Q: I have chronic headaches as a long term after effect of viral meningitis 15 months ago. Drugs reduce the severity but do not cure the pain completely. Could acupuncture help?
A: We always tread a little cautiously around the treatment of headaches which arise from distinct pathologies like post-viral conditions. In general, the use of acupuncture treatment for headaches is both well-researched and promisingly so, as our two factsheets on headaches and migraine show:
This has even led to acupuncture being recommended in one set of NICE guidelines for cluster headaches.
However, post viral conditions often present greater difficulty when they generate specific symptoms, as you can clearly see when you look at thee evidence for the treatment of the various chronic fatigue/post viral/ME style of problems. What would be a relatively straightforward 'fix' for some of the symptoms here does not always seem to 'take'.
Two factors, however, predispose people to have a go at acupuncture treatment for these types of headache. First, acupuncture treats the person, not the condition, and is aimed at much on the overall recovery of balance in the system as it is in simply reducing the effects of the symptoms. I many cases the body's ability to correct its own imbalances is severely impaired by viral infections, and anything which helps the whole system to function better is likely to have great impact in retaining any benefits a treatment may have.
Second, the Chinese medicine practitioners have looked at all of the different types of headaches for over 2500 years through an entirely different conceptual structure centred on the flow of energy. The exact nature of the presentation will point to specific types of imbalance for which there will probably be considerable secondary diagnostic information available to the practitioner. This might be in the form of changes to routine patterns which someone has just grown used to over the years, or in some cases signs from pulse or tongue diagnosis of which the patient would not be aware. This would probably give the practitioner some confidence that they could help.
The best advice we can give, and which we invariably give with problems like this, is to visit a BAcC member local to you for an informal assessment of the situation based on what they find. In most cases they may well see an immediate set of signs and symptoms which will enable to say with confidence that they think they might be able to help. In some cases they may decide that other forms of treatment may be more suitable, and we have certainly heard of people using herbal medicine, cranial osteopathy and homoeopathy to good effect.
In summary, we think that there may well be some benefit to be gained from acupuncture treatment, and for us the issue with headaches is usually the extent of the improvement and how sustainable this is. We hope that in your case this proves to be considerably so.
Q: I have focal dystonia affecting the middle finger of my right hand brought on by repetitive strain as I have been working as a secretary for about 40 years. Physiotherapy has not really made any improvement. Would acupuncture help?
A: Focal dystonia is an unusual problem. We are not sure how much you have been told about its causation, but although it has the characteristics of a repetitive strain injury it actually has a great deal more to do with the wiring in the brain brought on by the repeated actions. Musicians are particularly prone to focal dystonia, and sometimes the patterns are very predictable. In guitarists, for example, the third finger is most often affected.
This may explain to some degree why the physiotherapy hasn't been particularly helpful. However, although one might think that acupuncture would be similarly ineffectual, this is where the entirely different theoretical basis of the system of traditional acupuncture may yet offer some hope. As you have probably read, acupuncture treatment is based on using needles to influence the energy of the body, called 'qi'. It is the rhythm, balance and flow of this energy which determines the health and efficient function of the system as a whole and all the individual parts of it. When the flow is impaired for any reason pain and changes in function result.
Had this been an RSI type of problem we would have said with some confidence that acupuncture treatment could well help to restore the local flow and reduce the impact of the problem. This may well still be the case; the diagnosis of this condition can be rather imprecise and unless you have had a scan it might well be an RSI-related problem. If, however, it has a more systemic root then treatment may well be effective on a slightly wider basis, helping to improve overall function.
With conditions like this, however, it is very difficult to say that this remove whether treatment will be of possible benefit. This is why we always recommend that someone visits a local BAcC member for advice and guidance. Most are more than willing to give up a little time without charge to give a face to face assessment of what may be possible. The only thing we would say is that if you do decide to go ahead it is important to set clear review dates for progress and try to sort out an objective measure of improvement.
Q: My mother and I have been seeing an acupuncturist weekly for about a month. We are both experiencing good results, but the sessions are often very painful. My hearing has improved in left ear after 2 sessions. I believe it is about normal and prior I really should have had a hearing aid. My mother suffered hearing loss and left eye kept closing after Bell's palsy and 2 neurosurgeries. The pain in her face has improved, hearing is better and her eye is staying open. The Dr. Is very nice, but sometimes pain from needles going in and being removed is extreme. Is this normal.?
A: We are extremely pleased to hear that you and your mother are making good progress, and we have to say that given the nature of your problems this really is good progress. We are sorry, though, to hear that the treatment is painful. The most that people should experience is a slight and transient discomfort.
One possible explanation is to do with the sensitivity that people have to being needled. The sensations are not purely physical, and there are some reactions to needling which are what we would describe as energetic, usually a dull aching sensation or a mild electrical shock sensation. These tend to pass quite quickly, and are not really what one would call painful. We have seen this kind of sensitivity run in families, but the fact that a friend experienced the same problems suggest that it is the practitioner's technique which is the problem.
