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Q:  I'm having severe skin itching all over since having accupunture on Wednesday afternoon, today even antihistamine is doing nothing to relieve. I suffer with
systemic candidiasis which I keep in check with pau d arco etc. I'm literally tearing at myself constantly.

A:  This is certainly a very extreme reaction to treatment, and also quite unusual. However, that fact that you suffer from systemic candidiasis for which you appear to have sorted out a maintenance strategy with other forms of treatment suggests that the addition of a random element may just have upset this balance slightly.

That said, we have occasionally seen cases like yours where the reaction is a healing one, and if this is the case by the time you receive this reply things may have become a great deal easier. If this is the case, then the next treatment should be unremarkable. if, however, you get the same reaction, then it might be an indicator that acupuncture treatment is not the best therapy for you.

We are always cautious when someone has an extreme attack of an existing problem. There is a line of thought that says that things get worse to get better, and we do have a theoretical model which suggests that the energetic imbalances which cause problems like migraine or digestive problems can be expelled with extreme reactions as they leave the system. However, we have also seen cases where things were getting worse because they actually were getting worse, and equally things which have been generated by treatment because acupuncture is not the best form of treatment for the individual, so we are a little concerned when someone just responds 'healing crisis' without giving the problem much thought.

A:  Our advice is that you discuss the outcome with your practitioner. It may be, for example, that the treatment can be adjusted with less needles, less manipulation or even a different treatment strategy to ensure that the benefits are not outweighed by flare-ups of your problem. It may also be that the practitioner, based on your feedback, may decide that the treatment is not the best option for you and may recommend other forms of treatment which do not interfere so radically with the condition you have under
control.

We sincerely hope, however, that this was a short-lived reaction and that it has settled down with some improvements over where you started.

Q:  I've had 2 sessions of acupuncture with the NHS for chronic lower back problems over the past 2 weeks. I've had it before privately for my back and my bad knees. In
the past.  I just felt tired and a bit sore afterwards and was thinking it could be similar this time. However, at both sessions I have experienced pain on needles going in and being removed. I have felt very faint afterwards and my chronic pain has become far worse (I know that this can happen). I have also been having blurred vision on and off since I started. Is this a possible side effect? Also, is it likely that being treated for the same issues would cause me to feel so different or should I assume that the first practitioner had an approach that suited me more?

There are three issues in your question.

It is possible that acupuncture within the NHS, if administered by a doctor, physio or nurse, is slightly different from the treatment you would receive privately. Most private treatment is traditional acupuncture, based on theories of energy which have a 2500 year history and generally speaking employing a relatively gentle technique. Some practitioners manipulate the needle quite vigorously to generate a sensation called 'deqi', a dull aching feeling, but for the most part there is very little needle sensation. By contrast western medical acupuncture tends to use slightly larger needles and often aims to work on trigger points, knots in the muscle, which can be very painful. Also, it has to be said that the majority of acupuncture providers within the NHS use the treatment as 'another tool in the toolbox' and may not have the same subtlety as someone for whom it is a primary practice. However, it has to be said that treatment of any kind is very safe, with a remarkably good record.

That said, the adverse effects of your treatment are a little concerning. The fact that you feel faint after treatment would generally indicate that the treatment is too powerful for you. This has long been a point of debate with medical acupuncturists. Our experience is that some patients are sensitive to the movement of energy, and we have to adjust our treatment accordingly, using fewer needles, more gentle insertion and less manipulation. However, since medical acupuncture is not based on theories of energy, this would not necessarily be taken as a reason to change the style of treatment. It may just be that you are sensitive to acupuncture, which means that you may benefit from a lighter touch.

The adverse effects themselves warrant comment. Back pains can often get worse before getting better and we often warn patients that the couple of days after a session may just see the pain exacerbated. If this is the case, however, there is usually improvement thereafter. If there is pain for a couple of days and then everything returns to the status quo, the discomfort may be a direct reaction to the treatment and nothing more.

