Q. Last week I had acupuncture to treat neck and shoulder injuries caused by a fall in December and I could not believe how painful, both during and for 24 hours after the treatment it was. Is this normal? I recieved the treatment in an NHS hospital by a senior physiotherapist. My next appointment is tomorrow and I am dreading it.
A. One of the principal reasons for differences in technique between professional acupuncturists and medical professionals using acupuncture lies in the underlying theory on which the practice is based. The traditional acupuncturist is primarily concerned with the energies of the body, the term 'qi' which the Chinese use to describe all aspects of physical existence, and treatment can often be very subtle and gentle. The medical acupuncturist, however, is more often working on the basis of muscular and neurophysiological approaches. This can often involve the use of what are called 'trigger points', knots in the muscle tissue, and needling these can often be quite painful. The more physically based treatment often calls for a broader gauge of needle than BAcC members generally use, and it's something of a simple truth that the thicker the needle, the more likely it is to cause discomfort.
A great many physiotherapists have added some of the Chinese medical approaches to their repertoire and are equally subtle in their approach, so we would not want to generalise too much on the basis of a single report. It may be as simple as the fact that this person's technique is not that good, or equally that you are one of a small group of people who are extremely sensitive to acupuncture treatment and have to weigh the benefits of treatment against the discomfort of the needles.
All healthcare professionals can only work with the patient's consent, though, and if there is any aspect of a treatment which you do not like you are within your rights to withhold consent. Any practitioner that continues to use a modality after consent has been withdrawn immediately puts themselves on the wrong side of their professional code of conduct.
Q. I have suffered from severe migraine my entire life. I take daily medication which reduces attacks to 1-2 a year. When an attack begins, I haven't found any tablets that help. By chance I received acupuncture by my GP when I happened to see her whilst in the middle of an attack, which instantly ended the attack.
Would it be possible to be trained to give myself acupuncture (on the back of the hand) so I could use this as a first aid treatment if/when I suffer my next migraine?
A. Although it's great to hear of people having dramatic results from having treatment we do not encourage people to needle themselves. There are two main rasons. First, acupuncture involves piercing the skin and safely disposing of needles, and a professional practitioner spends a considerable time learning the skills and knowledge necessary to remove any risk of infection or cross-infection from the process. Our main complaint about very short training courses is that while they may train people in useful adjunctive skills they cannot hope to ensure that the person taking them is sufficiently well trained in safe needle practice and all the cautions that go with being a professional acupuncturist.
Second, although the treatment of symptoms has its place in Chinese medicine, symptoms are regarded as only a part of the picture, and are usually indicators of imbalances within the system which need attention. The risk is that using acupuncture in a first aid way, the underlying pattern is deteriorating, but the alarm bell which the symptom represents keeps getting turned off.
The fact that this works so well for you, however, is perhaps something you could discuss with your GP. Our members would possibly fall foul of our Codes of Professional Conduct if they taught people self-needling techniques, and our insurers would probably be less than happy with the practice. There have been one or two trials within the NHS which used self-needling, however, and it may be that your GP can authorise and delegate care in this way. If not, acupressure using the same points should offer a similar kind of relief.
Q. I am a student midwife and have been tasked with presenting information on the use of acupuncture for pain relief in labour. I am particularly keen to find out whether an acupuncturist would be likely to consider accompanying a woman into hospital for this purpose and whether the woman would have to remain still. Also how do acupuncturists normally manage their sharps.
Any help would be much appreciated.
A. An increasing number of BAcC members now attend births at the mother's request to help her through the stages of the delivery. Most hospitals seem to be reasonably relaxed about this, and as long as the practitioner has the consent of the consultant or the midwife in charge, and of the mother, of course, it is simply a matter of doing one's job and keeping out of the way at key moments.
The mother does not have to remain completely still, but there will clearly be limitations on how much movement is acceptable when needles are in place, and a delicate calculation of how many needles constitute a safe amount when the labour speeds up. Rather than set somewhat arbitrary guidelines or rules for this, we leave it up to the practitioner to assess the situation and make their own professional judgement about what it is best to do. For most, less is more at this critical time.
