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Q:  My wife has a ringing in her ears which is said to be tinnitus, I recently read of a lady who after many years of suffering this affliction was cured by acupuncture. Could this be true ? 

A:  We used to be a great deal more downbeat about the treatment of tinnitus than we are now because our experience in practice was that it could prove intractable to treatment. However, as our factsheet shows

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

and as some recent personal experience in clinic has shown too, there may be some hope. 

The problem with measuring the success of treatment for tinnitus is that its appearance and disappearance can be entirely random. If you read the tinnitus association's magazine you will see stories along the lines of 'I tried everything and then x worked' and an equal number of stories which say 'I had tinnitus for five years and then one day it just went.'  Research trials tend to be quite reliable - it would be a remarkable coincidence if half the trial participants experienced a spontaneous improvement - but one-off cases could be a coincidence, with acupuncture just happening to be the therapy of choice when the change happened.

The available evidence, however, suggests that it might be worth a try with the proviso that progress is reviewed at regular intervals, and some kind of objective measure can be found, i.e. how much it interferes with a radio set at a particular level. It might also repay investigation of what makes it worse and what makes it better. A long n-1 case study this expert conducted had very little impact on the condition but did increase the sufferer's ability to deal with it.

The best advice is to visit a BAcC member local to you and your wife for an informal face to face assessment of what may be possible. There are one or two clearly recognisable syndromes within Chinese medicine which might offer considerable confidence that muting the problem may be possible, but even a general balancing of the system may bear fruit.


Q:  I get a stabbing pain on the front of my lower right leg when I am in bed. I have found putting my legs up on wedge shaped cushions whilst I sleep helps. But I still wake up in the night. No problems during the day, apart from a very slight occasional  ache in that leg . Can acupuncture help me?

A:  This is a little difficult to answer. When people have pains in the leg while lying down it suggests that there may be a problem with the lower back which is eased when the legs are raised and placed on a pillow. However, this is just one of many possibilities, and we would be reluctant even to begin to attempt a proper diagnosis at this range.

From a Chinese medicine point of view there are a number ways in which we interpret a sharp stabbing pain. These can range from blockages in the system to points which can become spontaneously tender because of systemic imbalances elsewhere. We believe that this latter reaction is probably what first prompted the ancient Chinese to establish a sense of the body's internal connections. Here again, a great deal depends on exactly where the pains are and exactly what brings them on, i.e. how one can replicate them in clinic to get a real idea of whether this is something which is amenable to treatment or not.

Generally speaking acupuncture treatment can often have an effect on the more indefinable pains, but we are acutely aware that stabbing pain arising spontaneously needs to properly examined just in case it is the 1 in 10,000 chance that it signifies something which needs urgent attention. We are not intending to be alarmist; we're not thinking life threatening but perhaps some kind of nerve impingement or muscle tear which might need conventional treatment alongside or instead of complementary therapies.

The best advice we can give is that you contact a BAcC member local to you and see if they can take a quick look without charge to assess what may be possible and advise you accordingly. They will almost certainly have a network of local contacts in other therapies and will be able to make sure you are directed to where your best treatment options may lie. 

I recently had my second set of acupuncture treatments for ongoing shoulder and neck injury and since my treatment on Monday now Friday my sleep pattern has been ruined.  I am unable to sleep longer than 4 hours, I have a constant headache and I am feeling worse on daily basis.
Can this be a side effect of the treatment?  If so should it still be ongoing four days later as the insomnia at this stage is really starting to get me down.

A:  It is unusual for what we often call transient adverse events to last for more than 48 hours. If things persist after this we tend to check whether there has been any actual physical damage from treatment, which is exceedingly rare, whether the treatment has caused physical changes for the better which have started to cause 'downstream' discomforts as surrounding  tissue adjusts, or whether there has been an energetic change which may need further adjustment. Sometimes clearing a blockage, for example, can reveal further blockages lower down a pathway of energy. We have also come across situations where unravelling a pattern of unbalanced energies has made patients slightly 'hyper' for a few days as they start to function better, but in your case the headaches and feeling worse make this unlikely.

Such is the wide range of possibilities that we suspect the person best placed to advise you is your practitioner. If there has been some energetic shift which is responsible for the insomnia that should be apparent and he or she should be able to do something about it. Even if there is no obvious connection to the existing treatment there are nonetheless treatments for insomnia which may be beneficial.

The one note of concern always is that a change which happens after treatment may be nothing to do with the treatment itself. Our members offer 2.5 million treatments a year and there are going to be occasions when something happens after a treatment which has nothing to do with the treatment. This may sound like an evasion of responsibility but we have seen occasions where people have argued about whether or not a problem has been caused by treatment when the problem has been left untreated, and our first and most important duty is to ensure that someone gets proper treatment. If the headache and insomnia persist and the practitioner can see no obvious reason why they should be there (never been anything like this before, new and different), then you should see your GP to ensure that this is not something which requires conventional treatment.

