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A: Your question is a little brief, and we are not entirely sure exactly what has happened.

If we are talking about a needle being inserted which then seems to fall out rather quickly, this is often to do with it not being inserted quite deeply enough, and the weight of the needle can sometimes cause it to drop out. There are also a number of possibilities that the muscles and tendons near where the needle has been placed can adjust themselves after the needle has been place in the skin, and this can dislodge a needle. It is not uncommon, for example, for people to tense up before a needle is applied, and after insertion they relax and the configuration of the muscles changes, causing the needle to be forced out.

From an energetic point of view we have heard many tales of needles being left in place for a long time and gradually working their way out as the effect they have been chosen for is achieved, and one or two reports of needles being ejected with some force for what we presume to have been energetic reasons.

In all situations like this, the simpler explanation is usually the one which one should take, and it is most probably to do with the effects of the muscles where the needles have been placed. However, if you are at all puzzled by this the best person to ask is the practitioner who inserted them. First hand evidence is much more likely to explain what has happened than our speculation at a distance.

Q:  I had an acupuncture session yesterday for severe neuropathic pain in my kneecap, which started after a spine operation four years ago. Today the pain is very much worse. Should I be worried about that or is this normal? The acupuncturist is Chinese and extremely experienced.

There is no reason to be worried. It is not at all unusual for there to be a short term reaction to treatment which can make a musculo-skeletal problem in particular feel a great deal more painful. We tend to give advice to patients that they can expect up to 48 hours after treatment of these problems during which things may get a little worse, but thereafter there should be steady improvements. These kinds of reactions tend to be more common after the first or second session while the body gets used to treatment.

There are a number of reasons offered for this kind of experience. In conventional medical terms there are often reactions in the local muscles and tendons as the physical structure starts to free up, and in Chinese medicine it is often surmised that it is the reinstatement of the flow of energy which can cause an amount of pain, rather in the way that restoring blood circulation after being cold can be quite unpleasant. It is more difficult to explain an increase in neuropathic pain in conventional terms without knowing more about the circumstances which triggered it.

That said, we always take these kinds of reports seriously. Sometimes thing feel worse because they are worse, and a practitioner will always be alert to the fact that there are a small number of patients for whom acupuncture treatment does not really work - they are sometimes too sensitive to the treatment and other options may be more suitable. However, there are a number of adjustments which a practitioner can make in technique and needle selection which may go a long way to reducing painful but transient after effects, and if treatment continues to stir things up, it is well worth talking this over with the practitioner. No responsible acupuncturist will fail to do their best to make the treatment as comfortable as possible. 

,A:  As well as producing factsheets, we also produce review papers which give our research people a chance to go into a little more depth. The menopause and its symptoms are one of the areas where they have done this, and the paper

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

makes some very positive noises about the possible benefits of treatment for hot flushes. However, the paper acknowledges that there are a few methodological problems with the field, especially since some of the studies are from China where there less interest in checking whether acupuncture works and more in working out which treatments work better. This does not meet the standards set in the West, and although we have consistently maintained that the randomised double blind control trial from drug testing does not work for acupuncture, it remains the 'gold standard.' This underpins papers like this one

http://www.ncbi.nlm.nih.gov/pubmed/23897589

which tend to portray the glass as half empty rather than half full.

The thing to bear in mind is that the Chinese have been treating menopausal symptoms for over 2000 years. Although the theoretical basis of Chinese medicine is entirely different, based on theories of energy called qi, the Chinese have found ways of understanding the process of change in middle age which underpin a number of syndromes which provide treatment options.

Naturally, these have to be adapted to the individual because from a Chinese medicine perspective everyone is different, i.e. there are no formula treatments where the same needles work for everyone. However, the standard forms of imbalance can be interpreted within the context of the individual's energy to help them deal with the symptoms which arise.

The best advice is always to visit a BAcC member local to you to ask for an informal face to face assessment of what they think may be possible. This will be far more informative than our speculation at one remove, and the practitioner will probably be able to give you a good idea of what frequency and extent of treatment may be necessary. On balance, though, most of us find that we can treat hot flushes to a degree, and the main question we have is more a matter of how much change we can effect and how sustainable it is rather than does it work at all.


