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Q: I had acupuncture yesterday afternoon, and it's the night of the next day, and my stomach is still twitching?  I read that muscle spasms are normal after acupuncture, but I was wondering if they really last this long? I had acupuncture for my chronic tension headaches. I had 6 needles; one on each of my upper forearms, one on each of the areas below my knees, and one each between my big toe and second toe. Is it normal to still have these muscle twitches?

A:  The short answer is 'no'.

While muscles in the area which has been needled can twitch slightly when the needle is inserted and may continue to do so for a while, it would be unusual, but not impossible, for a muscle somewhere entirely different to react in this way. You can never rule out the extremely unexpected because acupuncture treatment treats the whole person, so in theory a needle could start a chain reaction which could lead to a palpable change somewhere else. However, changes are more usually functional than structural, i.e. a needle in the foot might make a headache go away but would be less likely to cause an unintended structural event.

That said, we don't think there is anything particularly worrying in what you describe, and we strongly suspect that by the time you get this response it will have stopped happening. If by some chance it does continue, then you should discuss the matter with your practitioner in order to see if they can understand what is going on. If this is a mystery to them it may be worth popping along to your doctor to see if there is something else going on. We say this because most unusual consequences of treatment disappear within 24-48 hours, and something which goes on beyond that may have coincidentally happened at the same time as treatment but not be related to it. In these circumstances it is important to find out what has happened rather than spend time trying to find out what caused it. The process of establishing what it is usually does that anyway.

Q:  I have been diagnosed with ocular myasthenia and have been reading up about possible benefits of acupuncture treatment.  I was wondering if I can get contact details about a good acupuncturists based in Edinburgh.

A:  There is, as you might expect, not a great deal of evidence for the treatment of ocular myasthenia with acupuncture. We managed to find half a dozen case studies, mainly in Chinese and not translated, which showed some encouraging signs, but the reality is that small case studies only get published because they are the ones where treatment worked. As such, they are not reliable, because in single cases there are many other factors which might have had an impact. However, there was one study of more cases which seemed a great deal more positive, which you can read here:

We were asked a little while ago about myasthenia gravis, and what we said there is just as applicable to your problem which is one presentation of the wider condition.

There is a small amount of evidence that acupuncture may be beneficial for treating myasthenia gravis, but the studies, like this one

are small in size and while suggestive of benefit a very long way from being conclusive evidence.

The trite answer we could give is that acupuncture treats the person, not the disease, and to the extent that all acupuncture treatment is geared to helping the body mind and spirit to normal function, then all conditions should, in theory, benefit from treatment. However, one has to be very careful with statements like this because it gives a false impression that all conditions are curable, which is clearly not the case. There are many debilitating diseases which are chronic and degenerative, for which the best one can say, as one patient famously did, is that they were 'very pleased because they were getting worse slower.'

The one advantage of Chinese medicine, however, is that it looks at the symptoms which patients experience through an entirely different diagnostic framework, one which can sometimes make sense of conditions in a way that conventional medicine cannot. Very few diseases are new, and Chinese doctors were probably treating this two thousand years ago without any concept of auto-immune disorders. they would simply have made sense of the presentation of the condition based on the understanding of the physiology in Chinese medicine and the pathologies which could arise when internal or external factors disturbed the flow of energy, or 'qi' as it is called, and led to organic malfunction.

Weakness and flaccidity of the muscles could be understood as a local or systemic problem, and the skill and art of the Chinese medicine practitioner lies in determining the most elegant and effective way to restore balance and good flow. It may be worthwhile asking a BAcC member local to you whether there is something obviously out of kilter in your system which might be contributing to the problems you have. 

On balance, though, we have to be realistic and say that even anecdotal evidence is not that great, and what acupuncture may do, more than remove or reduce symptoms themselves, is to help you withthe secondary stresses and anxieties which the condition can engender. Many patients report this as an outcome which in itself makes treatment valuable.

We think that asking a local BAcC member for a view remains sound advice, and is probably a more realistic way of approaching the problem than by reference to a named condition occurring in different patients with different baseline constitutions. How your problem presents will be something which can inform a professional view far better than we can do here at this remove.

A: As far as the condition itself is concerned, as our factsheet shows:

there is a small amount of fully researched evidence that acupuncture can provide short-term relief for the problem. The criteria for quotable research set the bar very high by employing research requirements more suitable for drug testing, the randomised double blind control trial. In daily practice tennis elbow is one of the more frequent named conditions for which people seek help from acupuncturists. Our usual recommendation to patients is to have two, three or four sessions along with trying as much as possible not to have to do the sorts of things which brought the condition on. 

We tend to look for regular reviews after four or five sessions and measurable outcomes - range of movement, weight bearing etc - to ensure that a pattern does not develop of ten or more sessions without any result. This tends to make unhappy patients, so we are very clear about drawing a line if there is no discernible change after the first few sessions.

On balance we think that the best advice we can give you is to visit a BAcC member local to you to see what they make of the problem that you have and by virtue of a face to face assessment offer you a very clear idea of what may be possible for you. 

A:  The abbreviations all relate to physiotherapy, as far as we can tell.  We assume that you mean MCSP rather than MCPS, this being Membership of the Chartered Society of Physiotherapy. MAACP means that the person is a member of the special interest group, the Acupuncture Association of Chartered Physiotherapists. SRP usually means  state registered paramedic, but we think in this instance it refers to state registered physiotherapist.

A:  We are often asked about specialists in treating certain kinds of problem, and the answer is always the same - from a traditional Chinese medicine perspective we are all generalists because we treat the person, not the condition. Indeed, in ancient times the specialist was looked down on as a rather unworthy being because they only treated a small range of problems! In reality, there are a number of areas like paediatrics, obstetrics and mental health where we are investigating how to accredit expert practice because we do recognise that in each area there is supplementary knowledge and experience which is not a part on undergraduate training, but this does not mean that only these people can treat these groups. The difference is between good and better.

The nature of Chinese medicine is that the symptom or presenting condition has to be seen in the context of the person's overall health or balance. This explains why twenty people with the same named condition might be treated in twenty different ways. In reality, though, there is quite great deal of research using slightly more formulaic points which can help the problem of chemo-induced neuropathy. Western research tends to eliminate variables, so treatment protocols tend to be repetitive, unlike most practice which is evolutionary and developmental.

There is a systematic review found here

which looks at all of the studies which have been conducted, and tends to be a little bit negative, although conceding that there are studies which look promising. Part of the reason lies in the fact that many Chinese studies, of which there are thousands, tend to be more concerned with what works better than with whether acupuncture works, and these tend to be dismissed as methodologically weak, hence the almost universal request for 'more robust' studies. The reality is that the gold standard of research in conventional medicine, the randomised double blind control trial, is not best suited to testing a therapy with many variables, so results are always going to be strange. The more the treatment fits the conventional structure of testing, the less it looks like what we do.

Anyway, enough carping about research! Most of us have had successes quelling the worst aspects of neuropathy, but we have also had our failures. It is very important to review treatment to avoid a subtle accumulation of many treatments, and equally important to try to find measurable outcomes to test whether there really has been progress. On this basis a course of acupuncture treatment will certainly not do any harm, and will probably do some good. The question is really how much good and how sustainable.

To find a practitioner geographically closest the best thing to do is to use the postcode search facility on the BAcC home page. We have just  tried it and generated thirteen hits on SO22 and SO23, so we are sure that you will find a suitable practitioner close to where you live. Most of our colleagues are happy to invite people in for a chat before committing to treatment, and this is often the best way to establish whether someone is the practitioner for you.

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