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Q: I have had a tendon reconstruction in my ankle and my ankle swells I have had physio but I was told it was the fluid is not draining as I was not very mobile for a long time will acupuncture help with the swelling . It swells so  I have trouble bending it.

A:  Sight unseen it would be quite difficult to say with any certainty that acupuncture treatment might do the trick.

A great deal depends on the damage caused by the operation. There is often collateral damage from reconstruction surgery in the form of scar tissue and from a Chinese medicine perspective even the most beautifully executed surgery can disturb the flow of energy in the channels. This can in turn affect the flow of body fluids in the area and lead to the kind of blockage and stagnation from which you appear to be suffering.

Recovery also depends on your overall balance and state of health. We are always at pains to point out that treatment is always of the individual, not simply the presenting symptom. A large part of our diagnostic process calls for skilled judgement about why some problems fail to heal in the context of someone's overall health. Sometimes a problem is self-contained in an otherwise perfectly healthy person, sometimes the problem is exacerbated and prevented from healing because of the person's overall condition.

That's the disclaimers out of the way! We suspect that acupuncture treatment might well be able to help the problem and enable you to do some of the physio exercises slightly better, which in turn will help to resolve the problem. The best advice is that you visit a BAcC member local to you for an informal assessment. Most are happy to do this without charge, and it enables someone to offer a much better idea of what is possible than we can offer here.


A: The simple answer is that it works!

As our factsheet shows

there is an increasing amount of evidence that acupuncture treatment is very effective at reducing back pain. One of the most impressive results comes from what are known as the GERAC studies, a truly huge study conducted in Germany about ten years ago. The scale meant that many thousands of treatments were examined, and the results, as you can see from the paper cited here

were very impressive. Of course, the so-called sham treatment also scored far better than the conventional treatment, but as a medical colleague of ours remarked, a 'placebo' treatment that can outperform conventional treatment by such a huge margin would be worth the investment even when the exact mechanism is not known.

In fact we have always taken issue with the idea of sham acupuncture. There are no places on the body, in our view, which are inert energetically, and what we see in most sham vs verum trials is a comparison between good and indifferent acupuncture. Some of the sham techniques are now becoming more sophisticated, but a great many of the aspects of traditional acupuncture which may well contribute to the therapeutic effect may well be a part of the sham mix.

NICE, the National Institute for Clinical Excellence, made ten sessions of acupuncture its recommendation alongside other treatments in the basis of cost effectiveness as much as efficacy, and for many years this has been the case. The sector paper is under review again and we are working our hardest to ensure that this situation does not change.

Back pain is, of course, as old as mankind, so it is not at all surprising that the ancient Chinese had a handle on what might be causing it from a Chinese medicine perspective, and plenty of potential treatments to help to relieve the symptoms.  It remains one of the conditions which brings clients to acupuncture practitioners, and our sense is that it is only because of the good reputation that traditional acupuncture has that the treatment works that word of mouth referral is still so strong.  The Chinese understanding of the flows of energy and the functional relationship of the Organs provide a detailed and elaborate picture of how the healthy back functions, and with that plenty of space for interpretation of how each individual presentation has occurred.

Q:  Do you know of doctors in Las Vegas, Nevada, USA, who use acupuncture to treat severe tinnitus? Also has seizure-like events been known to accompany tinnitus or has been caused by it? My daughter, born with a profound hearing loss in 1969, has lived with chronic pain since 1999 and tinnitus since 2012 with little relief. Any information you can provide will be helpful and appreciated. We are at a loss as to how to help her.

A:  We are sorry to say that we are not really aware of who works in Las Vegas, our reach being somewhat limited, and we certainly have not heard of any dramatic breakthroughs in the treatment of tinnitus. We are absolutely sure that had there been a serious development in the treatment of this chronic debilitating condition news would have travelled very quickly. When some acupuncture practitioners claimed to have a treatment for macular degeneration it sparked a whole host of questions across the globe.

We tend to be very conservative in the advice we give about tinnitus. One recent response said:

We used to be a great deal more downbeat about the treatment of tinnitus than we are now because our experience in practice was that it could prove intractable to treatment. However, as our factsheet shows

and as some recent personal experience in clinic has shown too, there may be some hope. 

The problem with measuring the success of treatment for tinnitus is that its appearance and disappearance can be entirely random. If you read the tinnitus association's magazine you will see stories along the lines of 'I tried everything and then x worked' and an equal number of stories which say 'I had tinnitus for five years and then one day it just went.'  Research trials tend to be quite reliable - it would be a remarkable coincidence if half the trial participants experienced a spontaneous improvement - but one-off cases could be a coincidence, with acupuncture just happening to be the therapy of choice when the change happened.

The available evidence, however, suggests that it might be worth a try with the proviso that progress is reviewed at regular intervals, and some kind of objective measure can be found, i.e. how much it interferes with a radio set at a particular level. It might also repay investigation of what makes it worse and what makes it better. A long n-1 case study this expert conducted had very little impact on the condition but did increase the sufferer's ability to deal with it.

