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Q:  I have had two spinal fusions (the second one through the stomach) due to different men running into me and then I fell down a flight of stairs so I have torn thumb ligaments and much back pain and sciatica down the left leg. I had acupuncture about 4 days ago, mainly for the back and sciatica, but, ever since I went, my legs are so painful, especially my right knee and at times it feels like the sciatica shifted to the left side and sometimes down both legs. I have had so much pain on the left for so long that now it hurts a lot! Especially if I walk or stand, then both legs are so painful! I keep thinking it like a positive shift and energy, but, it's new pain and I've been through SO MUCH! Help??

A:  We are very sorry indeed to read of your problems; you have had some very great misfortunes, by the sound of it.

 As far as your current problem is concerned, there is no doubt that when we start treatment for someone with lower back and sciatic nerve problems there is a very strong chance that the symptoms will become worse, and sometimes even transfer to the other side. We routinely warn people that there may be as much as two to four days of disruption after a session, and that they will only start to see progress when this has settled down. We are not alone in doing this; chiropractors and osteopaths do the same.

 Quite often it is the functional nature of the treatment which we do which causes the disruption. Once the musculature of the lower back starts to behave as it should it allows for the physical structure to re-establish itself. This can cause some muscles which have been allowed to work in advantageous conditions to tighten, and tight muscles to relax, both of which can cause pain. The change in physical structure which this creates can also put pressure on surrounding tissues and create different sensations when this settles itself into place.

 The only caution when treatment someone with spinal fusions is that the muscle tension from which they suffer is actually because the muscles are performing a useful job. Allowing these to relax is not only going to cause pain but may even cause new pains. Most practitioners assess carefully whether there is such a risk before treatment begins.

 

If the symptoms have abated by the time you read this, it will mean that the effects were transient and that you are very likely to begin to experience some improvements. If they are continuing, then you need to discuss with your practitioner what the next best step is. There are all sorts of reasons why a treatment can disrupt a system - too many needles, too much needle manipulation, too many needles close to an inflamed site - and a practitioner has a number of practical possibilities to consider and employ.

 Moving symptoms from one side to another is not unknown with sciatica, though, and does imply that the body is trying to correct its overall structure. This may well be a positive sign.

    

Q: In the last year I have been diagnosed with an inherited condition called spino cerebellum atrophy 6 (SCA6). One of the symptoms is nystagmus which sometimes means reading is difficult. Could acupuncture or acupressure help with either condition? If so, is there a practitioner in West London who might specialise in such conditions?

A:  We are always a little wary about answering questions about hereditary conditions, especially ones like yours where the condition is genetic and where there are few recorded instances of reversal of the symptoms, although several accounts of supportive treatments which reduce the rate of deterioration.

 The reason that we are cautious is that from a Chinese medicine perspective, where there was and is no concept of genes but often a very strong sense of patterns of energy being passed down from generation to generation, there are occasions when a hereditary pattern like migraine or asthma can be addressed successfully when the energetic 'glitch' is treated. However, our practical experience is that where the conditions are genetic and inherited, rather than energetic dispositions to certain problems, there is less chance of success. You can find a number of Chinese studies of the treatment of cerebellar ataxia which make very encouraging noises, but these are mainly stroke or accident related occurrences which have a more obvious and potentially treatable cause.

 Having said all that, there is no doubt that many of the symptoms of conditions like SCA6 can be successfully mapped onto the diagnostic categories of Chinese medicine, and it may be possible to help reduce the severity of some of the effects of the condition. A great deal depends on the causal pathway. There are occasions when the symptom is not a directly caused problem but the consequence of an earlier part of the 'chain' being disrupted. If this is so, then treatment may be worth considering, even if only for the fact that the general well-being associated with the use of traditional acupuncture may make someone's attitude and response to their condition improve.

 We think the best thing to do, given that we are not in a position to assess the Chinese medicine diagnostic patterns or the symptom presentation that you have, is for you to visit a BAcC member local to you for a brief informal assessment of what may be possible. Most of us are happy to give up a small amount of time without charge to assess whether treatment would be worthwhile, and this gives the patient a chance to meet the practitioner and see where they work before committing to treatment. There are no specialists in this particular field, or indeed in very few fields with the exception of paediatrics and obstetrics. Chinese medicine is by its very nature generalist, and all of our members are equally well qualified to treat the greater majority of patients who come to their clinics. 

 The one thing we would say, though, is to try to set measurable outcomes if you do decide to have treatment and to ensure that progress is reviewed regularly. It is quite easy to run up a large number of treatments without realising one has done so, and if there has been no real progress this can be a cause of some frustration. Better, in our view, to keep a careful eye on progress, or lack of it, and make decisions about carrying on on a clear basis.

A:  There are many ways of assessing whether a treatment has achieved anything. Many patients have a 'headline' condition for which they have sought treatment, and if this is the sole determinant of success, then we would have to say 'it depends what this condition is.' Some conditions do move slowly towards being cleared and there is a sense of progression - a backache not lasting as long as usual or needing as many painkillers, a migraine that is less frequent. In some cases, however, a problem can remain much the same until the change reaches a tipping point after which progress is discernible and quite often rapid. Knowing which is the more likely reaction is guesswork, and although nothing may have shifted yet there is often diagnostic information which points towards a likely change.

