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Bells Palsy can be a very frightening experience for people, as the symptoms mimic that of a stroke. Always go and see a medical doctor for a diagnosis first. Once you have your diagnosis, call your acupuncturist! Acupuncture can be very helpful and rapid for a persons recovery. The sooner you go for your first treatment, the faster it resolves and the better the longer term result. In the first week frequent visits are necessary. These are the spaced out depending on progress. Lets first describe what Bells Palsy is and then as always some of the science. Bells Palsy is a rapid, one sided weakness to paralysis of the face, that happens suddenly. It can then progressively worsen over the following 48 hours. It is a temporary condition. Generally, it is slow to heal taking 2 weeks, 1 month or even 6 months on average. The more severe it is the longer it takes to heal using a medicated approach. Occasionally it is permanent. The treatment is usually a course of steroids, prescribed by your GP or a hospital doctor. There is ample evidence to support it's effectiveness (1). The steroids have to be taken within days of the first symptoms occuring. Of course, the people we see as acupuncturists are generally those that it hasn't worked for. I would strongly suggest you consider using both concurrently, if you are taking perscribed steroids. There is no negative interaction between the two. Sometimes, the person simply does not want to take steroids because of their potential side effects. That is a discussion they have with their doctor first. The other people we see, are our clients that have been visiting our clinics regularly for different issues. Their faith in acupuncture is not blind faith, it is experiential with very positive results for them. Anti virals have not been found to be beneficial (2), even though a viral infection may be the cause of the Bells Palsy. Surgery that was used previously to relive pressure on the facial nerve is not recommended, because of the risks in having the surgery. The precise reason Bell's Palsy occurs isn't clear. It's often preceded by having a viral infection. There are at least 8 viruses that have been associated with Bells Palsy. There is also a list of other chronic health issues and traumas that can be associated with a person having Bells Palsy. Finally, there is thought to be a genetic component in some cases, where there is a family history and the person has repeated attacks. It's believed to be the result of swelling and inflammation of the nerve that controls the muscles on one side of your face. The facial nerve controls a complex array of functions, so when it is damaged, the symptoms can vary in type and severity. Signs are extensive and a person does not necessarily experience all of these. They can be very mild or severe Change in the ability to taste Difficulty speaking Dizziness Drooling Eye or mouth dryness Excessive watering in one eye Headache Hypersensitivity to sound Pain in the jaw or behind the ear Ringing in the ears Trouble eating or drinking There are various studies showing the effectiveness of acupuncture as a treatment for Bells Palsy. Some of them recommend, electroacupuncture (3), which involves a very mild electric current between needles, which is not a painful process. This study suggest it as an add on to medication and physio. I personally have found Distal Needling Acupuncture very effective for people. It does not necessitate any needles in the face or electric current. Distal simply means away from the problem area. I have used electro acupuncture in the past and observed many treatments using electroacupuncture. All were very effective. The enormous relief it brings to people is understandably pure joy or very emotional. There is a beauty in using two systems of medicine and the results of using both together, can improve a persons outcome dramatically (4). In some countries it is routine, to use the strengths of both Western Medicine and East Asian Medicine. Perhaps, if there wasn't a hierarchical view towards medicine, by some, there would be potential for a lot of money to be saved in healthcare, and enormous benefits to the taxpayer. A system where choice is accessible to everyone, would be very welcome by many people. Seek immediate medical help if you experience any type of paralysis because you may be having a stroke. Bell's palsy is not caused by a stroke, but it can cause similar symptoms. Written by Sinead Dee On the Pulse Clinics

Around 1 in 25 of the UK population has fibromyalgia, a lifelong condition involving widespread musculoskeletal pain and tenderness, fatigue, sleep disturbance, and functional impairment, without any known structural or inflammatory cause (Annemans 2008; Hauser 2008; De Silva 2010; Burckhardt 1994). In fibromyalgia, abnormalities in central pain-processing and the release of neurotransmitters including serotonin and noradrenaline lead to lower pain thresholds (Holman 2005; Clauw 2008). Predisposing factors for the condition include female gender, anxiety, trauma and viral infection (Clauw 2009). American College of Rheumatology diagnostic criteria for fibromyalgia are widespread pain lasting at least 3 months, affecting both sides of the body, above and below the waist; plus pain at 11 or more of 18 designated possible tender points, when 4kg/cm2 force is exerted at each point Wolfe 1990). In a recent study researchers have found that acupuncture can reduce pain, improve sleep and generally boosts health for sufferers of fibromyalgia. To read this study of fibromyalgia press here Acupuncture may help relieve pain in patients with fibromyalgia by: altering the brain’s chemistry, increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009; Cheng 2009), and reducing serotonin levels (Zhou 2008); evoking short-term increases in mu -opioid receptors binding potential, in multiple pain and sensory processing regions of the brain (Harris 2009); stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008); 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.

