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Q:  I've had one session of acupuncture done for the first time ever. I had the needles pretty much all over the top of my body including the temples.  Two  weeks on and I am now experiencing this pressure on my temples almost like someone is pressing each side with their thumb.  Is this normal, I feel really worried about it as I never had this sensation before.

A:  The first thing to say is: don't panic! Adverse events and injuries after acupuncture treatment are very infrequent, and those which do occur tend to be short-lived and relatively minor. Having said that, to have an off feeling two weeks after treatment is slightly unusual, especially on both sides of the head. 

There are two distinct possibilities. The first is that the practitioner has inserted needles quite deeply in this area and there has been bruising a little way under the skin which has not yet, or may never, appear on the surface of the skin. There are a many blood vessels and nerves travelling in this rather confined area, and slight pressure on any of them can feel very painful, sometimes out of proportion to the amount of tissue damage. The fact that it has appeared on both sides is unusual - bruising is not that common - but if someone is using a fairly heavy needle technique or inserting the needle quite deeply ot is not impossible to generate identical bruises on both sides at once.

The other possibility, and one which we might perhaps consider more likely, is that the treatment has caused a blockage in the flow of energy. From a Chinese medicine perspective pain arises when the flow of energy in the channels is either in excess, deficient or blocked. Needles help to correct these problems, but cam sometimes also cause them unwittingly. If the overall flow is quite weak and is suddenly stimulated it can occasionally reveal where things are blocked 'downstream', as it were. A good analogy is a blocked gutter on a house. When the rain is light, it can just about cope; when the rain is heavy, it overflows.

The best resource that you have in this case is the practitioner him- or her-self. Knowing exactly which points were used, and what the overall balance was, as well as the symptoms which made you seek treatment, will all help to pinpoint exactly what is going on. We are a little surprised that it is a fortnight since the treatment was done, and aren't sure whether you mentioned this when you went back after a week, often the normal interval at the beginning of a course of treatment, or whether you weren't sufficiently reassured by what the practitioner said and still have the pain. In any event, you need to call them to ask their advice. They will almost certainly be as concerned as you that a troublesome symptom like this persists, and will want to ensure that it is dealt with.

It is also worth adding, by the way, that it is not always the case that a symptom has been caused by treatment even when it appears roughly where the needles were inserted. We are always careful to help patients and practitioners getting locked into a 'it's you fault, no it isn't' exchange while a symptom persists. It is far better to seek medical advice by visiting your GP than to argue the toss about whether the acupuncture caused the problem or not. The main aim is to understand what is happening and deal with it first; discussions about causes can come later when it is sorted. If the symptom carries on much longer a short trip to your GP may be the best idea.

Q:  I have been suffering with post concussion syndrome for 2.5 weeks.   The main symptoms are pressure headache, nausea, dizziness and slowness of thought.  I am wondering whether acupuncture could help relieve these symptoms, and whether there are any practitioners who specialist in treating PCS.

Q:  As with any damage to the body there are two vital components to recovery. First is the removal or clearance of local blockages which contribute to the symptoms from which people suffer. Second is the overall healing response to any kind of injury, the system's ability to repair itself. Conventional medicine tends to focus. although not exclusively, on the former, while Chinese medicine tends to integrate approaches to the former with a more general consideration of the state of the overall energy flow. To use a very rough and ready analogy, unblocking a pipe where the water flow is generally weak will only be a temporary measure unless the flow level is increased till the pipe is self-cleaning. 

We are not claiming any higher ground or superiority, nor would we; there are ways of using Chinese medicine which are symptomatic and unlikely to provide the level of lasting relief which a patient seeks. In most cases this may not matter. Better is better, and once the problem is corrected, it is gone for good. However, if an accident occurs against a general background of weakness the recovery may not be as well-grounded.

in your case, a practitioner would almost certainly investigate with you in great detail the accident which gave you the concussion. There are a number of protocols in Chinese medicine for understanding 'blunt force trauma', as pathologists call it, and many of these are based on what the Chinese call stagnation or stasis where the blood or body fluids have thickened as a consequence of a bang on the head. While the energy remains stuck in this way, there will symptoms directly related to the pressure, symptoms locally because of the disturbance to nearby systems, and a generalised weakness brought about by the fact that the system is a closed system in Chinese physiology, and a blockage anywhere will impact on the whole body.

We have looked through the research literature, and there are a number of studies, some now quite old, which seem to give encouraging, although far from conclusive, results, and a great many articles from the US in particular where practitioners report great success in restoring people to good health. We are always cautious, however; we only find the cases where the treatment works and there may be many more unreported cases where it didn't.

We often tell people about the way that Chinese Medicine views each patient as unique and different, but in the case of concussions which can happen in thousands of ways this is all the more true. Without a huge amount more information we would not be able to give you any clear prognoses of what may be possible. All that we can say is that people do often consult acupuncture practitioners for the sequelae of concussion and it would be worth your while contacting a BAcC member local to you for a brief face to face assessment of whether they think acupuncture treatment might be a suitable option.

Based on our clinical experience we also think you might want to consider cranial osteopathy, a form of osteopathy which is particularly well-adapted to helping this kind of injury. We often find that combination of both therapies works particularly well for this kind of injury. However, best first to get the advice of a BAcC member who will probably already have good local connections for any other treatments that he or she may think would benefit you.

