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Q: My wife is currently seeing an osteopath after 9 procedures at the local hospital relating to two split discs and a prolapse. Even though he has 30 years experience he has told my wife that adhesions caused from the procedures are making it difficult for him to help with the pain control.
Therefore I was wondering if acupuncture is worth trying?

A:  It's always difficult not to sound trite when we say that acupuncture is always worth trying, but we all work in a tradition which is based on treating people, not simply the conditions or injuries which they have. By working in this way according to principles which have been developed and refined for over 2000 years we try to restore the balance of the energies of the body which in turn can encourage the body to repair better, and generally hope to elicit changes on all levels,  physical mental and emotional. 
 
Of course, this is all very much 'big picture' stuff, and there is plenty of evidence at the sharp end of practice about direct help for specific problems.  As our factsheet shows
 
 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html
 
pain relief was and remains one of the most commonly researched areas of acupuncture treatment, not least because there are plentiful assessment tools to help patients to quantify their experience and a significant number of objective pain measures which allow researchers to assess the efficacy of treatment. The evidence for the successful use of acupuncture for pain relief is plentiful, and while it is not yet wholly conclusive nearly every pain management clinic offers acupuncture as one of its packages. The only area of concern is how sustainable any improvements are alongside the degree to which pain reduces, an we rely on the probity of our members to discuss the benefits which treatment confers in relation to its continuing cost. Even where someone can easily afford the cost of regular treatment our member still have a responsibility to ensure that the investment in time and money is a wise one.
 
Mention of adhesions also brings to our collective mind the issue of scar tissue from surgery which in itself become a problem. We once commented directly on this:
 
However, scar tissue does have implications for someone's health within Chinese medicine. As you may have read from our website, the theories of Chinese acupuncture are based on the understanding of the body mind and emotions as a complex flow of energy called 'qi'. The distribution, balance and flow of this energy in what are called meridians or channels are what sustain us and keep us in good health. Scar tissue impacts on this flow in Chinese medicine theory as much as it impacts the physical health of an area in conventional medicine, and is especiually relevant in Chinese medicine because it is seen to impair flow. When this happens, the result is pain; a great many of the surface aches and pains which people experience often link to blockages or local stagnation, and the use of needles can often help to disperse this.

It is possible that treatment may help to restore healthy flow in the area of the operation.
 
Our best advice is to visit a BAcC member local to you for an informal face to face assessment of what might be possible. It is probable that the osteopath may know a BAcC member locally with whom they cross refer patients, and we often have very productive cross-referrals with osteopaths in cases like this where the sum  of the treatments appears to be greater than the individual parts, as the work of each enables the other to make more progress than might be achieved by a single modality.    
 

We were once asked a question about the fear of flying, which although it is not quite the same thing, can be answered in a similar way. We said:

Does acupuncture help with a fear of flying?

It was always said that if you wanted to get a straight answer from a doctor, you should ask them, 'would you be happy for your wife to have this treatment?' So, I suppose if you said to us, 'would you recommend acupuncture to overcome your fear of flying?', the answer would probably be 'no'. This is not to say that it might not work; over many years of practice we have heard of a number of almost incredible stories about changes which people have managed to make thanks to treatment, and quite often by the practitioner simply sticking to very basic traditional acupuncture. Extreme reactions of any kind are, from a traditional acupuncture perspective, indications that a part of the system is out of balance and generating inappropriate emotional or mental responses. It is sensible to be mildly apprehensive about flying, just as it is to be mildly scared of heights. If the faculty of sensible fear is out of balance, then extreme reactions abound.

However, with a problem such as this there are other possibilities which seem to us to go to the heart of the problem much more directly. Hynotherapy or CBT (Cognitive Behavioural Therapy) are both well tried approaches for phobias, with the added advantage in the case of hypnotherapy of being able to do trial runs under the power of suggestion. There are a great many forms of hynotherapy, all of which have their strengths, but those based around NLP and the work of hynotherapist Milton Erickson seem to have the most well attested handle on treating phobias.

There is no doubt that you would probably derive some benefit from acupuncture treatment in terms of a reduction in anxiety, as our factsheets show, and always the possibility that a skilled practitioner might look at your overall balance and get that feeling that there is something obvious to be done which may help. It is more probable, though, that they would do as this expert would, refer you to a trusted colleague who does hypnotherapy or CBT to ensure that your needs were skillfully and professionally met.

and we think that this probably represents the best advice we can give.

Because traditional acupuncture treats the person, not necessarily the condition they have, there is a danger that this can be re-framed as 'acupuncture can treat anything', and occasionally incautious practitioners let patients' expectations run away with them. From a Chinese medicine perspective every aspect of the human being, every inappropriate mental, physical, emotional or spiritual state, is theoretically amenable to change by treating the person as a whole. However, our clinical experience is that there are many problems, such as terminal illnesses or serious psychotic states, where expectation of recovery is virtually nil, and it is highly risky to feed the desperate need of patients with statements which might lead them to have hope where there is none. Cases like yours, although not quite as serious, nonetheless can represent entrenched patterns of thought and behaviour which require specialist skills to unravel.