This really only leaves a couple of options. Most practitioners can adjust a number of factors in how they work. This can range from using finer needles to using less manipulation of the needles when they are inserted and inserting to less depth. This can often reduce the impact of the needles being inserted, and can make the difference between someone continuing treatment and deciding that it is too unpleasant to continue.
You will find that most, if not all, practitioners are perfectly willing to discuss this with their patients, so you shouldn't feel any embarrassment at asking. However, if the answer is that this is the way that he works and he can't change it, then we're afraid that the only other options are to grit the teeth and accept that this is the price of making improvements or stop having treatment. We suspect that you are doing so well that it would be a shame to stop, so we rather hope that the doctor can adjust his treatment to make it a little less uncomfortable while still giving you the same level of improvement.
Q: My father suffered from brain stroke 5 yrs ago. He is getting physiotherapy but his left hand is still not working. Can he have acupuncture therapy for this? Does this procedure have any side effects?
A: We are sorry to hear of your father's continuing problems.
Let's deal with the easy answer first. There are very few side effects from acupuncture, and the vast majority are transient. We put together a safety website with the two leading medical acupuncture organisations (www.acupuncturesafety.org.uk) which quotes a number of research studies. These show that acupuncture ranks as one of the safest therapies around. There are occasionally minor reactions to treatment, like headaches or tiredness, and very rarely an injury caused by the needles, but when you consider that there are over 4 million treatments being given each year the number of these is remarkably low.
The other side of your question is more difficult to answer. We have on the BAcC website a very thorough review paper
as well as a simpler factsheet
which are both very encouraging about the use of acupuncture for the after effects of stroke. In China, however, it is common practice to start treatment on the day of the stroke itself and to treat daily or more to try to restore the 'lost' functions as quickly as possible. The received wisdom is that if the treatment is delayed it becomes progressively more difficult to achieve the same level of result and the final outcome may not be as good. This is paralleled by some treatments in the west, where drug intervention on the day may work when a gap means it won't. The fact that your father is now five years on from his stroke suggests that where he is now may not improve a great deal.
However, there's no point in being unduly pessimistic. All of us have taken on cases like this and managed to achieve a great deal more than we expected. The great strength of Chinese medicine is that it treats the individual, not the condition, and there is always a chance that if someone's baseline constitution is strong they may be able to achieve quite a great deal of improvement. Full restoration of function would be a stretch, but some gain may be possible.
The best advice, which we invariably give, is to visit a local BAcC member with your father to get a face to face assessment of what may be possible. Most of our colleagues are more than happy to give up a little time without charge to see whether acupuncture treatment may be of benefit.
Q: I get muscle spasms daily, every morning, in a very specific place, left side lower back, suspect the QL muscle. If allowed to rest, it relaxes and pain disappears after about 15 mins. I am 56 and have had this problem for 40 years but never as frequently as recently. I've had xrays, mri scan but nothing showing up. Would acupuncture help?
A: We are always a little cautious when we want to make comment about western diagnostic techniques, but one of the sayings in one form of psychotherapy is that if the only tool you have is a hammer then the only thing you'll find to hit is nails. X-rays, MRI scans and CAT scans are wonderful devices, but there are always going to be injuries and problems which they cannot identify.
Obviously we say this from the perspective of practitioners of Chinese medicine whose system is based on an understanding of energy, which the Chinese called 'qi'. The rhythm, flow and balance of the energies in the body is what determines our overall health, and whenever there are blockages and distortions in the patterns of flow, pain will result. Exactly what these disruptions are and how they are best addressed is where considerable skill comes in, but in essence it is a very simple underlying premise from which we work. We are not alone in having a different perspective on health, however; cranial osteopaths and chiropractors have complex systems which can understand pathologies in terms which are not always reducible to the testing systems of western medicine, and even the herbal medicine and homeopathic practitioners have ways of addressing issues like these.
We think the best advice that we can give is to visit a local BAcC member for a brief face to face assessment of whether they think they can help. Most are happy to do this without charge to ensure that the therapy is a good 'fit' for the presenting problem. It really benefits no-one if we take on cases where our professional judgement is that our system of medicine is not the best way of going after something.
What, we are sure, will interest the practitioner is what was happening at around the problem started to manifest, albeit a long time ago, and also what the overall underlying pattern of your constitutional energy is. They will be intrigued, as would we be, by the fact that this has persisted so long, and wonder what has prevented the body from healing itself.
We do hope that you find someone who can help you. 40 years is far too long to be in discomfort every morning, and we applaud your stoicism.