Neck pain is one of the three most frequently reported complaints of the musculoskeletal system. Twenty-six to 71% of the adult population can recall experiencing an episode of neck pain or stiffness in their lifetime. Neck pain is usually a benign and self-limited condition, but can be disabling to varying degrees. As such, it has a large impact on healthcare expenditure, due to visits to healthcare professionals, and sick leave, disability and the related loss of productivity.(Trinh 2010) Neck pain can be associated with symptoms that radiate to the arms or head, and may involve one or several neurovascular and musculoskeletal structures such as nerves, nerve roots, intervertebral joints, discs, bones, muscle and ligaments. Acupuncture can help relieve neck pain by: stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008); 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.

Up to half a million people in the UK experience work-related stress every year, which often results in illness.(Health and Safety Executive 2011) Other factors that affect stress levels include alcohol, smoking, exams, pregnancy, divorce, moving, death in family, lifestyle, drugs, poor nutrition and unemployment. The signs of stress can vary from one individual to the next.(NHS Choices 2011) They may manifest physically as an illness, tiredness or lethargy, or as symptoms such as sore, tight muscles, dull skin, lank hair, or erratic sleep patterns. Mental stress can result in depression, mood swings, anger, frustration, confusion, paranoid behaviour, jealousy or withdrawal. 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 benefit anxiety disorders and symptoms of anxiety 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); Improving stress induced memory impairment and an increasing AchE reactivity in the hippocampus (Kim 2011); Reducing serum levels of corticosterone and the number of tyrosine hydroxylase-immunoreactive cells (Park 2010); Regulating levels of neurotransmitters (or their modulators) and hormones such as serotonin, noradrenaline, dopamine, GABA, neuropeptide Y and ACTH; hence altering the brain’s mood chemistry to help to combat negative affective states (Lee 2009; Cheng 2009; Zhou 2008); Stimulating production of endogenous opioids that affect the autonomic nervous system (Arranz 2007). Stress activates the sympathetic nervous system, while acupuncture can activate the opposing parasympathetic nervous system, which initiates the relaxation response; Reversing pathological changes in levels of inflammatory cytokines that are associated with stress reactions (Arranz 2007); Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007, Zijlstra 2003); Reversing stress-induced changes in behaviour and biochemistry (Kim 2009).

Sports injuries are common, and vary from minor toe injuries to major complex trauma. Usually, only soft tissue is damaged, but there can also be fracturing of bone. Soft tissue injuries include sprains, strains and bruising. A sprain is a partial or complete rupture of a ligament, a strain is a partial tear of muscles and a bruise is a rupture of tissue leading to a haematoma. Any soft-tissue injury can lead to a tenderness, swelling, haematoma, scarring, fibrosis and loss of function. How acupuncture can help: acupuncture reduced pain in patients with plantar fasciitis (Zhang 2001); electroacupuncture had better therapeutic effects than medication, both in the short and long term, in patients with acute lumbar strain (Yao-chi 2007); acupuncture plus warmed needle relieved the pain of chondromalacia patella (Qui 2006); acupuncture reduced NSAID intake and relieved pain in patients with shin splints (Callison 2002); acupuncture reduced the pain of patellofemoral pain syndromes (Jensen 1999); acupuncture was effective for soft tissue disease (Yuan 1989).

Sciatica, more accurately termed lumbar radiculopathy, is a syndrome involving nerve root impingement and/or inflammation that has progressed enough to cause neurological symptoms (e.g. pain, numbness, paraesthesia) in the areas that are supplied by the affected nerve root(s) (Tarulli 2007). Posterior sciatica involves pain that radiates along the posterior thigh and the posterolateral aspect of the leg, and is due to an S1 or L5 radiculopathy. Acupuncture can help relieve back pain and sciatica by: stimulating nerves located in muscles and other tissues, which leads to release of endorphins and other neurohumoral factors, and changes the processing of pain in the brain and spinal cord (Pomeranz 1987, Zhao 2008). 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. causing a transient change in sciatic nerve blood flow, including circulation to the cauda equine and nerve root. This response is eliminated or attenuated by administration of atropine, indicating that it occurs mainly via cholinergic nerves (Inoue 2008). influencing the neurotrophic factor signalling system, which is important in neuropathic pain (Dong 2006). increasing levels of serotonin and noradrenaline, which can help reduce pain and speed nerve repair (Wang 2005). improving the conductive parameters of the sciatic nerve (Zhang 2005). promoting regeneration of the sciatic nerve (La 2005)