We hope that you find someone who can help you. We are aware of how limiting this phobia can be.

Although we are honoured to have as members practitioners of the stature of David Mayor, one of the leading electro-acupuncturists in the UK, the range of possible users runs from people like David with 30 years or more experience in a specialist field to members who use small devices occasionally in clinic for use with musculo-skeletal problems. If we create a list it would be essential for us to set a standard which became a criterion for entry on the list, and we do not have the resources even to begin that task, let alone a realistic chance at this stage of agreeing criteria.

It is extremely important, when we make recommendations about specific techniques or members treating specific groups of patients, that we are able to say with confidence what a patient can expect. For example, we have two working groups currently developing standards in paediatric acupuncture and obstetric acupuncture so that someone visiting a member offering this as a specialist service can be assured that the member is able to bring specialist training to the table.

Unfortunately we do not think there is a likelihood in the short term of being able to offer the same kind of 'kitemarking' for electro-acupuncture. Most members within our local communities of practitioners, however, are usually aware of which of their colleagues uses EA more regularly. If this is a modality which you would prefer to have than needles alone, we are sure that you can be directed to someone who can meet your needs by contacting a BAcC member local to you and asking for their advice.

Q:  ] I had my first ever acupuncture yesterday to help relieve headaches, the physiotherapist has found some tenderness around my C2 and gave me  acupuncture behind my ear.  I felt several sharp pricks and I think a nerve may have been hit as there was a very sharp pain.  I have since developed swelling on the side of my face that had the treatment and it feels like I have been to the dentist is this normal.
>

A:  We'd be reluctant to use the word 'normal' because that would suggest that what has happened to you is a frequent occurrence, but adverse events of this kind can occasionally happen. Even the best trained and most experienced acupuncturist will occasionally hit a nerve, and the effect is usually short-lived. In rare cass it is also possible to cause slight bruising slightly deeper under the skin which can then press on the nerve and cause irritation for slightly longer. Most adverse effects subside within 24 to 48 hours and are described as transient, but those involving the impingement of a nerve can last a week or more.
 
We routinely advise patients who call us with similar stories to visit their GP if an adverse effect lasts more than a couple of days. In the case of reactions from nerves being hit the GP can make the call about whether to refer on to a neurologist. In our experience this only happens when the problem persists for a number of weeks, but it can be as well to put down a marker at about the time the problem occurs to make sure that it is taken seriously if after a longer gap a symptom persists.
 
We would not want to sound alarmist but we are a little concerned that you have experienced swelling in the face as a consequence of being needled behind the ear, and this does suggest that the physio may have caught one one of the more substantial nerves which traverse that area. If this is still the case today, it would be as well to contact the physio to explain what has happened and seek their view, and then perhaps make an appointment with your GP early next week if any effect lasts over the weekend. In our experience, though, most of these kinds of adverse events are transient.
 
This is, in fact, a point we should emphasise. In two surveys conducted a decade ago there were only 14 minor adverse events from over 66,000 treatments, and a subsequent survey of patients rather than practitioners was only slightly higher, with only one more serious adverse event reported. This compares extraordinarily well with conventional medicine, and makes acupuncture one of the safest treatments around in the hands of a properly trained and qualified practitioner. We are assuming that your practitioner is a member of the AACP, the special interest acupuncture body within the physiotherapy profession, in which case you can be assured of their standard of training.  

Q:  Can you have have the needles inserted and manipulated and feel nothing, this has happened with 3 needles in my back.? I could feel the other 9

A:  This is perfectly possible. The combination of the pressure of the guide tube through which the needle is inserted and the pencil-point tip of many needles can mean that there is no discernible feeling when a needle is inserted and manipulated. It is also important to bear in mind that the back is not the most sensitive area of the body, and the special cells which detect feeling are often more widely spaced than elsewhere on the body.
 
There are a number of different styles of acupuncture, and the range of possible sensation is considerable. Modern practice in China is to elicit a very specific response to the needling, called 'deqi', which is a rather dull aching sensation, like the beginnings of a bruise. By contrast, modern Japanese techniques are often so subtle that there is no sensation at all, and we have heard stories of Japanese practitioners apologising if a patient makes any noise when the needle is inserted. The same applies to the needle insertion itself. Japanese needles are pencil-tip shape, in contrast to the slightly rounded end of the Chinese needle, and even at 0.2 of a mm, there is a tangible difference as these needles are inserted, with the Chinese varieties more likely to be felt as they break the skin. The sensation is usually not very great or very long-lasting, however, and if a sharp pain continues after the needle has been inserted it is as well to let the practitioner know so that they can make it more comfortable.
 
In any event if you cannot feel a needle either being inserted or in place when you can feel others it is as well to let the practitioner know. None of us is infallible, and the literally pinpoint accuracy needed is not always achieved. It can also be good feedback to the practitioner about the energetic sensitivity of the area, rather akin to the famous Sherlock Holmes 'dog that did not bark.' If there is a reaction in some places and not others this may be evidence of a poor flow of energy, or 'qi', in the area which may have diagnostic significance.