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Although we are honoured to have as members practitioners of the stature of David Mayor, one of the leading electro-acupuncturists in the UK, the range of possible users runs from people like David with 30 years or more experience in a specialist field to members who use small devices occasionally in clinic for use with musculo-skeletal problems. If we create a list it would be essential for us to set a standard which became a criterion for entry on the list, and we do not have the resources even to begin that task, let alone a realistic chance at this stage of agreeing criteria.

It is extremely important, when we make recommendations about specific techniques or members treating specific groups of patients, that we are able to say with confidence what a patient can expect. For example, we have two working groups currently developing standards in paediatric acupuncture and obstetric acupuncture so that someone visiting a member offering this as a specialist service can be assured that the member is able to bring specialist training to the table.

Unfortunately we do not think there is a likelihood in the short term of being able to offer the same kind of 'kitemarking' for electro-acupuncture. Most members within our local communities of practitioners, however, are usually aware of which of their colleagues uses EA more regularly. If this is a modality which you would prefer to have than needles alone, we are sure that you can be directed to someone who can meet your needs by contacting a BAcC member local to you and asking for their advice.

Q:  ] I had my first ever acupuncture yesterday to help relieve headaches, the physiotherapist has found some tenderness around my C2 and gave me  acupuncture behind my ear.  I felt several sharp pricks and I think a nerve may have been hit as there was a very sharp pain.  I have since developed swelling on the side of my face that had the treatment and it feels like I have been to the dentist is this normal.
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A:  We'd be reluctant to use the word 'normal' because that would suggest that what has happened to you is a frequent occurrence, but adverse events of this kind can occasionally happen. Even the best trained and most experienced acupuncturist will occasionally hit a nerve, and the effect is usually short-lived. In rare cass it is also possible to cause slight bruising slightly deeper under the skin which can then press on the nerve and cause irritation for slightly longer. Most adverse effects subside within 24 to 48 hours and are described as transient, but those involving the impingement of a nerve can last a week or more.
 
We routinely advise patients who call us with similar stories to visit their GP if an adverse effect lasts more than a couple of days. In the case of reactions from nerves being hit the GP can make the call about whether to refer on to a neurologist. In our experience this only happens when the problem persists for a number of weeks, but it can be as well to put down a marker at about the time the problem occurs to make sure that it is taken seriously if after a longer gap a symptom persists.
 
We would not want to sound alarmist but we are a little concerned that you have experienced swelling in the face as a consequence of being needled behind the ear, and this does suggest that the physio may have caught one one of the more substantial nerves which traverse that area. If this is still the case today, it would be as well to contact the physio to explain what has happened and seek their view, and then perhaps make an appointment with your GP early next week if any effect lasts over the weekend. In our experience, though, most of these kinds of adverse events are transient.
 
This is, in fact, a point we should emphasise. In two surveys conducted a decade ago there were only 14 minor adverse events from over 66,000 treatments, and a subsequent survey of patients rather than practitioners was only slightly higher, with only one more serious adverse event reported. This compares extraordinarily well with conventional medicine, and makes acupuncture one of the safest treatments around in the hands of a properly trained and qualified practitioner. We are assuming that your practitioner is a member of the AACP, the special interest acupuncture body within the physiotherapy profession, in which case you can be assured of their standard of training.  

Q:  Can you have have the needles inserted and manipulated and feel nothing, this has happened with 3 needles in my back.? I could feel the other 9

A:  This is perfectly possible. The combination of the pressure of the guide tube through which the needle is inserted and the pencil-point tip of many needles can mean that there is no discernible feeling when a needle is inserted and manipulated. It is also important to bear in mind that the back is not the most sensitive area of the body, and the special cells which detect feeling are often more widely spaced than elsewhere on the body.
 
There are a number of different styles of acupuncture, and the range of possible sensation is considerable. Modern practice in China is to elicit a very specific response to the needling, called 'deqi', which is a rather dull aching sensation, like the beginnings of a bruise. By contrast, modern Japanese techniques are often so subtle that there is no sensation at all, and we have heard stories of Japanese practitioners apologising if a patient makes any noise when the needle is inserted. The same applies to the needle insertion itself. Japanese needles are pencil-tip shape, in contrast to the slightly rounded end of the Chinese needle, and even at 0.2 of a mm, there is a tangible difference as these needles are inserted, with the Chinese varieties more likely to be felt as they break the skin. The sensation is usually not very great or very long-lasting, however, and if a sharp pain continues after the needle has been inserted it is as well to let the practitioner know so that they can make it more comfortable.
 
In any event if you cannot feel a needle either being inserted or in place when you can feel others it is as well to let the practitioner know. None of us is infallible, and the literally pinpoint accuracy needed is not always achieved. It can also be good feedback to the practitioner about the energetic sensitivity of the area, rather akin to the famous Sherlock Holmes 'dog that did not bark.' If there is a reaction in some places and not others this may be evidence of a poor flow of energy, or 'qi', in the area which may have diagnostic significance.   

