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Q:  When you are having acupuncture in your back and neck should you be moved and if you are moved can this cause more problems especially if you are jolted ?

This is a matter of professional judgement for the practitioner. Best practice is not to have to move the patient at all once needles have been inserted, and to avoid any contact which moves the patient or risks the patient pushing the needle(s) in further if, for instance, he or she loses their balance in moving from a prone position to resting on the side. Apart from the obvious risks about contact with other surfaces, there are a number of compelling anatomical reasons to avoid muscular effort by the patient when needles are in place. This could force an inserted needle into a nerve or blood vessel or could in an extreme case on the thorax cause a lung puncture. The deeper the needles are inserted, the greater the risk.

That said, the majority of practitioners in the UK use very shallow needle insertions compared to some of those favoured in the Far East, with needles being as little as 3mm to 5mm under the skin, and often at oblique angles rather than perpendicularly. It may well be that a practitioner has used professional judgement in this instance because, the most likely scenario, he or she wants to needle points which can only be reached after the body has been turned slightly. This can happen if one wants to use needles on the front and back at the same time.

We suspect that your question is driven by an actual occurrence. If so, the first point to make is that the risk of any damage is very slight, and if you had experienced  any damage the chances are that it would have been immediately palpable, especially in the needle had gone into a nerve or blood vessel. The best thing to do is to ask your practitioner about what they did. If they are sound and competent they will be able to provide you with a good explanation for why they did what they did.

If you are not satisfied with the explanation that they give, or are are unwilling to take up the matter with them, it is always open to you to make a complaint to the professional body to which they belong. Complaints do not have to be seen as combative. If there are concerns about someone's standards of practice, these can be addressed in the public interest. We do not encourage anonymous complaints because there is a risk of malicious intent, but if someone does not want to make a formal complaint but merely alert a professional body to a problem, most have powers to investigate further and require members to amend their practice.

Of course, it goes without saying that all UK practitioners are properly insured, and if you have suffered damage or detriment from your treatment you can seek redress from the practitioner's indemnity insurance. Here again, a good practitioner will direct you to the appropriate person without demur; insurance is in place precisely to cover accidents and extends to malpractice and negligence.

A:  We were asked about a ganglion on the thumb some time ago, and the response we gave then is equally as valid for the treatment of a wrist ganglion. We wrote:

Long gone are the days when the treatment for a ganglion was to lay the hand flat on the table and drop the family bible onto it. Current conventional medical treatment is to aspirate the rather thick, clear jelly-like content from the cyst at a GP surgery or occasionally to have a minor operation in the hospital day surgery unit. These latter are less frequent because they are regarded as relatively low priority, and also can be quite complicated if the cyst is entwined with nerves and blood vessels, as is often the case in the wrist area.  We are assuming that you have seen your GP and had the options explained to you. If you haven't this is always a worthwhile thing to do. GPs are very adept at making judgements about what may appear to be simpler conditions which in reality aren't, and having your GP take a look is a wise move.

 
From a Chinese medicine perspective any accumulation and thickening of fluids in the body points either to a local obstruction in the flow of energy, called 'qi' in Chinese medicine, or to a systemic problem which manifests in a number of problems across the body and mind as a whole. A skilled practitioner can quickly make this determination, and treat accordingly. The greater majority of cases we come across are local problems, often caused by muscular tensions which constrict the flow of fluids and blood. Treatment can help to reduce the tension and encourage flow, but can also help to disperse the thickened fluids. From a Chinese medicine point of view these are 'stuck' qi, and needling moves the qi and reduces the lump.
 
You won't, of course, find any clinical evidence for this; it is one of the least likely problems to be researched at great expense. Our experience, however, is that acupuncture may be helpful, but we always taken into account the other factors which may have contributed to the cysts' occurrence. There may be postural reasons - work stations, frequent use of the joint in a skilled operation - which mean that the cyst will return. There may also be wider tensions and stresses in the system which again may result from lifestyle. Addressing a small problem like a cyst may not work if it is part of a wider pattern of disharmony.
 
The best advice we can give you is to seek the face to face opinion of a BAcC member local to you. Our own feeling is that if you did decide to have treatment, the results would manifest relatively quickly or not at all, and you should not get tied into a long sequence of treatment. If it does work, the question then remains about how sustainable the improvement is. If treatment is only successful for a short time, then it may be worth discussing with your practitioner whether some forms of massage may be a more effective way of addressing the problem, either Chinese massage such as tui na or orthodox massage.  
 

We think that this probably remains the best advice we can offer. What we can say is that if a ganglion is going to respond to treatment it tends to do so quite quickly; this is not a cause for taking on an extended course of treatment. The one caveat is that 'easy go, easy come' occasionally applies; the ganglion can sometimes become visibly smaller during the course of a session and carry on shrinking, only to regain its original size again later. If this happens twice in a row, we would be cautious about treating over and over again, unless of course the problem was causing such an impact on someone's life that the cost of maintenance treatment over an extended period was more than offset by the gains, however temporary.

Q:  I have had chronic pain in the testicle and area of repair following a mesh repair of an inguinal hernia 4 years ago.  9 weeks ago I had the mesh removed and a neurectomy of the illioinguinal nerve, which was supposed to sort the problem out but has not. Would acupuncture help and if so is there any particular type that would be best. Can you recommend anyone in the Leigh on Sea area who would be appropriate.