We are a little more concerned about the blurred vision, though. If it is connected to the treatment this would be very unusual. We have looked carefully at the adverse events reporting over the last decade and apart from a couple of blogs on the web there are no actual case reports. It may simply be that the symptom is to do with the fatigue which many people experience after treatment of any kind. However, blurred vision is always worth checking, and if it has happened completely contingently, i.e. just happened to come on at the same time as the treatment but not actually connected to it, then it would be worth checking sooner rather than later.We have seen a number
of cases where people have assumed something has been caused by acupuncture treatment when it simply occurred around the same time, and our greatest concern is that they sometimes get diverted into arguing about whether or not the acupuncture caused the problem when the main priority is to get it sorted. Our advice would always be to go the style of treatment which seems to suit you better. This is not a matter of one treatment being better or worse than another, just a recognition that people are different and find some treatments and some practitioners more to their taste.

Q:  am an acupuncturist in Portugal and I wonder what  the parameter settings are to be able to exercise the profession in England

A:  There are very few parameter settings for the UK. In the absence of statutory/government regulation of acupuncture, it is in principle free for anyone simply to set up in practice. There is very little likelihood that statutory regulation will happen in the near future. The only laws which actually govern practice are the more general local, rather than national, laws about skin piercing which require practitioners to register or be licensed depending on where they choose to work. In Greater London it is a matter of
annual licensing unless you belong to an exempt membership body (the BAcC is one), in Scotland annual licensing unless you are registered member of regulated profession like doctors and physios (we aren't exempt), and everywhere else a one-off registration for every practice in which you work.

It used to be possible to set up in business with only the most rudimentary qualifications , but the last decade has seen many local authorities adopting byelaws (local laws) which require practitioners to have standards roughly in line with the degree level education recommended by the World Health Organisation.

As a citizen of an EU country you would be entitled to work here without a visa under the free movement of labour rules within the EU, so it would simply be a matter of deciding where to work, finding somewhere to work and the getting the appropriate license or registration. Setting up in business can be a slow affair. We advise new graduates that it can take two years or more to have a practice able to sustain them, and in the current recessionary times that may be even longer. We advise people not to give up their current work until they can comfortably switch to being free-standing practitioners, and for graduates for who this is a primary career to try to have some other form of steady income to keep them going.

Of course, joining a reputable professional association like the BAcC brings with it a great many resources and support, so we would obviously encourage you to give that serious thought if you do decide to come to work here.

 

Q:  i severed a nerve at the base of my thumb in an accident 2 years ago which was re-attached through surgery.  i still have quite a degree of numbness and
occasionly hypher sensitivity. can acupuncture help in any way?

A: This is quite a difficult question to answer. When we asked a similar question about nerve regeneration some time ago we said:

If there has been well-authenticated damage to a nerve then the chances of restoring its conductivity are very limited. If a nerve has been damaged beyond the body's ability to repair, then this severely limits what might be possible. There is a very small amount of evidence that acupuncture may be able to help nerve regeneration but this comes from the experimental end of the acupuncture world and often involves trials on animals, or 'ratpuncture' as some of our colleagues cheerfully dismiss it.

Obviously, though, we work in a different paradigm, and there are occasions where a symptom written off by conventional medicine as permanent and untreatable responds to acupuncture treatment. As you may be aware already from our website, the theories of Chinese medicine rest on a concept of energy, called 'qi' whose flow and balance determine good function and health in the body. If the flow is disrupted, as may be the case with accident, injury and occasionally surgery, then restoring the flow can
sometimes have significant effects.

The best advice that we can give is that you contact a BAcC member local to you to arrange for a brief face to face assessment. This will give them the information they need to assess whether in your specific case there are indications which point to the possible use of acupuncture.