Overt hypothyroidism is diagnosed by a serum thyroid-stimulating hormone (TSH) concentration above the normal reference range and a serum free thyroxine (FT4) concentration below the reference range (BTA 2006). Clinical features may be absent or present. Subclinical hypothyroidism is diagnosed by a TSH concentration above the reference range with an FT4 concentration within the reference range (BTA 2006). Clinical features are usually absent. In the UK, hypothyroidism is usually due to autoimmune hypothyroidism or thyroid damage after surgery or radioactive iodine therapy.(Wheetman 2003). It may be associated with a goitre (Hashimoto’s thyroiditis) or without (atrophic thyroiditis or primary myxoedema). The prevalence of overt hypothyroidism is 1.9% in women and 0.1% in men (Tunbridge 977), and of subclinical hypothyroidism is about 8% in women and 3% in men in the UK.(Vanderpump 1995). The most common symptoms are tiredness, weight gain, constipation, aches, dry skin, lifeless hair and feeling cold. Hypothyroidism is treated with levothyroxine. Research has shown that acupuncture treatment may specifically help in thyroid disease by: Increasing free thyroxine (FT4) and free tri-iodothyronine (FT3) levels in hypothyroidism (Xia 2012; Hao 2009; Hu 1993); Decreasing serum tri-iodothyronine (TT3), total thyroxine (TT4), free T3 (FT3) and free T4 (FT4) levels and increasing supersensitive thyrotropin (S-TSH) levels in hyperthyroidism (Li 2006); 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); Improving muscle stiffness and joint mobility by increasing local microcirculation (Komori 2009), which aids dispersal of swelling; Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007)

Tennis elbow (lateral epicondylitis) is characterised by pain and tenderness over the lateral epicondyle of the humerus. In the UK, the annual incidence of lateral elbow pain in general practice is around 4/1000 to 7/1000 people.(Hamilton 1986) It is most common in people aged between 40 and 50 years (Allander 1974); for example, the incidence is as much as 10% in women aged 42 to 46 years.(Chard 1989; Verhaar 1994) Tennis elbow is considered an overload injury, and it typically occurs after minor trauma of the extensor muscles of the forearm; tennis is a direct cause in only 5% of people with the condition.(Murtagh 1988). It is primarily a type of tendonitis though the muscles and bones of the epicondyle joint may also be involved. Pain can also occur on the inner side of the elbow, which is known as golfer’s elbow. Although generally self-limiting, symptoms of tennis elbow can persist for 1.5 to 2 years or even longer in a minority of people.(Hudak 1996) The aims of conventional medical interventions are to relieve pain, control inflammation and accelerate repair in order to improve function. Treatments include corticosteroid injections, topical and oral NSAIDs, other analgesics, exercises, ultrasound, orthoses and surgery. Acupuncture may help relieve symptoms of tennis elbow, such as pain and inflammation 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); delivering analgesia via alpha-adrenoceptor mechanisms (Koo 2008); 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.

Clinical trials evaluating acupuncture for osteoarthritis of the knee constitute some of the highest quality evidence available regarding acupuncture for any condition. As a consequence, researchers can be more certain in their conclusions. On the basis of the findings of the studies reviewed, acupuncture should be considered a viable adjunct or alternative treatment of knee pain and dysfunction associated with osteoarthritis of the knee for the thousands of individuals across the country who are suffering from symptoms of this chronic disease.

