Gravesend Clinic

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Unit 3, 128 Milton Road, Milton Road Business Park, Gravesend, Kent, DA12 2PG

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Monday – Saturday: 9am – 8pm
Sunday: 9am – 5pm
Kindly note that each practitioner has their own timetable of working hours.

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Fascial Pain

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Learn more about Facial Pain here

Facial pain commonly results from temporomandibular joint (TMJ) disorder. Many practitioners refer to TMJ disorder, or syndrome, as a single disorder but there are various sub-diagnoses (e.g. myofascial pain, temporomandibular joint inflammation). The disorder is common and most often occurs in people aged between 20 and 40 years (NICE 2009). Around 33% of the population has at least one temperomandibular symptom and 3.6% to 7% of the population has TMJ disorder with sufficient severity to cause them to seek treatment (Wright 2009).

TMJ disorder is an umbrella term covering acute or chronic pain, especially in the muscles of mastication, or inflammation of the temporomandibular joint (Zakrzewska 2007). The temporomandibular joint is susceptible to many of the conditions that affect other joints in the body, including ankylosis, arthritis, trauma, dislocations, developmental anomalies, neoplasia and reactive lesions. Symptoms usually involve more than one of the numerous TMJ components: muscles, nerves, tendons, ligaments, bones, connective tissue, and the teeth. Symptoms can include difficulty in biting or chewing, jaw pain or tenderness of the jaw, clicking, popping, or grating sound when opening or closing the mouth, reduced ability to open or close the mouth, a dull, aching pain in the face, dizziness, headache or migraine (particularly in the morning), neck and shoulder pain, blinking, ear pain, hearing loss and tinnitus.

Treatment of a patient with chronic facial pain includes analgesics, NSAIDs, an occlusal splint (bite guard), cognitive behavioural therapy, physiotherapy and surgery (Al-Jundi 2008).

Paul Blacker Acupuncture for Chronic Pain

Chronic Pain

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Chronic Pain

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Persistent (chronic) pain is a widespread problem that affects around 8 million people of all ages in the UK (Chronic Pain Policy 2010). In 22% of cases, chronic pain leads to depression, and some 25% of those diagnosed with chronic pain go on to lose their jobs (Chronic Pain Policy 2010). In fact, around £3.8 billion a year is spent on incapacity benefit payments to those diagnosed with chronic pain (Chronic Pain Policy 2010).

The International Association for the Study of Pain has defined pain “as an unpleasant sensory or emotional experience resulting from actual or potential tissue damage…”. Chronic pain may be defined as pain that lasts beyond the usual course of the acute disease or expected time of healing, and it may continue indefinitely.

Typical chronic pain conditions include: osteoarthritis; rheumatoid arthritis; low back, shoulder and neck pain; headache and migraine; cancer pain; fibromyalgia; neuropathic pain (e.g. sciatica, trigeminal neuralgia, post herpetic neuralgia); chronic overuse conditions (e.g. tendonitis); and chronic visceral pain (e.g. irritable bowel syndrome, interstitial cystitis, endometriosis) (Singh 2010).


How acupuncture can help

An early systematic review of acupuncture for chronic pain found very limited evidence to support it (Ezzo 2000), but numerous large, well conducted studies in the last 10 years have substantially changed the picture. Recent reviews have shown that it is more effective than no treatment or usual care for chronic back pain, osteoarthritis, or headache (Sherman 2009). There is also evidence that it is more effective than sham acupuncture for chronic knee pain or headache and, at least in the short term, for chronic back pain (Hopton 2010). Other conditions have been less well researched.

For more details of specific research on chronic pain conditions see our other Factsheets: Acupuncture and Back Pain; Acupuncture and Endometriosis; Acupuncture and Frozen Shoulder; Acupuncture and IBS; Acupuncture and GI Tract; Acupuncture and Migraine; Acupuncture and Headache; Acupuncture and Sciatica; Acupuncture and Fibromyalgia; Acupuncture and Osteoarthritis; Acupuncture and Rheumatoid Arthritis; Acupuncture and Dysmenorrhoea; Acupuncture and Neck Pain. There is also evidence from randomised controlled trials and systematic reviews that suggests acupuncture may reduce chronic pain in myofascial syndrome (Shen 2009), chronic shoulder problems (Lathia 2009), chronic prostatitis/chronic pelvic pain syndrome (Lee 2009) and tennis elbow (Trihn 2004). There is preliminary evidence for ear acupuncture in cancer pain (Lee 2005).

