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Q: ] I have been diagnosed with Spondylolisthesis (slipped disc).  I have spent  approximately £600 on chiropracty and podiatry and  would like to know if acupuncture would be effective. 

A:  We are always a little reluctant to make claims for the potential success of acupuncture treatment when there has been structural change in the body that is unlikely to reverse. In some cases, for example, the use of acupuncture treatment to strengthen muscles which then cause someone's posture to revert to its normal position is well-documented, and many practitioners work alongside osteopaths to off a two-pronged approach to treatment. If the spondylolisthesis you have involves a relatively short forward displacement, there may be some possibility that this may be of considerable benefit. In this case, however, we would usually be guided by the osteopath's view of what is happening; they are, after all, the experts in bone and structure.

Conventional treatment is generally about pain management through anti-inflammatories, steroids and some physiotherapy. Acupuncture treatment has a long history of being used for chronic pain; indeed, this is one of the more frequently researched areas, mainly because the markers of pain and pain relief in body chemistry are easily measured and mean that research can be quantified easily. Our factsheet on chronic pain

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

is generally pretty upbeat about what can be achieved. In clinical practice most of us do not find the reduction of pain difficult to achieve. What really matters is the extent to which the pain is relieved and how sustainable the relief is. In the end it may come down to a financial equation - if someone needs weekly treatment almost indefinitely but as a result can function nearly normally, that hay be the equation they have to deal with. We know that some practitioners are not happy to work indefinitely without making long-term improvements, but occasionally treatment can be about stability or ever getting worse slower, so if a patient is happy to be kept going in this way, so be it.

Since each case of a condition like this is likely to be unique, we think that the only realistic advice is to visit a BAcC practitioner near and ask for a brief face to face assessment of what they think they might be able to achieve. Most practitioners review progress after the first four or five sessions when dealing with chronic conditions, and if there is no improvement consider the benefit of continuing while the bill has only reached the £200 mark. If the practitioner can sense changes in some of the diagnostic signs which make them believe that change is on the way, then the patient can make an informed decision about whether to continue rather than simply run up a large treatment bill without tangible results.

Q: I went for accupunture treatment for vertigo and had  8 sessions. I developed pain in my lower abdomen and  pain while urinating.  Could it be a result of accupunture, or just a coincidence?

A:Our first reaction is that this is probably a coincidence, but it never pays to be over-assertive without a great deal of information to go on. Much would depend on where the needles were inserted and what kind of manipulation was applied to them. There are no standard treatments for vertigo, and the phrase we frequently use, that we treat the person not the condition, could mean that the needles were applied anywhere depending on your overall balance.

What we can say with certainty, however, is that adverse events after acupuncture are rare, and where these do happen, the vast majority are minor and transient, i.e. only lasting a day or two at most and generally speaking things like a mild headache or feeling slightly unwell. Longer term problems are extremely unusual, and would have to involve physical damage to body tissues. For this to happen it would probably mean being very conscious of the injury as it happened. UK practitioners all use pre-sterilised one-use disposable needles and are thoroughly trained in safe needling, so the chances of infection from the needling are very small.

Whatever the cause, however, it is important that you seek treatment with your GP promptly. Although these are not in themselves what we would call 'red flag' symptoms requiring urgent medical attention, the pain in the lower abdomen and painful urination suggest a possible infection or mild inflammation. This needs to be checked so that appropriate treatment can be arranged. If there is any suggestion that the treatment may have been responsible this can be followed up later.

Q:  Do you know of a dentist in London who practices acupuncture and offers NHS treatment?  I don't mind where in London as long as I find one.

A: If you are looking for someone who incorporates the use of acupuncture into their dental work, the best bet is to contact the British Dental Acupuncture Society. However, we have had a few problems trying to locate them of late, their web address not seeming to work. It may be worthwhile contacting the British Medical Acupuncture Society with whom many dentists undertake training. This group can be contacted at www.medical-acupuncture.co.uk.

The majority of dental treatments are for calming the gag reflex rather than managing pain through the consultation. It is possible that anyone trained by the BMAS may have wider skills to hand, the only requirement for training being a registrant of a statutorily regulated healthcare profession, but whether they are entitled to treat conditions other than dental pain is something you would have to explore with them. The text on one of the dental insurers' sites is very useful in this respect:

Q. I am a dental hygienist with training in acupuncture. Am I allowed to use these techniques in the dental setting and do I need any additional indemnity?

There are some aspects of the provision of dental treatment that the General Dental Council's Scope of Practice simply does not cover. Acupuncture would be a good example. In the past the GDC has been a little cautious about its use in dentistry, presumably because they are not quite sure where it fits in. The use of holistic medicine and hypnosis would be other good examples. This lack of clarity from the GDC is not helpful, although they would probably argue that there does have to be a point where the scope of practice has to be at the registrant's discretion.

If a registrant is to consider using these techniques, they would need to demonstrate that they are competent to do so and have acquired the necessary training. A training course run for DCPs by a UK dental hospital would probably be regarded as appropriate training.

The difficulty would be how you might decide to use this additional skill in the dental surgery. As a hygienist, using acupuncture as some form of relaxation technique would not seem unreasonable. If you intended using acupuncture for the treatment of TMJ dysfunction this would be quite a different matter. For obvious reasons this type of treatment is a long way outside the scope of practice for a hygienist.

