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Q: Good to have this blog to post questions.  My question is we have consulted a physio for neck pain and the physio instructed that it's due to trapezius muscle knot and he has given me acupuncture treatment. The neck pain has reduced but have the  trapezius muscle pain. I am worrying if its due to acupuncture treatment? What are the side effects for trapezius muscle acupuncture?

A:If we understand you correctly, the treatment for the neck involved releasing the trapezius muscle and now that the neck pain has reduced the trapezius is painful instead.

A great deal depends on how long it is since the treatment was given. Many physiotherapists use forms of what is known as 'trigger point' acupuncture. This is a western acupuncture approach which involves locating and treating tight spots in the muscle fibres which cause pain where they are and also cause muscle contraction which can then cause pain further down the line. Trigger point treatment often involves using longer and thicker needles than we would use in traditional acupuncture, and the treatment itself can sometimes leave a painful area for a few days. There is sometimes a little internal bruising after this technique, and this can also take a short while to go. You could normally expect this kind of pain to go after 48-72 hours, although if the treatment has been epecially vigorous this may be as long as a week.

If the pain persists after this the first person you should speak to is the physion himself; he will be in the best position to assess what is happening because he will know exactly what he has done, and may be able to apply further treatment and exercises to help to resolve the problem. If this does not do the trick then the next port of call is your GP. However, we strongly suspect that the problem will have gone long before you reach this stage.

The other possibility to consider is that sometimes a severe pain can overshadow another pain in the same area, and when the primary pain goes, the second one becomes more noticeable. This is very common in feedback when people have multiple problems. Here again the physio is the best person to speak to. If he has managed to reduce the neck pain, then he can probably release the trapezius pain too.

There shouldn't be any especially noticeable side effects from this treatment. Clearly if the treatment is vigorous you may feel a little bruised in the area for up to 48 hours, but if the physio recognises from your first session that you are quite sensitive to the needling he may well reduce the intensity of the treatment to make the after-effects a little less noticeable.

We hope that this reassures you.

A:  We drew up a review paper some years ago

http://www.acupuncture.org.uk/arrc/public-review-papers/substance-abuse-and-acupuncture-the-evidence-for-effectiveness.html

which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.

However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK (http://www.nadauk.com/) and SMART-UK (http://www.smart-uk.com) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.

There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).

This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.

 Q:  I have nerve damage following a spinal surgery, which sadly has complications. I now have chronic pain in my right foot and acute pain in my right lower leg. Would accupunture help?

A:  A great deal depends on whether the nerve damage has been shown to be directly responsible for the pains in your right foot and lower leg, or whether they have simply arisen at the same time as a consequence of the operation.

The reason we make this distinction is that traditional acupuncture is based on an understanding of a flow of energy, called qi, in the body whose balance and rhythms are responsible for everything functioning as it is supposed to. When the flow is disturbed by surgery or injury, this can have considerable consequences, often local to begin with and then becoming systemic as the flow to deeper structures starts to become impaired.

The reason for pointing this out is that is the nerves have been physically damaged by the operation, something which a neurologist should have established very clearly, then we would be dishonest if we did not say that there is not a great deal that treatment with acupuncture can do. There is a small amount of evidence from animal experiments, dismissed by many of our colleagues as 'ratpuncture', that acupuncture treatment may help nerve to regenerate, but whether one can take results from rats and extrapolate this to human beings is completely unclear. We tend to take the view that in the absence of any hard evidence to the contrary, when nerves are physically damaged there is not much to be done.

However, the flow of energy in the body is organised in what are called channels, and major surgery is often very disruptive of the flow of these. If you look on the internet you will see diagrams of channels, two in particular, which run down the centre of the back and then continue down the back of the legs to the feet. If there has been a blockage caused by the surgery, this might create long term pain because of the diminished flow.

It is difficult to give you a definitive view at a distance, however, and your best bet will be to visit a BAcC member local to you for an informal, and hopefully without charge, face to face assessment of whether treatment may be of benefit. There is no doubt that acupuncture can provide relief from pain; this has been one of the most heavily researched and documented areas of effect. The question is always how much relief and how sustainable, and balancing this against a long term continuing expense. A well-trained practitioner, though, should be able to make a relatively rapid assessment of whether the treatment may be able to achieve more than this based on a simple inspection of which areas are affected and how these relate to the flow of channels in the body.

 

Q:  have sarcoidosis and get accupuncture once a week at the hospital.  Lately the nurse has put needles near all the way in( i get them in my hands near the thumb and one in each foot).  I have had accupuncture before which was great but after my last couple of sessions I have lot of pain in my hands an don't feel well for a few days.  Is this normal?

A:It is not unusual to feel slightly different for a couple of days after treatment, even sometimes a little worse than before, and usually the effects are transient and wear off. If they continue for more than two to three days it suggests that the treatment is too strong or that there has been some internal bruising which will continue to cause discomfort until it clears. This may take a week or two.

The points you describe suggest that the nurse is using a treatment with which we are familiar which is often used to reduce pain and also used as a general calming treatment for the whole body. If so, unless the nurse is using very short needles there is a possibility that the very deep insertion is causing excessive stimulation, and the simple answer to that is to insert needles to a lesser depth and to do less with them by way of tweaking and twisting when they are in place. Generally speaking we do not favour putting needles in up to the hilt. We always recommend that practitioner use longer needles inserted half way than short needles to their fullest extent.

The best thing, though, is to describe what has happened to the practitioner and ask if he or she can reduce the strength of the treatment a little. Most responsible practitioners are very much guided by the feedback from patients, and there are patients who are particularly sensitive to acupuncture, whether this be traditional acupuncture or western acupuncture.

We are pleased, though, to hear that it has been of benefit and hope that once you have ironed out this slight problem you will experience the same levels of benefit.

]Q:   Do you work with the NHS can any of your associates  work through the NHS System?

A:  A small number of our members work within the NHS, but this is very much to do with local resources and personal negotiation. It is a stark reality that there is not a great deal of speare funding within the system at the moment, and very few Commissioning Groups are looking to import services which will add to their budgetary concerns. We do not anticipate any national agreements within the foreseeable future

There is a certain amount of acupuncture provisions within the NHS from doctors and physios who incorporate it within their work in specific areas such as back pain, but it is not usually possible to seek out an NHS acupuncturist as such.

Most people look for NHS provision of acupuncture treatment because of the cost, and it is important to point out that most BAcC members are prepared to reduce fees if someone faces genuine hardship in trying to meet the standard rate. There are also a number of facilities called multibed clinics which have been set up with the express inention of making acupuncture more widely available to a wider target group. Details of these can be found at www.acmac.net.