Q:  I've just started acupuncture at my local hospital and I feel worse.  Is it true you can feel worse, before you get better? How many sessions should I try before giving up as the person treating me reckons it's not working?   I suffer from chronic fibromyalgia with leg weakness and tremors. I feel even more tired than I did before and the pain, especially on the day after the treatment,  is worse.  I have been 3 times;  1st session two needles were placed as I have allergies to certain metals, 2nd session 5 needles hands head and feet 3rd session 6 needles hands head & feet.

A:  We are sorry to hear that you haven't been making much progress, but in our experience fibromyalgia can be a difficult condition to treat. As our factsheet shows

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

there is not a great deal of evidence which would mean that we could say with confidence that acupuncture treatment will work. However, as the factsheet remarks, we are always up against a problem with the way that trials are conducted, and the fact that the so-called 'sham' treatment works as well as the 'real' treatment. From a Chinese medicine perspective, there are no points on the body which don't work at all - everything is made up of energy, called 'qi', and the classically recognised points are simply the most effective places to achieve change.

Anyway, to more specific questions, we usually recommend that someone has four or five sessions if there is any doubt about whether treatment will be effective, and to review progress at this stage. This does mean that you need to have in place some very clear outcomes or markers for what counts as getting better. The trouble with fibromyalgia and similar conditions is that on some days you can feel fine and other days be in considerable pain. It is difficult to get an objective measure, but if there are things which can be measured, such as distance walked or time slept, or painkillers reduced, these can sometimes provide evidence that there is some progress. We are a little surprised that the person treating you is concluding already that nothing is happening, but there are signs which show how well, or indeed if, someone is reacting to treatment, and if these are unchanging, that might be the basis for her view. There are a small number of patients whom one knows almost from the off are not benefiting.

It is also possible in the early stages of treatment to feel worse rather than better, although in our experience this usually only lasts for about a day or two at most, and if someone feels worse for longer than this we tend to look at what else is going on. Your mention of allergic responses is an interesting detail, and there is a small question mark about whether the needles themselves are triggering a reaction. Though unusual, it can happen, and allergic responses can persist. However, in conditions like fibromyalgia and polymyalgia, the persistence of the condition can often mean that the feeling of being slightly worse can persist for quite a while too, so it may simply fall within what is sometimes called a healing response, and be perfectly normal. However, after four or five sessions this should not really continue, and if it does, then it calls into question whether it is worth continuing with treatment.

The one factor which we cannot explore with you for want of detail is the fact that you are having the treatment in hospital. This might mean that you are being treated in a pain clinic or by a hospital physio, and while we are always happy that other healthcare professionals spread the word about how acupuncture works, from a Chinese medicine perspective traditional acupuncture is a very subtle and sophisticated art which relies as much on treating the person as the problem with which they present. In some cases, the kinds of formula treatment which people using western acupuncture or cookbook treatments apply may not be sufficiently geared to the highly specific nature of why someone is experiencing their symptoms. Our concern is that this leads someone to conclude that acupuncture does not work when in the hands of a full time professional practitioner using traditional acupunctur eit may well be possible to achive progress.

The best advice always in these situations, though, is to discuss these issues with the practitioner herself. Whatever system of treatment she is using, she will have a very clear idea based on what she sees and feels of whether the treatment is having an effect, and she is best placed to address your concerns.

There has been an upsurge over the last few years in what has been described as 'cosmetic acupuncture' or 'facial revitalisation acupuncture'. With it has come a rather hot debate inside the profession, not least because some of the clinics where this technique is used charge fees that are considerably higher than the average fee charged by a BAcC member, and also because some of the people offering this treatment are not fully qualified practitioners but simply beauticians who have undertaken short course training.

Our general position is that there is not a specific separate discipline of cosmetic acupuncture but rather the application of traditional techniques on the face adapted for a specific purpose, but, and most importantly, taking into account the system as a whole as traditional acupuncture does. We have taken great care to get the message across that a properly trained traditional acupuncturist treats the person as a whole, not simply a named condition or a single part of the body, and that unless treatment is undertaken in this way, there can be no guarantees that short term local results can be be sustained.

We are also keen to get across the message that however limited the area of interest, acupuncture remains acupuncture wherever it is performed on the body, and our members undergo three years of degree-equivalent training to ensure that they are safe and competent and fully aware of factors affecting the safety of the patient. We do not believe that someone undertaking a short training over two weekends can realistically hope to match this level of safety training as well as learning the techniques. This is especially the case with some of the techniques commonly used in cosmetic acupuncture which are not a part of the standard protocols for body acupuncture.

We do not keep a separate register of our members who offer this type of treatment. The best bet would be to use google to identify someone in your area providing this style of treatment and then cross-refer with the BAcC Register to ensure that it is someone who is properly trained and insured.

As a general comment, though, we would want to have a look at what in your life was contributing to your wrinkles. If you are under constant stress and worry, there may be systemic treatments to help you to cope better with either in such a way as to reduce your wrinkles. We always ask whether wrinkles go when people are on holiday. You'd be surprised how many people say that they do. If so, local treatment will not be a proper solution to the problem unless it is supported by treatment of the system as a whole.