It is fair to say, though, that treating neck and shoulder problems can sometimes be a rocky road, not least because it can be very difficult to get the appropriate rest and immobility to allow for good healing, and often people find their sleep disturbed as the changes in the area take effect. We hope that this does prove to be a transient effect and that your practitioner can both explain what is happening and also do something to alleviate the problems.

 

A:  This is always a difficult question to answer.  The great Canadian physician William Osler once said' tell me not what kind of disease a patient has but what kind of patient has a disease.', and the traditional Chinese medicine system rests on a similar kind of premise. Not only would the presenting cause make a difference but also the overall constitution of the person. Sciatica from a jar in a sporting contest in a teenager will heal differently from that caused by a fall in a seventy year old.

What we tend to say to patients is that there should be some positive changes within three to four sessions, and our job then is to assess how much change and how sustainable it is. If there is a day or so of reduced pain which then returns, and this happens three or four times, then it may be an indicator that the treatment isn't really doing anything more than provide short-term pain relief. If the effects are slowly incremental, getting a bit greater and enduring with each session, then it is a matter of careful management to ensure that the changes justify the expense of treatment. Many of us also work closely with local osteopaths and chiropractors, and we often cross-refer to ensure that if there is a physical misalignment that this is addressed alongside what we do to speed the process up.

Our factsheet on sciatica

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

is very encouraging about the effects of treatment, and underpins our own sense that even where progress is slightly slower, i.e. more than four or five sessions, there is a good chance that it will ultimately have a positive outcome. The only common sense measure is to keep treatment under rolling review to avoid running up a large bill without realising.

Q: I've had some recent obvious mild trauma to my lower back resulting in 4 weeks of pain, reduced mobility and marked disinclination to stand for any length of time. The context for this is that 30 years ago I underwent discectomy at L4.   I have been mercifully pain free for the majority of the intervening years. In an attempt to expedite recovery I saw a registered chiropractor yesterday who augmented manipulation with three acupuncture needles: two into my right upper buttock area [pain free] and one directly into the centre of my surgical scar. The pain as the needle went in was immediate, sudden and shocking. My right leg went 'heavy' and horribly achey and the needle was withdrawn immediately. Today, with utter dejection and a feeling that I've made a huge mistake, all vestiges of recovery have gone. Walking has become agony, sciatic pain courses through my hip, knee and ankle and toes, standing up requires assistance and my usual excellent core stability has gone. I'd love some reassurance that this is a transient reaction to one nerve-irritating needle in tandem with system-jolting chiropractic manipulation and not signs that far from having recovery on the horizon I now face months of salary-impacting sick leave and rehabilitation. For the record,

 

We are very sorry to hear of your experience, and very much hope that by the time you read this the severity of the symptoms has subsided.

We often warn patients with back and neck problems  that the days following treatment can see a return to some quite painful symptoms. We understand that osteopaths and chiropractors tend to do the same,. From our perspective this is all about the body re-arranging itself into better shape, and the consequential change in position of the muscles and tendons which have become used to working in an incorrect way. These effects are always transient, though, and within a couple of days the patient often begins to see real improvement.

However, what you have experienced sounds like a very different level of experience, and we are somewhat concerned. At the level at which the needle was inserted it is highly unlikely that there has been any involvement of the spinal cord itself. We tend to avoid needling into scar tissue, and this article from the equivalent US acupuncture organisation's magazine

http://www.acupuncturetoday.com/mpacms/at/article.php?id=27842

describes what many traditional practitioners do needling just off the perimeter of the scar. Although it is not backed up by any significant research there is a common perception amongst many fields of complementary therapists that scar tissue can lock in both physical and emotional reactions which were current at the time of the operation. The argument is often advanced that treating the scar can sometimes 're-awaken' this sort of reaction. Although we cannot show any published evidence to support this view there have been occasions in clinic where treating scars has had this effect of a kind of 'release', often to good effect.

More likely, however, given the manipulation and other treatment applied is that the combined effect has been to change the physical structure slightly and as a consequence cause some localised inflammation which in turn in impinging a nerve or nerves. With anti-inflammatory medication this should settle down quite quickly.

That said, these are powerful and disturbing symptoms, and if they have persisted until you read this you need to be seeking medical advice sooner rather than later. There is a possibility that the treatment may have caused the displacement or rupture of another disc, and although it will not do any further harm if left untreated for a few days there is no doubt that earlier intervention could make recovery quicker.

It is also important that the chiropractor is alerted to what has happened and is also asked to provide some sort of explanation and advice. He or she will have a much better knowledge of the specifics of your case than we have at arm's length, and your experience may well make sense within the paradigm of their treatment.

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