Q: Over the last year I have had a lot more problems with cramps. I am only 27 years old and this year. I have had several serious cramps on my quads, hamstrings and calves simultaneously. The cramp in my quads are the worst and the latest time last for 2 and a half hours of intense cramp. Since then my legs have never recovered. I cant really run or doing any leg movements without them tightening up and feeling like they are going into cramp. It almost feels like constant DOMS for months. I was just wondering would acupuncture be effective as the GP's and phyiso have no answer for what I can do?
A: On the face of it it would seem very likely that acupuncture treatment might well be able to help you. The theories and practice of traditional acupuncture rest on a concept of energy, called 'qi', and its flow, rhythm and balance in the body. When the flow is compromised for whatever reason the resulting blockage or stagnation will cause pain which will continue until the blockage is released. We find that there are many conditions which demonstrate this kind of pathology, notably a great many of the repetitive strain injuries, and the use of needles together with ancillary techniques like moxibustion (the use of a warming herb) and cupping can make a huge difference.
A practitioner would be very interested to take down a great deal more case history before being certain about this as a diagnosis, however. DOMS was always thought to be a consequence of the build-up of lactic acid in the body, but more recent assessment seems to suggest that microtrauma to the muscles and tendons can be a contributory factor. The problem with microtears and the inflammatory response which they provoke is that most athletes tend to try to work through the pain, regarding this as likely to improve their overall fitness. The reality appears to be that the microtears never get a chance to settle, and simply become worse and worse. It would be essential to establish whether you had now ceased from all forms of exercise, or whether you were still training, even to a minor extent. If so, then a part of the rehabilitation programme might involve extended rest, together with other treatments.
There is certainly a growing number of acupuncture practitioners who specialise in sports injuries, and if you manage to track one down near to you then it may be worthwhile making a slightly longer journey to someone with this kind of background even though there may be other practitioners who are nearer. Our experience is that it really does help to be able to talk the language of training and understand the specifics of an exercise programmes which may have been a contributory factor. That said, Chinese medicine has existed for 2000 years longer than the average gym, and has addressed the same problems brought on by over-work in an unkind climate effectively. All of our members will be able to offer the same level of acupuncture skill.
Our best advice is to find a practitioner local to you and ask for a brief face to face assessment before committing to treatment. Most of our colleagues are willing to give up a little time without charge to offer a better judgement than we can make at this remove and to advise you on whether acupuncture is the best modality to pursue.
Q: My father is 87 and suffered unstable c1c2 neck fracture 8 months ago due to falling. He has no paralysis and has refused most medical interventions (including wearing a collar which he finds too painful) as his desire to live was reduced by recent bereavement. He has severe chronic neck and head pain ever since, with little or no relief even on opiate medicines. Please could l ask if acupuncture might perhaps give him any relief or reduction of pain if it is safe for cc2 fracture?
A: There is no reason of which we are aware why acupuncture would be absolutely contra-indicated for your father's problems. However, there are degrees of relative contraindication, but these depend on the professional judgement of the practitioner and the specific circumstances of the case.
The one caution of which we are aware is one which mainly appears in the literature of physios who perform acupuncture. We have seen them say that there are rare occasions where the muscles of the back or neck brace themselves to maintain stability, and any treatment which relaxes muscle, even unwittingly, might make the joints of the spine more mobile and thence cause pain. However, we recently put together an acupuncture safety website with the main physio and doctor acupuncture associations www.acupuncturesafety.org.uk and this was
not thought to be significant enough to warrant mention. Indeed, the fact that your father is wandering around without a neck brace is probably an indicator that while painful the neck is not that close to giving way.
We do publish a fact sheet on neck pain
which quotes a number of encouraging studies, and certainly neck pain is one of the more frequent reasons why people seek treatment. Since the greater majority of referrals are by word of mouth res ipsa loquitur, as solicitors say - we wouldn't get the referrals if it didn't work.
The best advice, which we invariably give, is to see if your father is willing to drop in to see a local BAcC member who can assess his specific presentation. Most members are happy to give up a little time without charge, and seeing a problem first hand gives a much better idea of what may be possible. We also are very emphatic that we treat the whole person - body, mind and spirit - so it may even be that your father could derive some benefit in other ways to help him deal with what must have been a very painful bereavement for him.
Q: Had acupuncture more than 30 years ago and STILL have pain and some numbness on the site of a wayward needle. However, I now have chronic back, hip pain with the neck and referred pain to the testicles thrown in from time to time.
A: Without knowing exactly where the needle was placed we find ourselves a little restricted in what we can say.
Clearly, the one possibility which you need to rule out is that there is a piece of needle still inside your body. In modern times this would be almost unheard of. The use of disposable needles has eliminated the one main cause of pieces of needle snapping off, and that was the use of autoclaves to sterilise and re-use needles. The constant heating and cooling tended to make the steel in the needles a little more brittle, and there was a risk that a small fragment could break off. Possible as this was we have no records of any such occurrence in the BAcC (formed in 1995) or in the five precursor bodies. We did hear, however, over twenty years ago about a legal case involving a claim that a piece of needle tip had broken off and 'travelled', but we suspect that the matter was settled out of court because there is no trace of it that we can find from our searches.