The use of acupuncture for a condition that was unrelated to dentistry would also be unacceptable. Indeed it would be necessary to ensure that a clear distinction was made between this alternative practice and the practice of dentistry. You could not, for example, advertise yourself as being a hygienist and in some way give additional credence to the treatment you provide from your GDC registration. On these occasions you would need to obtain additional indemnity from another provider.

There are overlaps which tend to complicate matters even further. It is, for example, the duty of all clinicians to provide advice on smoking cessation and to encourage patients to give up the habit. In the past, acupuncture (rather like hypnosis) has been shown to be quite successful in this respect. It is debatable whether the use of acupuncture in such a way is part of the practice of dentistry, or outside the dental field.

From Dental Protection's point of view, provided you are using acupuncture as part of dental treatment, there is no particular difficulty in relation to recieving an indemnity as a benefit of dental membership. This may change in the future if the GDC should decide that it falls outside the scope of practice for a hygienist.

Any DCP members finding themselves in a similar situation are invited to contact Dental Protection for advice.

We have done a brief web search for a dentist using acupuncture on the NHS in London and come up with nothing,so it may well be only through direct enquiry that you manage to locate someone. In this context it may well be worth contacting Guy's dental school http://www.guysandstthomas.nhs.uk/our-services/dental/overview.aspx. They offer emergency cover at all times and often seem to be in the forefront of new dental services. It may well be that someone there could advise you.

Q: I had a session of acupuncture to relieve some pain and inflammation. The acupuncturist I saw used points on my left hand and arm (close to the wrist).  During the treatment I felt a heavy pain moving up and down my arm which was quite uncomfortable.  When I got back home my wrist and hand swelled up and was painful. Today the symptoms remain the same . Should I worry or contact a doctor?

A: The short answer is, 'no, you shouldn't worry' but 'yes, you should see your doctor.'

Without knowing exactly what kind of acupuncture you had (traditional acupuncture according to Chinese Medicine principles or acupuncture from a doctor or physio) it's a little difficult to say with certainty what the heavy sensation was. There is a specific sensation elicited by the use of needles in traditional Chinese acupuncture which is called 'deqi', and which feels like a dull aching sensation which can travel along one of the channels in which the energy, or 'qi', flows. In China this is a sensation which the practitioner works hard to elicit, and many Chinese patients will not regard themselves as having been treated unless they feel this. In the West there is less insistence on making this happen, and often a greater use of Japanese needling techniques which cause little tangible sensation. If deqi occurs it is usually a good sign that the practitioner has managed to get things moving.

However, the wrist and hand swelling up is a little more of concern. The chances that there is an infection are remote. Most practitioners use pre-sterilised one-use disposable needles, and unless by a rare chance something was transferred from the skin surface to deeper tissue, there is unlikely to be an infection,. If there were the hand would be hot as well as swollen and quite clearly inflamed. The more likely possibility is that there has been some local bruising, possibly below the skin surface and not necessarily visible, which has caused some form of obstruction in the flow of blood and lymph tissue. The condition called carpal tunnel syndrome, which involved impingement of the nerves in the wrist near where your needles were inserted, can sometimes generate this as a symptom. In all probability the swelling will go down shortly.

However, with problems like this it is always safer to err on the side of caution, and we would advise you to make an appointment with your doctor as soon as possible for both reassurance and for immediate treatment should it turn out to be more significant. Doctors do not mind being consulted where something is unclear, and nobody benefits from a symptom being allowed to run unchecked for any longer than is necessary.

It may be useful to ask the practitioner exactly what points were used and where. This will certainly help the doctor to be able to diagnose what is happening

Q:  I have had problems with TMJ for approx 4 months.  My dentist has now fitted me with a splint which I am building up to wearing day and night .Would accupuncture help with this problem?

A:  We have produced a factsheet on facial pain which focuses heavily on tempero-mandibular pain

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/facial-pain.html

and the evidence for the effectiveness of acupuncture treatment is reasonable.

A great deal depends on the initial cause of the TMJ disorder. In many cases this may be a result of dental work itself, not least because some of the more difficult operations like root canal work and wisdom tooth extraction involve some considerable force being applied to what is a relatively unstable joint. This is not to blame dentists, though - it's just a possible risk of treatment like any other.

In Chinese medicine proper function determines structure, that is, if everything is working the way it should be, then the body will assume its proper shape. There are ways of analysing the flow of energies on the face and head which reveal whether they have been disrupted and whether treatment might reinstate them to good effect. This expert has certainly managed to deal with number of cases by using local treatment and on occasion used a much more systemic treatment when it is clear that the problem has been able to happen because of a generic weakness which has given rise to a local symptom because the musculature of the body was not as resilient as it should be.

However, that said, the people who may be able to offer the most direct help are cranial osteopaths. In this specialised sub-system of osteopathy, the TMJ is a central part of the focus of attention. The average osteopath's knowledge of treating it on a regular basis will far exceed the average acupuncturist's. That is not to say that acupuncture treatment may not be able to offer you some help. In fact, we would still recommend that you visit a BAcC member local to you for advice and an honest assessment of what they can do, and if they believe that referral to a local osteopath is a better bet, you will no doubt get a named referral, which is always better than picking a name at random out of a book.

Don't, though, under-estimate the value of advice from your dentist himself or herself. Many now offer much more comprehensive advice about the management of these issues, and often work closely with other professionals around them to provide joined-up care for their patients.

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