A:  At this level of generality your question is rather difficult for us to answer. What we can point to is a broad difference between traditional acupuncture and manipulative therapies like osteopathy and chiropractic. From the point of view of the latter two structure governs function. If everything is in the right place, especially the core musculo-skeletal tissues, then the body as a whole should function as it was intended to do. From the traditional acupuncture perspective, the reverse applies. If everything in the system functions the way it should, then the structure will fall into line. A traditional acupuncturist would be working to ensure that energy flowed where it was supposed to, and the fact that the body's muscles and tendons were properly nourished would allow them to do what they are supposed to and pull the body into it's proper shape.

Easier said than done! You may have heard of the Alexander Technique, a postural therapy which is taught rather than performed, where the body is encouraged to re-learn its proper shape. Years and years of misuse can create a kind of 'habit energy' where people will be shown what good posture is, sustain it for a few hours or even days, and then slowly revert to what the body has become used to. A teacher may take up to a year of lessons to get someone to sustain the right shape.

We have found that the same can often apply to acupuncture treatment. Correcting imbalances should, in theory, correct problems and leave them corrected. However, in practice the system can quite easily revert to its familiar position of unstable balance, and when this happens the symptoms which were a feature of that may well return. This is why treatment often falls into a similar pattern - a sequence of weekly treatments, followed by fortnightly or monthly treatment, and eventually treatment at the change of season with occasional one-off treatments to deal with short term problems.

Our advice to you would be to contact a BAcC member local to you to discuss what may be possible, and also to discuss with them how they might co-ordinate their work with someone who can look at your posture from a more structural point of view. It is often good to work in tandem with, for an example, an osteopath because they can achieve change to structure more quickly than through acupuncture but acupuncture at the same time can often help the body to maintain the changes.

From a Chinese medicine perspective, however, each patient is unique and different, and you would really need to see someone face to face to get the best idea of what acupuncture treatment may be able to offer.

There is no regulation of acupuncture by law in the UK, what is termed statutory regulation, and in theory anyone could undertake a short course in acupuncture and start up in business. In practice there is health and safety regulation in law about all forms of skin piercing which means that all practitioners have to either registered or licensed. Different rules apply in Scotland and Greater London from the rest of the UK, with practitioners having to hold an annual licence unless they belong to a professional body which has exempt status, like the BAcC, or are already regulated for their primary activity like physiotherapy or osteopathy. In the rest of the UK everyone except doctors and dentists has to be registered for every practice in which they work, but only pays a one-off registration fee.

In practice, environmental health officers who administer these laws now check whether the applicant is properly trained and insured, and we are aware of people with inadequate training being refused registration.

We do not anticipate that acupuncture will be regulated by statute in the short term. Our work is very safe and there are no reasons to spend money protecting the public interest when self-regulation, as praised by the Minister three years ago, seems to do the job. There is also a national scheme for voluntary registers run by the Professional Standards Authority which applies a very rigorous testing process for professional associations and has considerable national status as a government-backed initiative. The BAcC was one of the first two organisations in the UK to achieve accreditation.

Since there is no national regulation there are no nationally agreed standards. However, the BAcC is widely regarded as the leading body for acupuncture in the UK and its Codes, which you can find herehttp://www.acupuncture.org.uk/public-content/effective-practice/bacc-professional-codes.html

are often used as the benchmark for other associations, especially the Code of Safe Practice. These are all in the process of being updated to accommodate changes over the last five years in related law relating to data protection, etc etc.

Q: Could you please give me details of acupuncturists practicing in Central London who have experience in treating cancer patients. My husband has throat cancer and is receiving radiotherapy. i would very much like him to be treated for pain relief by an acupuncturist.

A:  Our stock response to these sorts of requests is that as well-trained generalists working within a Chinese medicine tradition which treats the patient, not the condition, any of our members should be able to offer you the same exemplary standards of care and treatment. The only areas where we have spent time investigating standards for expert practice are obstetrics, paediatrics and mental health issues. In all three there is a strong argument for recognising the additional training which members undertake, often in conventional medicine but also drawing on the experience of practitioners who have made these areas their entire practice focus for twenty years or more.

However, our own view is that the treatment of patients during cancer treatment is a strong candidate for the next round of expert practice investigations. Our experience in working with chemotherapy and radiotherapy patients is that both treatments have a substantial number of energetic as well as physical effects, and treating the person constitutionally is not always sufficient to offer the greatest benefit, good but not necessarily optimal.

Our hands are tied a little insofar as we cannot recommend individual practitioners, even though we know of several members who work within major cancer care establishments. Our advice to you would be to contact some of the more well-known treatment centres like the Royal Marsden or UCH and see if they offer acupuncture services within their brief and if so whether your husband can attend any of the clinics which they offer. If not, they may be able to recommend acupuncturists with whom they are associated.

Some of the leading experts in the field are not BAcC members but medical acupuncturists, but we are aware from their publications over the years that their expertise is considerable, and as we intimated above, traditional treatment may not always be sufficient in itself for dealing with the after-effects of radiotherapy. Chemotherapy is more commonplace, and most members will have a least a handful of patients at any one time following chemo regimes. Radiotherapy is less common.

Whichever route you follow, we would advise you to be a little cautious. There are a number of acupuncture facilities in the private cancer care field which offer acupuncture but there is no way online to check the bona fides of the practitioners. we believe that for your husband's optimal care you need to be looking at a properly trained traditional acupuncturist or a practitioner with several years of demonstrable experience working in this sector.  

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