A: A great deal depends on what may be causing the pain. We are assuming that the neurectomy was selected after a very thorough neurological examination; it is not common practice to start cutting nerves unless there is a very good and clearly diagnosed reason. On the assumption that this nerve corresponded to the area in which you were and still are experiencing pain, then there may be a small chance that acupuncture treatment may be of benefit.

Acupuncture treatment does have a general pain-relieving effect which has been the object of a great deal of study over the years, as our factsheet on chronic pain shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

The chemical markers for pain relief, the neurotransmitters, are easily measured to provide an objective marker of whether something is happening. The main question with treating at this kind of generic level is how much relief the treatment may give and how sustainable the relief is. In many cases this comes down, unfortunately, to a financial question: is the treatment affordable and worthwhile when the cost is set against the relief.

However, the understanding of the body as a system of energy in flow which underpins traditional Chinese medicine does afford other possibilities for consideration. Like any enclosed and self-contained system, if there is damage then where the flow is impaired pain will arise, either from a deficiency or excess of energy in the area, or through the stagnation in the flow. Using needles this flow can be reinstated, and the pain reduced or removed. Sometimes the very fact of surgical incision can create a blockage, as can the formation of scar tissue. This can sometimes have effects some distance away from the scar tissue itself. Treatment is often a mixture of local treatment and treatment some distance away, although we can reassure you immediately by saying that there are no acupuncture points on the testicle or scrotum! There are, however, points on the lower leg a which refer directly to this area, and these may come into play.

The best advice that we can give is to visit a BAcC member local to you for an informal assessment of what may be possible. Although we can be quite confident about the treatment of conditions which we often see it is far more difficult to offer opinions on unique presentations like yours. However, a skilled practitioner may well be able to make a few diagnostic soundings which can tell them how likely it will be to help your problem.   

Q: I'm now 5 weeks into my course for migraines and all been going well. However I still have pain  from my treatment 8 days ago. It's just above my
temple and makes me wince when washing or brushing hair etc. what is this and what should I do ? 

A:  The most frequent cause of the pain which you describe is that a needle has caused a small bruise beneath the surface of the skin which has not, and may never, be visible at the skin surface. You would certainly experience discomfort if this proved to be the case, and it might last for up to a couple of weeks. The bruising may cause a slight impingement of a nerve when pressure is applied.

The other slightly more remote possibility is that the needle used has just caught a small nerve caused minor damage. This would be more likely to cause more random occurrences of discomfort rather than simply as a reaction to pressure.

In any event, if the problem continues beyond a second week then it is worth investigating further, and you may well want to arrange a visit to your GP. At this stage they would probably do no more than keep an eye on what is happening, but it would at least place you within the system for potential referral on.

The other thing to do, of course, is to discuss this with your practitioner. They will know exactly what they did, where they placed needles and to what depth, and can see if the problem is related to treatment. It very likely is, but we have seen occasions where a problem has randomly arisen near where acupuncture was administered and arguments have kicked off about whether it was caused by treatment while the problem itself was not being properly addressed. Our view is that it is best to establish and deal with what is happening first before starting to apportion responsibility.

Judging by what you say, though, it is most likely to be a short term transient adverse effect of the treatment and will clear of its own accord within a few more days. Hopefully the treatment of your migraines will continue to show improvements, too; we certainly hope so.

A:  We are somewhat surprised at how infrequent the requests have been for advice on sinus problems given the frequency with which they turn up in clinical practice. The last answer which we gave quite a while ago was:

Would you recommend an acupuncture for sinus problems?

A: We are assuming that your question is about whether we think acupuncture would be good for sinus problems. As our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/sinusitis.html
  
the evidence from the few trials there have been of sinus problems have not been that encouraging. This reflects the clinical experience of many practitioners, that sinus problems can be intractable and defy all attempts to relieve them. It would be good to be able to conclude that surgical options like rhinoplasty and sinus washes were the best alternative, but many acupuncture patients who come to treatment with sinus problems find that surgery has only offered temporary relief.
 
A great deal depends on the wider backdrop of your health against which the problems can be seen. Chinese medicine looks at the whole picture of someone's health, and it would be unusual for someone to be troubled by a single, quite unpleasant problem without their being other health issues, even if these are not particularly troublesome in themselves. It is this whole complex picture which can give the practitioner a better idea of what is happening and by the same logic a better idea of how difficult or how straightforward it will be to treat a problem. The best advice is to visit a BAcC member local to you so that they can offer a better assessment based on a face to face chat.
 
What we often find, however, is that there is often a lifestyle factor such as diet which is at least contributory to the problem. Many people eat a great deal of dairy produce in the form of milk or cheese, and this can often have aa significant effect on the body's fluids, from a Chinese medicine perspective making them more thick and less free-flowing. Cutting out some of these foods can often have a profound effect. A practitioner would very quickly be able to assess whether this was the case, and also consider other common contributory factors.   

We think that this still remains pretty good advice. Each person is unique and different from a Chinese medicine perspective, and there are occasions when it becomes clear very quickly that the sinus problems have an obvious cause which is responsive to treatment. More often, though, people usually come to acupuncture treatment when the problem has existed for some time, and by this stage  it has actually become a more fixed problem in itself, whatever the original cause. Your best bet is, as we said in the earlier response, to visit a BAcC member local to you for a more informed assessment based on seeing what is actually going on.

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