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Q:  After my first acupuncture treatment  I was lightheaded and fatigued. I went  home and rested after which I  went from hot to cold with soreness around my  left ear. Is this normal?

There are a number of short term after effects from acupuncture treatment which are common enough for us to mention these in the after-care advice leaflets which many practitioners offer to patients. Light-headedness and fatigue are relatively frequent after effects, and both will usually subside within 24 hours. On occasion the feeling of fatigue can continue for a while longer, but this should be relatively predictable from the case history. If a patient has, for example, been working flat out in a very stressful job for many months or has been through an emotionally difficult period, it is not unusual for the body to play catch-up in the sleep and rest which it has missed. This can mean that the process of turning things around initiates a period of tiredness.

The feelings of hot and cold are also a possible outcome from treatment. In Chinese medicine there are some very clear patterns which accompany the release of blocks and pathogens from the system, especially if someone has had a number of colds or infections which the body has failed to clear, and variations in temperature can occur. There is also in Chinese physiology an Organ responsible for maintaining the body's temperature, but since this is related to the whole system it may have a slight hiccough in maintaining balance while the whole system is adjusting.

The soreness behind the ear is more unusual, and we would need to know a little more about which needles were inserted where. If needles had been placed there it would be not unusual for there to be a palpable feeling for a day or so. If needles were placed elsewhere there may be a connection between the points and the other parts of the channel on which they lie, several of which run behind this area. The best person to ask is your practitioner; he or she will be able to explain this far more fully and be more than happy to do so.

In the vast majority of cases short term side effects disappear within a couple of days at most. We sometimes talk of treatment being like dropping a stone in a pond and causing ripples which eventually subside and then let us see what the picture is like after everything has stilled again. Most people, we find, only get these reactions in the first couple of sessions. After the system gets used to treatment, reactions tend to be less obvious, and where they do continue the practitioner cna then adjust the treatment to make it more comfortable for the patient.

Q: I have pins and needles in my lower legs and feet.  I am an NHS patient, not covered by private medical insurance.  I have received physiotherapy treatments to strengthen my knee  ligaments. I would be interested in accessing acupuncture for the relief of pain and discomfort. Could my GP practice make a referral ?

We're sorry to say that we think that it is highly unlikely that your GP surgery will be able to make a referral within the NHS. The provision of acupuncture is somewhat random, and depends to a large extent on individual healthcare professionals extending their own personal scope of practice. If you happen to get lucky, and your GP surgery happens to have a partner, salaried GP or locum who has trained in acupuncture you may get a referral within the practice.

To get a referral outside the practice would be difficult for another reason. Generally speaking, GPs have to refer to treatments for which there is a proven evidence base. From a conventional medical perspective this involves testing therapies against a standard which is largely unfeasible for healthcare practices which are not drug-based. As a consequence the number of conditions for which a GP could make a legitimate referral are few and far between.

Leaving aside the problems of getting NHS-funded treatment, we believe that acupuncture treatment can often be very effective for the short term relief of pain and also for the kinds of neuropathic pain from which you appear to be suffering. Mention of your knee, however, makes us wonder whether there has been some sort of structural change or accident which the physiotherapy is aimed at helping, and this would have a significant bearing on what may be achievable.

Normally we would recommend that people visit a BAcC member local to them for advice on whether acupuncture might be beneficial, or whether a treatment which looked at structural issues like osteopathy might not be a good starting point. Clearly our members are not treating free at point of delivery and have to make a living like everyone else, but most are happy to respond to cases of individual hardship and prepared to make concessions. It's just that most of us don't advertise this because it is rarely the people who need them who ask but often the people who don't but like to drive a bargain. Living In South East London gives you a vast range of choices, as you will see if you use the 'find a practitioner' facility on our home page.

You may also find listings for multibed clinics on this website, http://acmac.net/acu/, which is a sub-group of mainly BAcC members committed to making acupuncture more widely available to people who might not otherwise be able to afford it.

Q:  When I left my  acupuncture session, I found a needle left in the top of my head. I pulled it out, and had slight bleeding. Now the
area is sore.  Should I worry?

Let's start off by saying that there is very likely to be any risk from what has happened. Needles are not usually left in place for a very long time, and when they are removed the skin's natural elasticity tends to close the 'hole', which is why there is rarely any bleeding after being needled. However, if a needle is left in place for a very long time, this seems to increase the risk of a small drop of blood being released, almost as though the skin has got used to the new arrangement and takes a while to recover.

