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A:  I had my first acupuncture session a week ago and after the session I noticed some localised swelling at the point between the thumb and index finger on both hands.  After a few hours it  had gone. However, my second session took place two days ago and the swelling is back in my right hand (between thumb and index finger) and hasn't gone down at all. It is quite tender and feels a little weird. Also things like writing now feel a little numb too. Will this swelling reduce over the next few days?

Generally speaking, after effects of the kind you describe, what we call transient adverse events, resolve within 24-72 hours after treatment. The area of the point where you were needled is rich in blood vessels and it is not unknown for a small bruise to be formed under the skins which can cause considerable swelling and look quite dramatic when it comes out. The thumb joint is in constant use in the average day, and this is clearly going to impact on a whole hist of activities. The swelling is going to be pressing on some of the nerves in the area and causing what is technically called impingement, leading to numbness and loss of sensation, and occasionally slight weakness in performing standard operations like writing.

The sensation should, as we have said, already be starting to subside and we would anticipate by the weekend will be back to normal. However, the fact that the same point has generated the same reaction twice in a row suggests that either you are being needled too vigorously or that you have a slightly raised tendency to bruise. If it is the latter then this is something which we assume you would have mentioned and/or just seem this event as another version of a common problem, so we suspect it is the former. It is very important to let your practitioner know what has happened and if need be ask them not to use this point again until it has healed fully, and then with as little needle action and depth as possible.

In the unlikely event that the problem persists into the beginning of next week without manifest sign of bruising, it may then be worth touching base with your GP to have a good look at it. There is very little they are likely to do in the short term, but it marks the spot in case the problem continues and shortens the timescale for onward referral to a neurologist. This is highly unlikely, though; there have been very few reports of permanent or semi-permanent damage at this point site, but we have seen several patients over the years who have bruised very colourfully because of the nature of the tissue into which the needle has been inserted. 

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.

 

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