the pressure on the affected areas while any treatment beds in.

Each case is unique and different, however, and the only real solution is to seek face to face advice from a BAcC member who can look at exactly how the problem manifests in you, and more importantly, can see the overall context in which it is occurring. One of the great strengths of Chinese medicine is that it looks at the whole system, not simply at a symptom which is regarded as merely a warning sign. Thousands of people with identical foot structures to you will walk thousands of miles without getting neuromas, and there may be systemic problems which have predisposed this to happen.

The other recommendation we would make, and we are sure that you have done this already, is to find a good chiropodist or podiatrist who can work alongside any other treatments you try to help to maintain improvements. Working in partnership with other health professionals for problems like yours can often be extremely powerful.

This still represents the best that we can say. We have looked at the research databases to see whether any further case studies have appeared, but the cupboard is remarkably bare.

There is an interesting case study about the use of therapeutic massage is useful for the background information, but nothing new involving acupuncture treatment.

However, we have since heard anecdotal accounts of people committing to lengthy spells of treatment which have seen significant changes, and when you consider that surgery is probably one of the few other options available, this may not be a bad thing to try.As always in cases where the evidence base is a little thin and where the stories of success are not that frequent we advise prospective patients to set or find measurable targets for change, and also to insist on regular review periods if they do go ahead. The measurable target is essential; problems like Morton's neuroma can lead to good days and bad days, and asking how things are on either won't really help to decide whether to carry on. Walking further and with less pain is something which is more difficult to argue about, and this really helps where changes can sometimes be too small to recognise day by day.Reviews are equally essential. Where there may be a long haul it is very easy to rack up a very large bill for treatment without realising it, and it always pays to know where you are, both in terms of progress and expense. As above, an initial informal chat with a local BAcC member is a great place to start.

We don't think that there is a great deal that we can add to this. Some cases respond well, others don't but we have never found anything with predictive value to see which is which before starting to treat. That is why we are very cautious, review regularly and make sure that a patient is happy to continue in the absence of immediate change. 'Treatment habit's can become expensive very quickly and don't play well when someone realises that nothing much has happened.

Q. Are Accupuncturists on Cruise Ships qualified?
Thompson/Marella have refused to divulge the qualifications of a Dr who carried out treatment in the Spa on the ship saying 'nothing to do with them'.

A. This is quite complex at the best of times, without adding a cruise ship to the mix. At the moment there is no statutory regulation of acupuncture, so in theory anyone can set up in practice. In reality, though, unless someone is a doctor or in certain parts of the country a statutorily regulated healthcare practitioner like a physio or osteopath, then you have to register or be licensed by a local authority under national skin piercing laws which are adopted and enforced locally. Most licensing and environmental health departments tend to check whether someone is properly trained and insured, although in only a few cases has it been made a legal requirement.

However, cruise ships operating outside territorial waters are not subject to the same laws or regulations, and a cruise operator can employ anyone they choose and decide for themselves whether someone is suitably qualified. Some BAcC members have done stints on Stena Sealink ships, and they have been subject to some fairly rigorous checks.

If the cruise line won't give any details, you can always try checking the register of the various professional bodies, like the BAcC, the British Medical Acupuncture Society, the Acupuncture Association of Chartered Physiotherapists, the Acupuncture Society, the Association of Traditional Chinese Medicine to see if he is a member. Membership always entails meeting qualifying standards. Alternatively you can just google search on his or her name and see what comes up. If you don't understand what you read you can always get in touch and we can tell you whether a qualification is reputable or not. Most are, but some aren't, being of the 'how much can you afford' variety.

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