As for soreness it is highly probable that the needle has moved around a little more than usual as you have moved, and there has probably been a little bruising at the site, which will feel uncomfortable. This will probably last for 24-48 hours at most, or even less. If it continues beyond that point, then it may be worth visiting your GP for reassurance, but the chances are that there will only be the tiniest mark where this has happened. You can always check, though, by using a mirror or by asking a friend to have a look for you.

As for greater damage, had the needle been pushed into the head any further by your movements you would certainly have felt it. The head is also very well protected; there isn't the slightest chance that a needle could penetrate the skull. The needles are usually no more that a quarter of a millimetre in width and very pliable; they bend before they go through solid material.

Accidents like this are unusual, but we have to say that a needle left in the head is one we particularly caution members about. There is a commonly used point right at the top of the head, and unless the patient is bald it is very easy to overlook that it has been placed there. This, however, is why we have very clear rules about counting needles out and counting them back in again. This is something which you should report to your acupuncture practitioner immediately or at the next session you have. They need to be aware that they have done this. You may also want to contact the professional body to which they belong. While it may be a little over the top to make a formal complaint, there is no doubt that they will want to hear in case this forms a part of a pattern of careless work. It may also serve to inform their work with their membership as a whole if it turns out that the current warnings are not having the desired effect.

In summary, we are sorry to hear that this has happened to you. There is very little risk that it will have serious consequences, but these sorts of accidents can be quite distressing, and practitioners try to be as careful as possible to make sure that they do not happen.

Q: I have neuropatic condition symptoms -  itching, prickling, stabbing pains in my  back .  Would acupuncture help these conditions?

A: A great deal depends on the exact nature of the neuropathic condition. Some, like shingles/herpes zoster for example,  are from both a conventional and chinese medicine perspective difficult to treat once they have become entrenched. Rapid treatment after their onset can often achieve quite a great deal from both perspectives. Other neuropathic pains can result from disturbances of the structure of the body, like problems with vertebral discs, and these can equally be a challenge. If the pain arises from a structure problem then the limit of what is possible may be a short term reduction in the pain.

Indeed, acupuncture has a long history of being used for pain relief and for this to be heavily researched, mainly because the variables in the body's chemicals can be precisely measured and the patient's responses easily assessed. The question here is how much relief and how sustainable, and then how affordable.

Without knowing a great deal more about the precise nature of your systems and the overall picture within which they present it is difficult for us to say more. However, we have to say that the system of Chinese medicine is very different from conventional medicine, based as it is on a belief in an energy called qi which makes up the body in all its aspects and on the regular and harmonised flow of that energy in defined channels. When there are disturbances in the energy symptoms appear, and the precise nature of the symptoms points to specific problems in the flows of energy. This in turn often points to systemic imbalances and a practitioner will often find that a patient has a number of signs and symptoms to accompany the pains and which point to a treatment strategy.

Of course, the only way to make this determination is for a practitioner to look at the patient, and you will almost certainly find that any of the BAcC members local to you will be more than happy to give up a little time without charge to assess face to face what is going on and give you an idea of whether acupuncture treatment may help, and if so how much may be necessary.

Q: I have been diagnosed with tendinitis of the ankle/foot . It is very disabling . The doctor told me that the only cure is rest. Would a course of acupuncture help?

A:  We have to be honest and say that this is one of the areas of treatment where the formal evidence is not that good but the evidence by word of mouth from practitioners is pretty good. We have done the usual searches of databases to see if things have changed much from the last time we answered questions about tendonitis in the Achilles tendon, and the answer is 'not much.' There are quite a few studies of tendonitis in  various areas of the body, and both these and the systematic reviews tend to conclude that evidence looks promising but that larger and better trials may be necessary. There are frequently criticisms of the trial methodologies which are often used to undermine the provenance  of their results.

However, from a Chinese medicine perspective the proper functioning of tendons, their flexibility and strength, is seen to be a part of the wider functional responsibilities of some of the Organs (these are capitalised to distinguish them from organs as we understand them in the West) . If there is a functional disturbance of an Organ which could impact on the tendons, then it is highly probable that a skilled practitioner will see further evidence of Organic failure, and by treating the system as a whole begin to restore balance and proper function. Even where this is not the case, the theories of the flow of energy in channels known as meridians means that there are sometimes local blockages, occasionally bilateral, which can impair the nourishment of local tissue and cause weakness and pain.

We think the best advice we can give is that you see if a BAcC member local to you is happy to give up a small amount of time without charge to give you a brief face to face assessment of what might be possible. Most are only too happy to do this, and if they think that they can help they will give you an idea of what might be involved in terms of frequency and cost of treatment. They may also recommend other modalities which may help. We have seen many patients benefit from reflexology either alongside or instead of acupuncture treatment, and some forms of massage can also be very helpful.

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