The other possibility is that the needle caused physical damage. It is hard to imagine what this might be to have endured for 30 years and to be causing secondary symptoms. However, we think that the best, and perhaps only, thing that you can do is to go to your GP and ask for an X-ray of the area to determine whether there is any physical object in place, and then to discuss with him or her whether the other symptoms to which you refer could be a consequence of physical damage in the area. This might involve a referral for an MRI if there is a chance that the damage is in deeper tissues.
It may well be the case that you have already done what we suggest; thirty years is a long time, and if you have been experiencing discomfort for this length of time it is highly likely that you have. However, the spread of symptoms needs to be investigated anyway, whatever the root cause.
We are sorry not to be able to offer more help or advice than this, but with the information you have sent us this is the best that we can suggest.
Q: I am a registered midwife with the NMC and have been personally been a patient of acupuncture for years. Recognising the benefits I am very interested in completing training in acupuncture so that I can benefit pregnant women and ideally support women trying to conceive. Are there any courses for midwives which you would recommend. I have found a few advertised but only want to gain the correct qualification
A: This puts us in a rather difficult position. There is currently a great divide in the BAcC between those members who are suspicious and at times downright hostile to the idea of anyone learning a small number of acupuncture skills in order to be able to practise in a defined and limited area. In their view it is only possible to use TCM safely and well if the treatment is given on the basis of a full training in traditional acupuncture. At the other end of the spectrum we have an equally forceful group of members who believe that as long as people work within the scope of practice which they have learned and are aware of the contraindications from a Chinese Medicine perspective, then it is a benefit to patients who might not otherwise have been exposed to acupuncture. It also may well encourage them in the future to use acupuncture treatment in other circumstances.
Clearly it is not for us to endorse either view; we're all for the quiet life. Suffice it to say that we are pretty sure that you will not find a traditional acupuncture training course, at least not one associated with the BAcC, which will offer a bite-sized chunk of training. However, if you switch paradigms you will almost certainly find training courses if you look at the website of the British Medical Acupuncture Society. They offer training to statutorily regulated healthcare professionals, and we seem to recall that some time ago they offered training in this particular field in partnership with UCLH. It should be a relatively simple matter to track this down.
We are sorry we can't be more explicit than this, but as well as providing a service to the general public we also have to be aware of the kinds of issues which are inflammatory for members, and the issue of cherry-picking, as it is perceived, is a particularly vexatious one.
Q I have no upward movement in my big toe joint following an operation to remove a lump in the base of my foot. Can acupuncture help with muscles and nerves?
A: A great deal depends on the extent of the damage caused by the operation.
We do not intend any criticism of your surgeon or podiatrist, but any operations to remove lumps or growths carry a small but real risk of interfering with both the nerves which supply the foot 'downstream' and also the muscles which sometimes have to be cut slightly, or may even have become fused to the lump and become collateral damage when the lump was taken out. It would only be fair to say that if the damage is permanent then acupuncture treatment will not make a difference.
However, traditional Chinese acupuncture operates on an entirely different theoretical basis from western or conventional medicine. The basic premise is that the body, mind and emotions are all one interconnected flow of energy, which the Chinese call 'qi' and which does not translate well into English. Health, vitality and proper function all depend on a good flow, rhythm and balance of energy. When someone has an operation involving cutting through tissue there is always likely to be some break in the flow. In severe cases, especially when someone has a great deal of keloid scar tissue, the blockage this creates can cause significant trouble. In more confined areas it can result in symptoms such as you describe, loss of sensation or loss of movement.
Of course, if everything in life were that simple it would be an easy thing to fix; just pop into an acupuncturist's clinic, have a few needles and all should be well. In reality, some cases respond well and others don't respond at all. There are all sorts of factors which influence this, not least of which the overall balance of energies in the person in whom the problem occurs. This will mean that some people will heal faster anyway, and others will struggles. A skilled practitioner would take this into account when making an assessment.
In any event, where the outcome is rather uncertain it is vital to set a limit to the number of treatments which someone has before drawing a conclusion about whether it is working. Having a measurable outcome makes life much easier because progress will be visible, not just based on how someone feels on the day. We tend to suggest that four or five sessions at most are a good chance to tell whether treatment will work. If there has been no change at this point it may be good to look at other options.
The best advice, which we invariably give, is that someone visits a local BAcC member for an informal assessment of what may be possible. Actually seeing a problem is a far better basis for offering advice, and most members are happy to spare a short time without charge to see if it is something they think they could help with.
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