A Question Of Health

Will acupuncture help me? Why can't I buy melatonin?

JOINT PAIN

Q. I have had a frozen shoulder since April 2005. It is now not as painful as it was, and exercise has increased its mobility, but there is still a long way to go to regain the movement that I need. Would acupuncture help?

A. Frozen shoulders are mysterious. They sometimes appear for no apparent reason, although they often follow what seems at first to be a relatively minor strain or injury. A typical victim is a woman between the ages of 40 and 65. Men can get frozen shoulders too, although less commonly. The shoulder usually goes through three stages: "freezing", being "frozen", and then "thawing". The freezing stage begins with pain, and the movements of the shoulder joint become progressively more difficult. When the shoulder is frozen, the pain sometimes begins to lessen, but movement is very restricted. As thawing begins, movement becomes easier and eventually returns to normal or near normal. The whole process can last for two years or more. Even without treatment, it usually gets much better. But quite a few frozen shoulders never fully recover.

If there was one excellent treatment for frozen shoulders, everyone would know about it. Unfortunately, there are lots of treatments, none of which is terrific. Exercises to gradually increase the range of movement help. Anti-inflammatory painkillers make movement easier by reducing pain. You should use pain as your guide to how much movement you should attempt. If it hurts too much, don't do it. Some doctors will advise steroid injections into the joint, and there is evidence that these injections make things better more quickly, although they are not a magical cure. What about acupuncture? We simply do not know if it works for frozen shoulder. It may relieve pain for a short while, but it certainly is not the whole answer for everyone who has a frozen shoulder.

INSOMNIA 'CURE'

Q. I find that melatonin helps with insomnia. Why is not sold here?

A. Melatonin is not sold in the UK because the Medicines Control Agency (now called the Medicines and Healthcare products Regulatory Agency - the MHRA) banned it from general sale in the UK in 1995 on the grounds that it was a medicinal product.

Because it does not have a licence for sale as a medicine, it is not available in pharmacies. Because it is considered to be a medicine, it is not available in "health food" shops. It is not a sleeping pill, but it does have an effect on the body's circadian "day-night" rhythm. If you don't mix melatonin with medicines for epilepsy, or warfarin, it seems to be safe and free of serious side effects.

Readers write

SG writes about tea-tree oil as a treatment for fungal nail infections:

"The chiropodist told my husband that there was little hope of saving his fungus-infested toenails, but suggested we try tea-tree oil. After just a month of daily applications of the pure oil, new unaffected nails started to grow in. After six months even the horrible black ones had grown out. I tried the oil on my chronic athlete's foot, and that, too, cleared."

Please send your questions and suggestions to A Question of Health, 'The Independent', Independent House, 191 Marsh Wall, London E14 9RS; fax 020-7005 2182 or e-mail to health@independent.co.uk. Dr Kavalier regrets that he is unable to respond personally