This is where secondary information plays its part. Quite often people have what we might regard as second-string conditions, ones which would not have seen them seeking treatment but are nonetheless a nuisance. It is quite common for someone to report that a problem like acid reflux or poor sleep has resolved, and this can often be an indicator that the main problems are likely to shift.

Many patients also report a more general and diffuse sense of 'feeling better in myself' which, vague as it sounds, is often a really goo indicator that there are some significant changes in progress.

The bottom line, though, is that there comes a point where we all have to admit that the treatment is changing things enough or at all, or the changes are short-lived, and the challenge then is to use the evidence of what has happened and reactions to treatment to determine what may be the next best option to pursue. Your practitioner should be only too happy to sit down and review progress with you, and tell you what they have found in your energies and what they think the prognosis is. If they are convinced based on what they have seen that the treatment will work, it is important to set a limit at which you review the decision to continue.

It may also be important to review the markers for progress which you have adopted. These sometimes need to be really clear to record exactly what may be happening. People occasionally make a little more progress than they think, and clear outcome measures are essentaial to establish this.

A: There isn't actually a great deal of evidence for the treatment of COPD as our factsheet

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1587-copd.html

 shows. If you click on this link and then click on the 'evidence' button you will see that there hasn't been a great deal of research, and it only cites a trial from 2004 conducted by George Lewith and a systematic review from a few years ago. There has been another systematic review published more recently

http://www.ncbi.nlm.nih.gov/pubmed/25478799

 and evidence that another is about to be done, so there is clearly a great deal of interest. This is probably because COPD rates as one of the more frequently occurring and debilitating problems, and anything which can help is worth investigating. Acupuncture treatment has shown encouraging signs of helping existing treatments to be more effective, so larger studies may well follow.

 Of course, this is the problem as seen from a conventional medical perspective, and one of the factors which makes the research so difficult to organise is that there are many possible causes, some of which are more tractable to treatment than others. If, for example, someone has smoked for fifty years or has emphysema then the potential for improvement is severely limited. If the obstruction is more transient, like excessive phlegm or poor lung function, then there may be more that can be done. The great strength of Chinese medicine is that it looks at the symptoms which someone has in the context of their overall health, and also has a number of different ways of viewing the same symptom pattern. This means that the treatment is very much geared to the individual, and not simply a protocol based on the symptoms alone.

 A great deal depends on the reasons for the development of your COPD, so it would be unwise to start making too many promises about what may be possible. Your best bet would be to visit a local BAcC member for a brief face to face consultation to get advice on what may be possible. Most members are happy to see someone without commitment for a few minutes to assess whether acupuncture is the best treatment for them.

 We think, though, that the advice is likely to be very realistic. Once someone has been diagnosed with COPD it is for the most part a matter of getting worse slower rather than getting better, so outcomes have to be realistic from the off.

 

Q:  I have bad sciatica had 3 visits to a chiropractor and started to feel a bit better  yesterday.  I was given acupuncture in the bottom of my spine.  The needles caused me a lot of pain when inserted and since then I am in so much pain feeling  like raw nerves -  is this normal ?

A:  We would hesitate to use the word 'normal' in circumstances like this but it can happen.

 There are two possibilities. First is that the treatment has caused an exacerbation of the original problem. This can happen with treatments for back, neck and sciatica types of pain, and if this is the case then the feeling will subside within 48 hours, or by the time you read this reply. Many health professionals like us, osteopaths and chiropractors do warn people that this can happen, and take it as a good sign that the treatment has 'engaged'. 

 The reaction is not usually that severe, however, normally the existing problem plus a bit more, so we suspect that the problem may well have been caused by the treatment. Chiropractors are not within the mainstream of acupuncture practice within the UK, and many learn small amounts of acupuncture for treating specific problems within their scope of practice. This can mean that there use of needles is slightly more hard-hitting than, say, a traditional acupuncturist who is trying to move energy. Trying to get a neuro-physiological effect can sometimes mean using thicker needles and deeper insertions, and with that the risk of a bruise or a slight nerve impingement increases considerably. This does not usually mean permanent damage; even when people do suffer treatment injuries very few indeed cause more than a short lived problem. It does mean, though, that there can be a very different kind of post treatment pain, often sharp and severe.

 The best thing to do is to discuss the problem with the person who gave you the treatment to see if they can provide any illumination about where they were needling, how deeply and with how much manipulation, to get a sense of what damage might have been caused and how quickly it will resolve. If it carries on for a week then it would be advisable to arrange a GP appointment for the doctor to have a look at what is going on, and possibly prescribe some pain relief.

 The chances are that the reaction is the former. We certainly hope so, and this will mean that it has resolved by the time you read this. If it hasn't, then it would warrant further investigation

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