In the UK, the prevalence of substance misuse is around 9 per 1,000 of the population aged 15-64 years, and around 3 per 1,000 inject drugs, in most cases opioids (NICE 2007). In 2005/6, around 181,000 people were using drug treatment services in England and Wales (Commission for Healthcare Audit and Inspection 2006). Also, research in England in 2005 estimated that 7.1 million people, or 23% of the adult population, could be categorised as hazardous or harmful alcohol users (Drummond 2005). Indeed, in England, 150,000 hospital admissions annually result from acute or chronic alcohol use, and alcohol use is implicated in 33,000 deaths each year (Academy of Medical Sciences 2004). Dependence on drugs is a cluster of physiological, behavioural, and cognitive phenomena in which the use of a substance takes on a much higher priority for a given individual than other behaviours that once had a greater value (WHO 2007). Drugs of abuse include cannabis, opioids (opiates), CNS stimulants (cocaine, crack, amphetamines, ecstasy, crack), CNS depressants (barbiturates, benzodiazepines, alcohol), hallucinogens (LSD, psilocybin), and volatile substances (glues, gases, aerosols) (DTB 1997). Opioid misuse and dependence are associated with a wide range of problems, such as overdose; infection with HIV, hepatitis B or hepatitis C; thrombosis; anaemia; poor nutrition; dental disease; criminal behaviour; relationship breakdown; lost productivity; unemployment; imprisonment; social exclusion; and prostitution, as well as withdrawal symptoms (Prodigy 2006; Gowing 2006; National Treatment Agency for Substance Misuse 2006). Problems associated with excessive alcohol use include hypertension, accidental injury, hand tremors, duodenal ulcers, gastrointestinal bleeding, cognitive impairments, anxiety and depression (Saunders 1990). The development of alcohol dependence appears to involve changes in brain neurotransmission (Littleton 1994; Tsai 1995). Acupuncture is used extensively, and worldwide, in substance misuse treatment centres. This stems from the development of a simple 5-point auricular acupuncture protocol at New York’s Lincoln Hospital in the 1970’s, originally for drug users but subsequently extended to tobacco, alcohol and other addictive substances and behaviours. The protocol was designed to operate within Western health settings and mutual peer support systems, not as an isolated treatment. 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 and worry (Wu 1999). Acupuncture may help relieve symptoms of drug withdrawal by: normalising the release of dopamine in the mesolimbic system. This reduces the over-stimulating effects of abused drugs and modifies behaviours associated with addiction such as those around desire and reward. Several brain neurotransmitter systems, for example serotonin, opioid and GABA, are implicated in this (Lee 2009a, Yang 2008, Zhao 2006) reducing anxiety (Samuels 2008). Acupuncture can alter the brain’s mood chemistry, reducing serotonin levels (Zhou 2008) and increasing endorphins (Han 2004) and neuropeptide Y levels (Lee 2009b; Cheng 2009); modulating postsynaptic neuronal activity in the nucleus accumbens and the striatum to reduce nicotine addiction (Chae 2004) and increasing corticotrophin-releasing factor to attenuate anxiety-like behaviour following nicotine withdrawal (Chae 2008)

Stroke is defined as a neurological deficit of sudden onset which results from cerebrovascular disease and persists for longer than 24 hours (DTB 1998). Stroke is very common, with, for example, around 110,000 people each year in England alone experiencing a first or recurrent episode (DH 2007). Consequences of stroke can include disability and early death, and the condition costs the UK economy around £7billion annually (NICE 2008). There have been a large number of systematic reviews and randomised controlled trials looking at the effects of acupuncture in the management of acute stroke and for poststroke rehabilitation. Many of these have been conducted in China and are published in Chinese journals (stroke is the most prevalent condition treated with acupuncture for in-patients at Chinese hospitals). In fact most of the individual systematic reviews have found acupuncture to be superior to conventional treatments, or to provide added value to them. There have been numerous physiological studies on acupuncture and stroke, examples from the last three years are presented in the table below. They indicate multiple possible mechanisms by which acupuncture treatment may help in the management of stroke: Harnessing the anti-inflammatory effects of acetylcholine receptor activation (Wang 2012); Protecting the brain from ischaemic injury by increasing cerebral blood flow (Zhou 2011, Du 2011); Alleviating cerebral oedema after cerebral ischaemia (Zhang 2011b); Preventing the impairment of cortical GABAergic neurons (Zhang 2011c); Regulating differential expression of multiple serum proteins involved in stroke, and enhancing muscle strength recovery (Pan 2011); increasing production of glyco-metabolic enzymes and hence improving post-stroke cognition (Zhao 2011); Improving motor cortical excitability, and facilitating motor function recovery after focal cerebral ischaemic injury (Lin 2010); Restoring the expression of Na(v)1.1 and Na(v)1.6 (sodium channel sub-unit genes that are down-regulated in cerebral ischaemia) thus reducing infarction volume and decreasing stroke damage (Ren 2010); Up-regulating bcl-2 , hence reducing the expression of caspase-3, one of the enzymes involved in programmed cell death in stroke (Chen 2009); Promoting neuroprotective effects against focal cerebral ischaemia (Kang 2010); Modulating brain glutamate release (excessive glutamate in the ischaemic zone is neuro-toxic) (Lee 2010); Increasing the production of endocannabinoid 2-arachidonylglycerol and N-arach-idonoylethanolamine-anandamide, which elicits protective effects against transient cerebral ischaemia through CB1 receptors (Wang 2009); 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); Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Kavoussi 2007). References

Research into acupuncture as a medical treatment has grown exponentially in the past 20 years, increasing at twice the rate of research into conventional biomedicine. Over this period, there have been over 13,000 studies conducted in 60 countries, including hundreds of meta-analyses summarizing the results of thousands of human and animal studies.1 A wide-variety of clinical areas have been studied, including pain, cancer, pregnancy, stroke, mood disorders, sleep disorders and inflammation, to name a few. Evidence Based Acupuncture have created a portal which summarises the most recent studies ranging from random controlled trials to systematic reviews. This can be seen here or on our website www.theacuhub.org . If you have any queries contact Sharon Martin @the_acu_hub or theacuhub@gmail.com .