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety (Wu 1999).


Acupuncture may help relieve chronic pain by:

  • Stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (e.g. neuropeptide Y, serotonin), and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Han 2004, Zhao 2008, Zhou 2008, Lee 2009, Cheng 2009);
  • Stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors (e.g. neuropeptide Y, serotonin), and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Han 2004, Zhao 2008, Zhou 2008, Lee 2009, Cheng 2009);
  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);
  • Modulating the limbic-paralimbic-neocortical network (Hui 2009);
  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003);
  • Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling.

References

  1. Chronic Pain Policy Coalition, 2010. About chronic pain [online]. Available:
  2. http://www.policyconnect.org.uk/cppc/about-chronic-pain
  3. 2010 [online]. Available: http://emedicine.medscape.com/article/310834-overview

 

Paul Blacker Acupuncture for Carpal Tunnel

Carpal Tunnel

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Carpal tunnel syndrome

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Carpal tunnel syndrome comprises potentially disabling sensory and/or motor symptoms in the hand. Around 1 in 10 people develop carpal tunnel syndrome at some point, and it is particularly common in women (Hughes 2007), with one study in the UK indicating an incidence of 139.4 cases per 100,000 women per year and 67.2 cases per 100,000 men (Bland 2003). The condition carries considerable implications for employment and healthcare costs (Bland 2007).

The symptoms of carpal tunnel syndrome are caused by compression of the median nerve in the carpal tunnel at the wrist and include numbness, tingling, and burning sensations, and a dull ache in the hand and fingers (Hughes 2009). These symptoms are usually restricted to the thumb, index, middle and ring fingers, but may affect the little finger and/or the palm as well (Stevens 2005). They usually occur at night, often waking the patient from sleep, but can be relieved within a few minutes by shaking the hand (Stevens 2005). Pain sometimes radiates up the forearm as far as the elbow, and even as high as the shoulder or root of the neck (Stevens 2005). Other, less common, symptoms include weakness or clumsiness of the hand, and dry skin, swelling or colour changes in the hand (Bland 2007). Symptoms may recur during the day when the hands are used for carrying things, and for activities that involve holding them up, such as driving or using a keyboard (Stevens 2005).

Predisposing factors include genetic predisposition (Hakim 2002), diabetes mellitus, pregnancy, obesity, myxoedema, acromegaly, and infiltration of the flexor retinaculum in primary and hereditary amyloidosis (Stevens 2005). Carpal tunnel syndrome may also develop as a consequence of wrist joint involvement in rheumatoid arthritis or osteoarthritis, or deformity related to an old fracture (Stevens 2005). Whether overuse of the hands is a cause of the syndrome is not clear, although most patients report that symptoms are aggravated by heavy use of the hands (Bland 2007). Current standard treatment options are splinting, local corticosteroid injections and surgery.


How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in the management of carpal tunnel syndrome. There are also factsheets on neuropathic pain, osteoarthritis and rheumatoid arthritis.

There has been one systematic review, which demonstrated that the evidence for acupuncture as a symptomatic therapy for carpal tunnel syndrome is encouraging but not convincing (Sim 2011).

In addition there are a few randomised controlled trials (RCTs) published since this systematic review. All were for mild-to-moderate carpal tunnel syndrome. Two compared acupuncture with sham acupuncture. In both cases acupuncture produced improvement over baseline levels but in one the real version was superior to the sham (Saeidi 2012) and in the other it was not (Yao 2012). Such contradictory results are common in sham acupuncture trials, for ‘sham’ interventions are not inert placebos, hence potentially underestimating the effect of ‘real’ acupuncture and making interpretation of the results difficult (Lundeberg 2011). In another two RCTs acupuncture was compared with orthodox treatments, either steroids (Yang 2009 and 2011) or splinting (Kumnerddee 2010). It was found to be at least as effective as these, and in some circumstances superior.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being.