All needles used now are single-use and disposable, and the majority of members use yellow sharp's boxes within their clinics for the disposal of needles and small items of clinic waste. These boxes are collected by regsitered carriers when they are three quarters full, and there are very clear guidelines which we expect members to follow. There are also very clear guidelines for using smaller transportable sharps boxes in the event that the practitioner treats away frmom their normal base.
You may also be interested in the (10 minute) video of BAcC member Sarah Budd at the recent ARRC symposium entitled "Maternity acupuncture in the NHS : a "MYMOP" audit" which deals with pain relief.
As our factsheet here shows low back pain is one of a small number of conditions for which the evidence is good enough such that acupuncture is now a NICE recommendation for people with chronic non-specific back pain of over six months duration. This does not mean it doesn't work on many other things, only that the specific type of evidence accepted in the West is very narrow, and the vast quantity of Chinese research available is often methodologically less than perfect.
However, if your case the pain appears to have a very clear specific cause which may make it not be so amenable to treatment. If the scarring and adhesions are significant and permanent, it is possible that acupuncture may have little or no effect. That said, it is surprising how often a physical manifestation such as degeneration of the lower vertebrae or scar is adjudged without further ado to be the explicit cause of a pain. Most people over the age of 50, for example, are likely to be showing some signs of degeneration of the vertebrae in the lower spine, and that does not necessarily mean that this is the root of every reported back pain.
It would be worthwhile discussing the specifics of your case face to face with a practitioner to get a better idea of whether they feel that treatment may be able to help based on a proper inspection of the nature of the problem. The fact that you have scarring and adhesions suggest a wider pathology than simply back pain, and a practitioner would perhaps be able to make better sense of any patterns by actually looking directly at what's going on.
We have provided answers to other people's questions about tinnitus, insomnia and migraines on the site already, but what is interesting about your case is the mention of all three in the same presentation. One of the strengths of Chinese medicine, which operates from an entirely different knowledge base from conventional medicine, is that it can sometimes make sense of a group of named western symptoms in a way which would not make any sense to a western practitioner. This may point a Chinese medicine practitioner towards a particular syndrome or pattern which makes sense within the Chinese medicine framework and offers possible solutions within that same framework.
Tinnitus is a highly intractable condition, and the magazines put out by the support organisations testify to the fact that while one solution may work for somebody it rarely works for everybody. Some of the more symptom-based systems of Chinese medicine are equally clear about the relatively small number of cases which present a clear diagnostic pathway, and of these the kinds of 'full' symptoms such as high BP and migraine are not usual as accompanying symptoms.
The best course of action is to visit a BAcC member local to you and seek their advice on whether, with this background of related complaints, they believe that they might be able to help you. If you do decide to go ahead with treatment we would recommend that you keep your progress under constant review. Conditions like tinnitus are bad enough to encourage people to persist with treatment even when their practitioner wants to draw a line under the attempt, and we believe that a responsible practitioner will have the honesty to admit when there is no more that they can do.
Trigeminal neuralgia can be a totally debilitating and painkiller-resistant problem. Although we have had a number of anecdotal remarks from members that they have treated the problem successfully it would only be fair to say that an equal number report it as having not responded. As with tinnitus, another problem which proves remarkably treatment-resistant, the best that one can sometimes achieve is to make the condition a little more bearable.
However, Chinese medicine does operate from an entirely different conceptual basis from western medicine, and is premised on the even flow and balance of energy, called 'qi', in the body. Where serious pain exists this can sometimes be due to a straightforward blockage in the flow, and on occasions such as these there is some possibility that a few simple treatments may prove to be helpful. A well trained and professional practitioner would be able to tell you relatively quickly whether they thought there was some prevailing diagnostic sign which gave them confidence that treatment might be beneficial.
It is perhaps also worth bearing in mind that cranial osteopathy may help in cases like these. Structural alterations in the tempero-mandibular joint brought about by accidents, injuries and occasionally fairly agrressive dental procedures can generate neuralgia, and gentle manipulation may offer another possible solution.
The majority of cases of venous insufficiency involve the circulation in the lower limbs, and while there is very little specific western research on this, we have to remind people that Chinese medicine has dealt with problems liek this for centuries, and has a number of treatment strategies for problems in which this is one of the symptoms.
