Q:  Four years ago I had surgery for an abscess in my foot, which has left me with nerve damage. The pain has got worse recently with constant throbbing day and night in my big toe, so much so that sleeping has become a problem. I have been prescribed Gabapentin which did help with sleeping but I have had several side effects and I do not like the idea of being on medication permanently. I do take regular exercise. Do you think acupuncture would help?

A:  This is rather difficult to say. A great deal depends on what damage was actually caused during the operation, and more particularly why the pain has started to get worse four years after the event. There is quite a deal of evidence suggesting that nerves in the periphery can regenerate, and one would assume that after four years most of this has already taken place. If there is now continuing and increasing pain, it suggests that either a nerve ending has permanently severed and rather like phantom limb syndrome is sending out signals which cause considerable pain, or there is scar tissue from the operation which is now impinging on a nerve and generating pain. The latter would seem more likely on the basis that natural changes in the gait might be more likely to bring the scar tissue into increasing play, but this is speculation – the bottom line is that you have pain.

From a Chinese medicine perspective, pain results from changes in the flow of energy, either excess or weakness of flow, or more often blockages. The aim of treatment is to restore the proper flow in the simple but effective belief that improved flow means less pain. Interestingly there is evidence for the treatment of phantom limb syndrome, as we wrote recently

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google ‘acupuncture phantom limb pain’ you will find examples such as:

http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97

Hecker H. -U et al (2008) Color Atlas of Acupuncture 2nd Ed. Thieme, Stuttgart

Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142

Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112

Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213

Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in ‘conventional’ Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

and we have also written about scar tissue and its impact on health. There is little research to back this up, but many of us have had the clinical experience of using very simple treatments across scar lines to ‘join the dots’ as it were and often to great effect.

Since each particular instance of damage will be unique and different, though, the only really good answer we can give you is to visit a BAcC member local to you for a brief face to face assessment of what may be possible. What we would say, though, is that if your health is otherwise good, you would be well advised to limit the number of treatments you have initially to three or perhaps four. Our experience is that if something is amenable to change then there should be some signs quite rapidly. What we don’t like to see is patients buying into extended courses of treatment when there is really no evidence of change.

We should also mention that acupuncture can be used as a more general systemic agent of pain relief. Indeed, after Nixon’s visit to China in the 1970s and strange footage of people having operations without anaesthetic a great deal of research was done about the ability of needles to release the body’s own painkillers, enkephalins and endorphins. There is substantial evidence supporting this facility, and the question is how much relief and how sustainable. Unless the relief is very long lasting, though, or the pain so intractable that any relief is worthwhile, it may not be an economically viable option for most people if the improvements are only ever short term.

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