Research has shown that acupuncture treatment may specifically help in the management of carpal tunnel syndrome by:

  • Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
  • Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010);
  • Regulating the limbic network of the brain, including the hypothalamus and amygdala (Napadow 2007a);
  • Inducing beneficial cortical plasticity (i.e. conditioning the brain to stop processing sensory nerve input from the affected fingers maladaptively, which leads to improved symptoms) (Napadow 2007b).
  • Lundeberg T et al. Is Placebo Acupuncture What It is Intended to Be? Evid Based Complement Alternat Med. 2011; 2011: 932407

References

  1. Bland JDP, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991–2001. J Neurol Neurosurg Psychiatry 2003; 74: 1674–9.
  2. Bland JDP. Carpal tunnel syndrome. BMJ 2007; 335: 343–6.
  3. Hakim AJ et al. The genetic contribution to carpal tunnel syndrome in women: a twin study. Arthritis Rheum 2002; 47: 275–9.
  4. Hughes RAC et al. Peripheral nerve disorders. In: Candelise L et al (Eds). Evidence-based neurology. Management of neurological disorders. London; BMJ Books, 2007.
  5. Hughes RAC, Thomas PK. Diseases of the peripheral nerves. In: Warrell DA et al (Eds). Oxford textbook of medicine. London: Oxford University Press, 2009.
  6. Stevens JC. Median neuropathy. In: Dyck PJ, Thomas PK (Eds). Peripheral neuropathy. Philadelphia: Saunders, 2005.

 

Paul Blacker Acupuncture for Bells Palsy

Bells Palsy

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Bells Palsy

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Each year in the UK, around 1 in 5,000 people develop Bell’s palsy, which is characterised by unilateral facial weakness of rapid onset (Rowlands 2002,Holland 2004). The condition can develop at any age, but seems to be most common in those aged between 15 and 60 years (Peitersen 1982).

In about 71% of patients, it resolves spontaneously without treatment, but 13% are left with slight facial weakness and 16% with moderate to severe weakness that results in major facial dysfunction and disfigurement (Peitersen 1982, Peitersen 2002, Ikeda 2005). Bell’s palsy is due to inflammation of the facial nerve in the internal auditory canal, but the cause of the inflammation is unknown (Adour 1972, Gacek 2002). The condition results in an isolated unilateral lower motor neurone palsy, with impairment of all facial movements on the affected side, including blinking. Conventional medical treatment includes eye protection, drugs (i.e. corticosteroids, antivirals), surgery and physiotherapy.


How acupuncture can help you

Clinical trials suggest that acupuncture is at least as effective as corticosteroids and may improve recovery in patients with Bell’s palsy, either used alone or in combination with drug treatment (Tong 2009; Li 2004).

Note though that most of the trials to date have been of poor quality which allows only tentative conclusions to be reached (Chen 2010).


Acupuncture may help in the treatment of Bell’s palsy by:

  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kim 2008, Kavoussi 2007, Zijstra 2003);
  • Enhancing local microcirculation, by increasing the diameter and blood flow velocity of peripheral arterioles (Komori 2009);
  • Nerve and muscular stimulation (Cheng 2009).

References

  1. Rowlands S et al. The epidemiology and treatment of Bell’s palsy in the UK. Eur J Neurol 2002; 9: 63-7.
  2. Holland NJ, Weiner GM. Recent developments in Bell’s palsy. BMJ 2004; 329: 553-7.
  3. Peitersen E. The natural history of Bell’s palsy. Am J Otol 1982; 4: 107-11.
  4. Peitersen E. Bell’s palsy: the spontaneous course of 2,500 peripheral facial nerve palsies of different etiologies. Acta Otolaryngol Suppl 2002; 549: 4-30.
  5. Ikeda M et al. Clinical factors that influence the prognosis of facial nerve paralysis and the magnitudes of influence. Laryngoscope 2005; 115: 855-60.
  6. Adour KK et al. Prednisone treatment for idiopathic facial paralysis (Bell’s palsy). N Eng J Med 1972; 287: 1268-72.