It is important to be aware that Chinese medicine operates from an entirely different conceptual basis in which the flow of energy, called 'qi' in Chinese, is central to the effective flow of all body fluids and to the overall balance of the system. The practitioner of Chinese medicine uses his or her skills to try to determine how the system is out of balance and then devises treatment strategies to correct imbalances. In some cases this is symptom led, and in other cases, the treatment is much more general, aimed at correcting the overall balance premised on the simple belief that when a system is in balance, symptoms repair themselves.
The best course of action is to visit a BAcC member local to you to seek their advice on whether your particular case makes sense from a Chinese medicine perspective and what they would advise. In many cases acupuncture would be an appropriate treatment, but there may be other options which a practitioner may recommend as better suited for what specifically troubles you.
Q. I am currently 30 weeks pregnant and my morning sickness has unfortunately started to return. My yoga teacher suggested acupuncture may help. I am epileptic and currently 8 months seizure free. Is there any evidence or suggestion that acupuncture can cause seizures?
A. There is no evidence or suggestion that acupuncture can cause seizures when patients with controlled epilepsy have treatment.
All BAcC members are extremely careful to ensure that the patient remains on the medication they have been prescribed. The only treatments which are proscribed involved the use of electroacupuncture on people with poorly controlled epilepsy, and the only advice we give is to ensure that anyone with poorly controlled epilepsy is not left unattended during treatment. This is simply a common sense precaution to avoid accidents if someone did happen to have a fit while they had needles still inserted.
Q. i suffer from pcos on both ovaries, i also suffer from weight issues due to this but have been told by nhs that they cannot help until my bmi is below 30. I know that i need to help myself but can accupuncture help whilst trying to concieve. Have been trying for 5 years.
A. The evidence for the treatment of fertility problems with acupuncture is a little thin, as our factsheet here shows. There are a number of studies which appear to indicate that acupuncture may help PCOS and the attendant fertility problems which it can cause, but not enough and not enough of consistently high quality for us to make any claims.
However, traditional Chinese medicine has a very long history of treating exactly the same issues which trouble people today, and although its conceptual basis is entirely different from conventional western medicine, the symptoms which people have and the way in which they describe them haven't changed, and have been diagnosed and treated in Chinese medicine terms for centuries. There are a number of patterns or syndromes in Chinese medicine which reflect quite closely the sorts of problems which PCOS sufferers have and their problems with fertility, and a practitioner may be able to use these as the basis of a worthwhile strategy.
We have to be realistic, though, PCOS makes pregnancy difficult, whatever system of medicine you use to diagnose it. Our main concern is that you are not led into unnecessary time and expense for something which cannot help, and not diverted from conventional treatment which may ultimately be of benefit. Our members are responsible and safe practitioners, and if you visit one local to you, we hope that they are happy to see you for a short consultation, hopefully without charge, to determine whether the unique case which you represent in Chinese medicine terms is one for which they feel that treatment may offer some hope.
Q. I'm extremely interested in having facial/cosmetic accupuncture, I have reserached it feel it would be of huge benefit to me. However as I am on a low wage I wanted to know if there were any accredited accupuncture schools that could offer low cost, safe treatments done by the students? Please advise.
A. A number of the acupuncture teaching institutions offer low cost treatment for patients attending their student clinics, but we are not aware at this stage of any teaching institution which offers facial or cosmetic acupuncture as a part of its core curriculum. It may be possible to ask if this can be offered, however, and a full list of institutions accredited by the British Acupuncture Accreditation Board can be found at baab.co.uk.
Facial acupuncture/cosmetic acupuncture is something of a lively debating point within the profession at the moment. There is no doubt that it is popular, and many BAcC members attend postgraduate training courses to learn some of the special techniques involved. However, the consensus appears to be that it is best used in conjunction with treatment of the person as a whole, and that some of the underlying causes of the problems which manifest on the face need to be addressed as well.
There are now a number on non-acupuncturists being trained in and using the techniques of cosmetic acupuncture, and we have concerns, as we do with any short courses, about the standards of safe practice involved in this treatment. If you do choose to go ahead with treatment, we recommend that you check carefully what other primary training the person offering the treatment has. You also need to be aware that there is no agreed standard for this kind of treatment, and any claims that someone's training has been endorsed or accredited need to be examined with care.
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