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Q: I am suffering from acute chronic pain in the lower part of my legs. I live in Delhi, do  you know of an acupucnturist who can treat at home?

A:  There is a long history of acupuncture being used for pain relief, as our factsheet on chronic pain

shows. The measurement of pain and its neurotransmitter trails lends itself to western research methodology.

However, the kind of pain which you describe would almost certainly be of interest to a practitioner because of how it is presenting. The theories of Chinese medicine are premised on a flow of energy, called 'qi', whose flow and balance determine the health and well-being of the person. When this flow is disrupted, pain and poor function result. For a problem such as yours, the practitioner would want to establish whether the problem was local rather than systemic, although the fact that it is on both sides seems to indicate systemic, and then to look at what aspect of the body's function was causing this to happen. The fact that you have had heart operations will almost certainly be a factor to take into account; there are a number of heart problems which dispose people to circulatory problems in the lower limbs, and a number of other conditions which predispose people to heart and circulatory disorders. An acupuncturist will always see local problems in the context of the whole person rather than simply stick needles in where it hurts.

With any treatment for pain relief, the bottom line is how much relief the treatment gives and how sustainable it is. This can often, unfortunately, come down to money and the balance between the amount of relief and the cost of achieving it. It is possible that treatment may improve the circulation and remove the pain, which we hope to be the case, but in the event that the pain arises from a condition which is unlikely to be reversed, like atherosclerosis in the arteries of the lower leg, it is important to maintain a regular review of whether the treatment is worthwhile.

We have very few overseas members working in Delhi and we have no idea of their working patterns. Many practitioners are not happy with undertaking home visits because to charge realistically for the time it takes to travel to and from the patient can sometimes make treatment unaffordable. However, you can always ask any practitioners local to you whether they are prepared to do this. Since we cannot direct you to any of our members, we can only advise that you check that the people you call are properly trained. For us, a sound training involves three years of study to a degree level. Bona fide practitioners will have done this; any others with less training may be a gamble.

A:  The BAcC gives very comprehensive advice to members about the absolute and relative contraindications for acupuncture treatment, but because there are very few absolute contraindications we do not publish a list. The majority of areas where we tell members that acupuncture treatment would be inadvisable are where patients or prospective patients have bleeding disorders, weakened immune systems, malignancies (but only as far as not treating near the tumours) or lymphoedema in certain circumstances. There are also a number of localised restrictions such as avoiding treatment near pacemakers or other implanted devices, restrictions on some techniques where patients have had heart valve replacements or rheumatic heart disease in earlier times, and restrictions on treatment where a patient's condition is unstable, as in poorly controlled epilepsy.

That said, the flexibility of traditional Chinese acupuncture means often needles can be applied in area of the body which connect with areas of disease without compromising them, so it is really only major immune suppression in blood disorders, immune system problems or post-transplant, or bleeding disorders where the INR is outside the safe range where we would say to a patient that treatment was not possible. In many cases, however, where people really want treatment and there is a question mark, BAcC members will always contact the senior conventional medical practitioner in charge of a case and seek their authority before proceeding. What the consultant says goes, and this does mean on occasion that, for example, treating lymphoedema is ruled out by a consultant, even though there is research evidence which shows that needling away from an affected limb works, because he or she places a blanket ban on all acupuncture for the patient. In these circumstances our role can only be to educate and inform, not to disobey.

There is a larger number of relative contraindications which make perfect sense - not needling into an open wound, not needling specific areas of the body - but these are more often than not a matter of professional judgement. The safety record of acupuncture treatment suggests that this works; serious adverse events from acupuncture treatment are rare and do not very often arise from using acupuncture where it would have been inadvisable.

There is also a large number of points which cannot be used from a Chinese medicine perspective for specific reasons. In pregnancy, for example, a number of points which have a heavily downward and expulsive effect are ruled out in the first trimester, as are a number of other points throughout the various stages of pregnancy. All students are taught these very carefully during their training, and all point books and charts make very clear annotations of when to avoid using specific points.

There is also an interesting set of points which we would avoid in certain patients but which are often used in western medical acupuncture for musculoskeletal problems. One of the major points for treating tennis elbow, for example, can if vigorously needled lower blood pressure quite dramatically. We are not sure that many conventional medics are aware of this, and one of our tasks is to compile a list of points which from a Chinese medicine perspective are ones where caution is needed.

We should add that our reason for avoiding a printed list is that where there are both relative and absolute contraindications for treatment, it would be unnecessarily alarmist to do so. As long as someone on anticoagulants has a stable INR, for example, there is no reason not to treat carefully with acupuncture, as long as shallow needling and minimal manipulation is used. The subtleties of this kind of judgement do not translate well to lists.