In your case there might be slightly more reason for hope insofar as the injury which severed the nerve is almost certainly going to have had an impact on the superficial tissue which the sharp edge penetrated, and had you asked us the same question about scarring and the symptoms which you have we might have been a little more upbeat. In a recent answer about post-operative scar tissue we said:

There are times when the simple act of cutting tissue can cause a break in the flow of energy, and we have come across many cases where even a well-healed scar has blocked the flow in a channel. When you consider that there may well be thicker keloid scar tissue and adhesions as well as surface interruptions it is possible that
acupuncture treatment may offer some hope. and this particular expert has had one or two occasions when treatment along or across scar tissue has had disproportionately great effects.

It is best to realistic, though. nerve damage can sometimes leave the sorts of symptoms which you have, and they can often take a long while to diminish as the body learns to block the signals. There would nonetheless be good reason to talk to a BAcC member local to you, and possibly having a small number of treatments, but we would suggest that if you do, the number should be tightly controlled. In our experience these sorts of problems either respond quickly or not at all, and it is best not to develop
a treatment habit which runs to a dozen sessions with no result. This does not tend to play well with the patient.

Q:  BAcC registered acupuncturists' patients are prevented from giving blood. What does the BAcC intend to do about this parlous state of affairs?

A:  The current situation has moved on a little since our last press release in July last year:

The BAcC continues to receive calls and emails about the NHBTS policy that any patient who has had acupuncture treatment delivered by a practitioner who is not statutorily regulated has to wait four months before they can donate blood. This change to the NHSBT's donor criteria came into effect in late 2009,and with the statutory
regulation of acupuncturists now unlikely in the foreseeable future, this could mean that someone having regular treatment with a BAcC member would never
qualify to donate blood.

The BAcC has exemplary safety standards and campaigned vigorously to challenge this decision. We have since done our best to make sure that all of our members let their patients know that they must wait four months to donate blood or bone marrow products.

The official notification and rationale for the decision is available on

http://www.transfusionguidelines.org/docs/pdfs/dl_change_note_2009_32.pdf

and

http://www.transfusionguidelines.org/docs/pdfs/dl_change_note_2009_33.pdf

but some enquirers have found this difficult to locate on official sites.

The BAcC is fully committed to reversing this decision for the benefit of the patients of its members. The recent accreditation of the BAcC under the Professional Standards Authority Assured Voluntary Register scheme has given us hope that this new flagship scheme will provide the recognition of exemplary standards the BAcC needs for its members to be granted exemption from the deferral period for donation.

Since then, we have met senior officials in the NHBTS, and discussed with them how we might help to re-instate the donation of blood by non-statutorily regulated healthcare profesisonals, there having been no reported instances of blood borne virus transmission by acupuncture practitioners in the last decade. In order to change policy, however, there has to be evidence, and the NHBTS is proposing to conduct an analysis of previous screened donors to establish the level of risk. This study will take place later this year or early this year.

The wheels of bureaucracy turn slowly, and until that time anyone who has had acupuncture treatment from a BAcC member will have to wait four months until they are allowed to give blood.

The study mentioned in the press release has now progressed a great deal further, and the information which has been gathered will be given the full statistical analysis by August, we are told. It is also interesting to note that the Welsh Assembly has accepted the BAcC's accreditation with the Professional Standards Authority as a basis for exemption from its new licensing arrangements, and this opens up a potential second front if the statistical evidence is inconclusive.

The whole situation has been rather odd from the outset. Leaving aside all of the arguments about accountability and statutory recognition, the simple fact is that we all use single use disposable needles, and short of a practitioner with a blood borne virus inserting a needle in themselves and then into a patient, itself a criminal offence which even statutory regulation could not prevent, there is no possible risk of cross infection. However, by the time that this very simple fact became a part of the discussion the moment had long been lost. Indeed, there had been minimal consultation at the outset because the decision makers did not anticipate any adverse reaction to what they planned.

However, there's no point in re-hashing a poor process. We are where we are, and still working constructively to bring back into play the 10,000-15,000 donors we believe may have been lost as a consequence of this decision.

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