The best advice is to visit a BAcC member local to you and your wife for an informal face to face assessment of what may be possible. There are one or two clearly recognisable syndromes within Chinese medicine which might offer considerable confidence that muting the problem may be possible, but even a general balancing of the system may bear fruit.

As for links between epileptic seizures and tinnitus there are a number of scientific studies which speak of a patho-physiological similarity in the two problems, and there is well document evidence of epilepsy affecting the vestibular apparatus which may well have an impact on the auditory ability of the body. We are acupuncturists first and foremost, though, not medical practitioners in the conventional sense, so we would have to say that we are not the best placed to answer your questions on this.

There is no doubt, though, that acupuncture has a long history of being used for pain relief, much of which was provoked by interest after Nixon's visit to China in the 1970s. That acupuncture treatment can have an effect on the release of the body's natural painkillers like endorphins and enkephalins is not in doubt. The main concern is how much pain relief and how sustainable it is. This can often be a delicate balance between outcome and cost, but it is always worth trying.

That's about the best that we can say. Our members tend to offer people brief face to face assessments which enable them to give a slightly better insight into what might be possible, and this seems to us the best way forward. Looking at things through the perspective of Chinese medicine can sometimes open up new lines of treatment which can in some cases provide unexpected relief.

Q:  I have had accupuncture and cupping and electrodes on my back for whiplash and headaches. Second time yesterday and last night a large lump appeared on back of neck right side and severe headache all over

A: Without being able to see the problem at first hand it is very difficult to say what might be happening here. Each of the three types of treatment can generate what are called 'transient adverse events', i.e small things like bruises or lumps which generally persist for no more than 48 hours. Of the three, cupping has the most obvious potential for creating a bump if it causes blistering of the skin. On the neck, however, it may be less likely that you had cups in place (although we are not quite sure where on the neck you mean) and the next most likely problem is a small bruise beneath the surface of the skin.

Whether this is related to the headache is difficult to say. Although transient adverse events are rare, they can lead to secondary problems, especially if a lump or bump presses on a nerve. This may not be the reason, though. Amongst the more frequent of the few transient advents we see headaches are quite common, especially where we have been trying to reinstate the flow of energy through an area like the neck which may have an impact on the channels of energy on the head.

However, this is all speculation. The best person to speak to in the first place is the practitioner who gave you the treatment. He or she will know exactly what they did and where, and can perhaps make sense of the fact that you have a lump where you describe. We hope that they are not defensive about this; accidents happen even in very safe professions like ours, and finding out what has happened and sorting it out is more important that arguing about liability. If this does not provide an answer and the problem persists for more than 48 hours it is perhaps worth making an appointment with your GP to be sure that there is nothing requiring treatment.

Generally speaking, problems like this do tend to resolve quickly, often before someone has had a reply from us, and we hope that this is the case here. The important thing, though, is to gather as much information as you can so that anyone you talk to can make a rapid judgement about what might be happening.

Q:  I had acupuncture today. The practitioner said he wanted to treat metal element and I specifically told him that was not the right thing for me. He went against my wishes and did it anyway and since I have been experiencing terrible symptoms from excessive confusion, dizziness, feeling sick, off balance and feel like all the energy from my body has been brought into my head. I feel worryingly ill. What should I do?  I have of course fired the practitioner as someone who goes against a patients wishes in this way should not be practicing as far as I am concerned. 

A: This is quite a tricky issue. There could be an argument here that by asking the practitioner not to do something, you were effectively withdrawing your consent to treatment. By carrying on in the way that he did he may have been technically in breach of his Code of Ethics. In situations like this, if we come across patients who have specific requests ('don't needle my feet', don't use moxa')  we can discuss with them the reasons why they might not choose to have this kind of treatment but in the end we have to find alternative ways of working with them.

The situation is a little more complex when it involves an aspect of the treatment where some form of diagnostic interpretation is called for. Treating acupuncture students can be something of a trial because they occasionally have a tendency to tell you what needs to be done, and can get quite indignant if you do something different. The bottom line, though, is that someone is paying you to use your skills and experience, and should in theory be left to get on and do what they do best.

However, many patients have now had considerable experience of acupuncture, and many are aware of things that work for them and things that don't. If a patient is reasonably well versed in the system of Chinese medicine they may well have sufficient understanding to be able to say what they can or cannot tolerate. If so, and if the practitioner feels that this is the only appropriate treatment, the only answer left to them would be 'I'm sorry that this is not possible, but in my judgement this is the only appropriate course of action and I would be unhappy to treat and charge you for an alternative treatment which I did not believe was the best possible option for you.' 

We can understand the strength of your feelings about what you consider to be a breach of trust, and we hope that you found another practitioner to help you who can make sense of the symptoms which you now have. This would be necessary to differentiate between those adverse effects which were a part of a process of recovery ('getting worse to get better' as is sometimes said) and adverse effects which may have arisen from incorrect treatment.

It is not our place here to test out responsibility and blame. Each professional body has its mechanisms for investigating what has happened when poor communication has resulted in problems or where a patient may feel that their wishes have been over-ridden. If you need to we are sure that you can find the appropriate conduit to make a formal complaint. We are simply sorry that you have had a poor experience of acupuncture treatment and hope that it has not put you off seeking help with another practitioner.

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