Q:  I have had recurring back pain problems for about 10 years.  I have had various physiotherpists give me exercise but I am still have back pain.  Would acupuncture help?

A: For back problems we can make a positive recommendation of acupuncture treatment. The evidence which has accumulated over the years has been sufficient to convince NICE, the body which defines suitable treatments within the NHS, that a course of up to ten treatments should be available within the NHS for chronic back pain. Unfortunately acupuncture is just one of a number of options for treatment, and we have seen very little evidence of anyone contracting with our members to provide treatment which is free at point of delivery, but in time we hope this begin to happen.

Our fact sheet on back pain

provides references to some of the research, but such is the prevalence of the problem there have been many more studies of varying degrees of rigour which all seem to point to positive outcomes.

The two factors which will be of interest to a practitioner will be the way that the problem developed and how it relates to the overall functioning of the body, and how entrenched some of the coping patterns have become. As far as the former is concerned, unless the pain has arisen as a consequence of an injury it is usually a part of the much larger picture of what is happening in the body, and this is the great strength of Chinese medicine, understanding this back pain in this person rather than simply applying formula treatments for everyone. The latter issue can sometimes be important. People learn a number of coping mechanisms to deal with the pain, such as holding their bodies in different ways, and it can sometimes take a while to encourage the muscles to revert to natural positions when they have been trained over time to hold the body in a position which avoids pain. Many of our members often work closely with osteopaths in a  two-pronged strategy to encourage the body back into its correct shape.

The best advice always, though, is to visit a BAcC member local to you for advice on whether acupuncture can help your specific problem. Although the evidence is good, most of us can tell quickly what the best options for a patient are, and are always happy to refer on to other healthcare professionals if we think that they are the best line of attack.


Q:  When I had acupuncture re-usable needles were used instead of disposable ones. I was assured by the acupuncturist that they were sterilised.  Shouldn't all acupuncture needles be disposable?

A: Don't panic! The risk of infection from a re-used needle is very very small indeed if the autoclave is used properly, the needles are prepared and stored properly and the autoclave is properly maintained. For forty years before the change to disposables autoclaving was standard practice, and there were no reports of cross infection from this method. The risk of prion transfer was taken very seriously when the BSE/vCJD crisis was happening, but was subsequently downgraded.

In short, there is no reason to get tested, and no reason to suspect that anything has gone wrong. The practitioner sounds as though she is on top of her game, and has made a choice which we would not permit for our members. For every thousand practitioner who re-use, though, there may be one who doesn't do it with proper care, and that is the one who might cause a problem.

Our view is that patients are more comfortable with disposable needles, there is no economic advantage to re-using them, and we cannot understand why someone would choose to do this. If the practitioner is one of our members, we need to know because we need to stop her from doing this. If you pass the name to us, we can take action without bringing your name into the discussion at all. If she belongs to another professional body we shall take the matter up with them; all, as far as we know, insist on disposables too. If she is working as a 'freelance' we may decide to go to the local authority licensing people, again keeping your details out of the loop. 

This is as much to protect her as it is to protect everyone else. If anyone did develop an unexpected infection, then the autoclaving would automatically tip the balance of probabilities against her because of the minute theoretical risk.

We are sorry that you have been made uncomfortable by her practice and our response to your query, but we are grateful that you have got in touch and equally certain that you have not been put at risk.

Q:  Can acupuncture help with treating glioblastoma or swelling in the brain. Coming off the steroids has been causing seizures.

A:  We have to be honest and say that there is no research which we can trace which suggests that acupuncture can be of proven benefit, but given the aggressive nature of many glioblastomas that is not a surprise. You will find a number of case histories on the web, rather similar to this one

but it is always difficult to generalise from individual cases because there may be any number of reasons why this particular individual had such a good result. We tend to work on the adage that there is always someone for whom everything works but rarely something which works for everyone.

However, the essence of traditional Chinese medicine is that it is based on an entirely different way of understanding the body, mind and spirit as a complex flow of energy, called 'qi', whose rhythms. flow and balance determine the health and well-being of the person. The symptoms from which someone suffers are interpreted through a sophisticated conceptual grid which has developed over 2000 years, and are made sense of within this grid. On occasion this can present options for treatment which can reduce some of the secondary effects of serious conditions, and in a small number of cases affect the condition itself.

Glioblastoma has a rather bad reputation as an untreatable condition, but there are good reasons to believe that treatment, both conventional and complementary, can on occasion slow down the progression of the problem and reduce some of the effects caused by the presence of the tumour in the frontal and temporal lobes.

Our best advice in your particular case is to visit a BAcC member local to you for an informal chat about what may be possible. You will clearly have a great deal of case history which is not touched on in your e-mail, and which will guide the practitioner towards a better understanding of the progression of the problem and with that a better assessment of whether acupuncture treatment may be of benefit.  


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