Dear Doctor: I have played tennis for many years, but have been unable to play over the last year, due to tennis elbow. Would acupuncture help?

Dear Reader: Lateral epicondylitis, or tennis elbow, is a tendon inflammation at the elbow. You don't have to play tennis to develop the condition, but the specific motion of hitting a ball with a tennis racket is, unfortunately, an effective way of doing so. There are many different types of treatment for tennis elbow, including anti-inflammatory medications, physical therapy, ultrasound, platelet-rich plasma injections and steroid injections.

As for acupuncture, a review of multiple studies published in the British Journal of Sports Medicine attempted to answer your question. One of the studies found significant pain relief with acupuncture compared with placebo. Overall, reduction of pain was 55.8 percent in the acupuncture group and 15 percent in the placebo group.

However, another study showed an immediate improvement of symptoms with acupuncture after two weeks, but no difference after two months compared to placebo. Lastly, a study comparing acupuncture to ultrasound therapy for tennis elbow found no difference between the two treatments.

Overall, the authors concluded that acupuncture was helpful for tennis elbow, but it did not have a sustained response, lasting only two to eight weeks.

A 2015 study combined results from six different studies. Two of the studies compared real acupuncture with sham acupuncture, which involves placing the needle in non-traditional acupuncture points at random. The authors found a benefit with standard acupuncture compared to sham acupuncture. Also, there were conflicting studies on whether acupuncture with electrical stimulation was beneficial or not.

One other review from 2002 showed that acupuncture for tennis elbow did have immediate benefit, but the authors could not conclude a long-term benefit.

Now, I have to acknowledge that I've been performing acupuncture for tennis elbow for the last 12 years and have seen that the treatment has been beneficial for the majority of patients. I have treated these patients with non-traditional acupuncture points at the tendon insertion of the elbow and have used electrical stimulation. I also add traditional acupuncture points. It is difficult for me to assess how much of the benefit is from the acupuncture, how much is from physical therapy and how much is just the tincture of time.

The studies do appear to show pain relief, but I feel that acupuncture should be combined with physical therapy. The bottom line: Acupuncture is one of many therapies that can help the pain of tennis elbow.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Can you give me some ideas on how to lose weight while using a wheelchair? I'm 66 and need a wheelchair to get around. When the distance is short enough, I use crutches. I'm on a tight budget, but try to work out as much as I can, with very little results. I'm getting depressed because nothing seems to work.

Dear Reader: One look at the multibillion-dollar weight-loss industry, and it's clear that staying fit is difficult for many of us. And while limited mobility certainly adds to the challenge, with creativity and determination, you can win this battle.

When you use a wheelchair, it's particularly important to get fit and to maintain a healthy weight. Even a few excess pounds can make it more difficult to get into and out of a wheelchair. In that same vein, you need your shoulders, arms and abs to remain strong so you can easily move into and out of the chair, and to prevent injury as you do so.

Let's start with what you eat. Focus on a diet made up of a variety of fresh fruits and vegetables, lean proteins, dairy products, healthy fats, legumes, whole grains and leafy greens. Limit added sugars, and cut out empty calories like sodas and processed snack foods. The key here is to adjust your diet to your level of physical activity.

One tool that really works (and takes a bit of courage to do honestly) is keeping a food diary. Even if just for one week, write down everything that passes your lips. The details will jolt you into awareness and, quite possibly, motivate you to make some changes.

As for exercise, the days of the sedentary wheelchair-user are over. There are several exercises you can do from your chair.

With a pair of hand weights, you can keep your biceps, triceps, pectorals and even your abs strong and toned. Resistance bands are another way to maintain strength and range of motion.

An exercise ball is an excellent workout tool. Hold it above your head and, as you engage your stomach muscles, slowly rotate from left to right and back again. Lift the ball above your head and slowly lower it, again engaging your abdominals. Hold the ball above your head, once again engaging your abs, and perform slight tilts to the points of the compass.

With all of these, the idea is to start slow and gradually build up repetitions. Stop if you feel any pain. And be sure to drink water and stay hydrated.

Is there a senior citizen center in your area? Many of them have exercise and yoga classes that can be adapted for someone using a wheelchair. Some even have sports teams that will make room for a rolling athlete.

A challenge for all of us as we get older is social isolation. A group activity can help you feel connected, which will raise your spirits and keep you motivated.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)

Dear Doctor: Which pain reliever is safer -- acetaminophen, ibuprofen, celecoxib or naproxen? It seems as if they all carry some risks.

Dear Reader: Pain is a symptom to which we can all relate. It's also an important indicator of possible injury within the body and should be acknowledged, not simply by taking medication, but also by understanding the cause of the pain. That said, one person's pain is different than another's, with some people needing greater pain relief.

So, if you need a medication for pain, what should you use? Let's look first at acetaminophen (Tylenol). Acetaminophen has been used since 1955; it is available in multiple products, works well for pain, and is for the most part safe. However, at high doses -- specifically, above 4,000 milligrams a day, or eight tablets of Extra Strength Tylenol -- the medication can cause liver damage, or even death, especially in those who are malnourished, drink alcohol in excess or consistently take more than 4,000 mg per day. Age is also a factor, as those over 40 have a greater risk of liver failure and death after over-dosage.

Ibuprofen (Advil, Motrin) has been used for pain since 1974. It is one of many medications classified as non-steroidal anti-inflammatory drugs (NSAID). NSAIDs work by inhibiting formation of mediators of pain and inflammation, and they're notably effective at decreasing inflammation in swollen joints related to arthritis.

Naproxen (Aleve) was first marketed in 1976 and works similarly to ibuprofen. But it has a longer half-life, giving it a longer-lasting effect. Both ibuprofen and naproxen decrease the formation of prostaglandins in the stomach. These chemicals produced by the body have hormonelike effects, protecting the stomach lining from acidity. The decrease of prostaglandins can injure the stomach lining, leading to stomach inflammation, ulcers and possibly severe bleeding.

Celecoxib (Celebrex) is a more selective NSAID and does not decrease prostaglandins in the stomach. This translates into significantly less likelihood of creating ulcerations.

All NSAIDs also reduce prostaglandins in the kidneys, which can lead to kidney injury. This injury becomes worse in people who have a history of chronic kidney disease, who are older, or who have congestive heart failure or cirrhosis.

Lastly, the chronic use of high-dose NSAIDs has been linked to an increased risk of heart attacks. Celecoxib may have a slightly greater risk of this than ibuprofen and naproxen, but a recent New England Journal of Medicine study looking at those who used NSAIDs chronically for arthritis found no difference in cardiovascular events between celecoxib and either ibuprofen or naproxen.

Of the drugs you listed, my feeling is that acetaminophen is the safest when used regularly. However, I would use acetaminophen at no higher doses than 4,000 mg per day and, if you were to use it regularly, I would recommend decreasing this amount to 2,000 to 3,000 mg per day.

The NSAIDs -- ibuprofen, naproxen and celecoxib -- are needed by some who have inflammatory arthritis, and they are good medications in the short-term. I would caution against consistent long-term use, especially at high doses and especially if you have any history of heart disease.

(Send your questions to askthedoctors@mednet.ucla.edu, or write: Ask the Doctors, c/o Media Relations, UCLA Health, 924 Westwood Blvd., Suite 350, Los Angeles, CA, 90095. Owing to the volume of mail, personal replies cannot be provided.)