Q:  Can acupuncture can be useful for back and body acne. I am having an outburst for which they prescribed antibiotic treatments, but I am looking
for an alternative valid solution. 

A:  Not surprisingly we have been asked about acne on several occasions and an example of the reply we often give is:

I suffer from a severe form of acne and have despaired of all the drugs, treatments and diets.

Q:  I suffer from a severe form of acne and have despaired of all the drugs, treatments and diets. Can I be recommended a specific practitioner with experience of treating skin conditions?

 

A:  As our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/acne.html
 
there is some evidence to suggest that acupuncture treatment may offer some hope of relief for sufferers from this condition. However, the trials on which this conclusion are based are almost all ones conducted in China and generally on a rather small scale with some methodological weaknesses, so we would be reluctant to say that you would be guaranteed positive results from treatment. We do know that it wouldn't do any harm, but after years of suffering that is not going to be a unique selling point.
 
When people approach us about skin problems we very often suggest that they consider Chinese Herbal medicine alongside, or possibly even instead of, acupuncture treatment. There is no doubt that the evidence from herbal medicine for treating skin problems in general is encouraging, and although CHM is based on the same diagnostic criteria which underpins a large percentage of conventional treatments, the fact that treatment is daily and that the herbal preparations are mixed for the specific presentation can add value to the outcomes.
 
The greater majority of practitioners on the Register of Chinese Herbal Medicine (RCHM) are also BAcC members, and the Association of Traditional Chinese Medicine (ATCM) has members who are dual qualified in acupuncture and herbal medicine. Both have websites where you can find members near to you and it is highly likely that they will be able to offer you a brief consultation without charge to give you a face to face assessment of whether acupuncture and/or herbal medicine may be worth pursuing for your condition.

We think that this remains the most appropriate advice. Since this was written, however, there has been another publication, albeit a rather dense one, which seems to make encouraging noises about the use of acupuncture treatment for acne. You can find it here:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3689157/

and although it is a hard going to read, it does cover the ground very thoroughly. As it says, more and better trials are warranted, but as a start this is promising.

 

A:  We have passed your other comment to our technical people!

On the basis of your necessarily brief description of your problem, it would seem that acupuncture may well be able to help you. The kind of tension you describe in the thigh is one which both eastern and western versions of acupuncture would recognise as something which they regard as inherently treatable. Although some of our colleagues are often quite hostile to western medical acupuncture, its theories of trigger points, muscle knots which can cause extreme discomfort, are just as plausible description for what is going on as the theories of stagnant energy, or qi as we call it, in the local area. Both systems can use roughly the same points for addressing the problem.

However, getting rid of the tension is like turning off an alarm without finding out why it went off, and any good diagnostician is going to want to know what made/makes the muscle tense up to the extent that it can then put such pressure on the knee joint. This suggests either some major postural shift or something happening to the tendons at either insertion which is not allowing sufficient expansion in the muscle fibres, and this needs to be sorted out. Certainly from a Chinese medicine perspective it is rare for a severe symptom to exist in isolation, and a skilled practitioner will usually find a pattern against the backdrop of which the emergence of the symptom makes sense.

The other issue which a practitioner may want to assess is whether cause and effect are actually the other way around, that there is a problem with the knee joint itself which manifests as a severe pain in the thigh before it becomes symptomatic in itself. We have come across a number of situations like this where the outcome has been the reverse of what we expected, and it may well be worth investigating the knee independently, especially if the pain is as severe as you indicate. We take it very seriously when people describe pain as 'suicidal'; some pains on the body are simply that unpleasant.

The best, and most frequent, advice that we give is to visit a local BAcC member to seek a brief face to face assessment of what may be possible. Most are willing to give up a little time without charge to assess whether acupuncture treatment may be beneficial. You may also want to consider a similar brief visit to an osteopath to find out whether there is any obvious change in the overall structure which is putting pressure on this muscle group.

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