Q:  Please could you recommend an acupuncturist who has experience of percutaneous tibial nerve stimulation to treat stress and urge incontinence in women in the Dorset area. I am enquiring for my mother who lives in Weymouth, Dorset.

A: As our factsheet shows  there is some evidence to suggest that urgency of urination can be helped by acupuncture, although there is not yet anywhere near enough evidence to make substantive claims here. If you search the internet there are a number of studies such as this one

http://ncbi.nlm.nih.gov/pubmed/15994629 which offer some hope

 However, we have to remind ourselves sometimes that Chinese medicine has been dealing with problems like this for over 2000 years, and has a very sophisticated process for understanding patients' symptoms against a backdrop of an entirely different conceptual framework. The understanding of the body as a system of energy, 'qi', in flow and the concepts of yin and yang to describe its flow and inter-relationships is very alien to the western ear. However, the rather wider understanding of organs as functional units with effects on body mind and spirit, and the underlying premise that symptoms are alarm bells, not the problem itself, can sometimes offer possibilities for understanding a problem in a far wider context. This will often be corroborated by other problems which a patient suffers and by diagnostic signs which the practitioner sees, and can often lead to a situation where a practitioner can tell the patient about symptoms that they haven't yet mentioned. If the problem is a part of a recognised syndrome or pattern of symptoms a practitioner will be able to give a clear idea of prognosis. Even if it doesn't the attempt to re-establish balance in the system can also have an effect on individual symptoms.

We recommend that you talk to a BAcC member local to you an ask for their advice in a brief face to face consultation whether they think that they can help you. We trust that they will give you an honest assessment, and refer you on to other modalities of treatment if they felt that these offered a better prospect of success.

We think this still reflects our view. There has been no further research of which we are aware, although there is a study which we did not mention on the last occasion from 1995 which shows encouraging results but is small in number and mainly dealing with men.

The factsheet can be found at:

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

Q:  I am wondering if accupunture is recommended for the last trimester of pregnancy and if it helps dialation and to get the baby into a good position for birth. Also is it safe to do at the same time as osteopathy?

A: Acupuncture treatment is perfectly safe throughout all stages of a pregnancy when undertaken by a properly trained and qualified practitioner. However, the majority of BAcC members tend not to treat in the later stages of pregnancy unless they have undertaken postgraduate training specific to issues surrounding pregnancy. There are now an increasing number of courses available for members who want to work with the pregnant woman from pre-conception to post-birth, and many advertise on their personal websites that they offer this focus of treatment. There are also a number of well-known training courses whose details and whose graduates are easily identified on the internet, although we are unable to provide direct referrals or namechecks.
 
We understand that the techniques trained in these courses are intended to facilitate the later stages of a pregnancy, and are based on a Chinese medicine understanding of the energetic changes taking place at this time. However, all acupuncture treatment is aimed at enhancing the natural energetic processes, and in theory all treatment should help the pregnancy to progress as it should. However, many women find it reassuring to seek treatment with someone who has undertaken specialist training in this area and is completely au fait with the conventional medical understanding of what is happening.
 
It should be relatively straightforward to find a suitably qualified practitioner by using the BAcC search function for practitioners in your area and running a rapid google search on keywords like pregnancy and their names. Even 'acupuncture' and 'pregnancy' with your own area should find you a practitioner who can help you. 
 
We know of no reason why someone should not have osteopathy treatment at the same time as acupuncture and often find that the two treatments are complementary to each other, with osteopaths often reporting that acupuncture treatment allows for easier manipulation of the joints and tissues.  
 

Q:  My first visit for acupuncture was nearly 2 weeks ago. I wanted to try it for my hot flushes, itching skin(due to a medication I am on) and arthritis. Unfortunately that evening I realized I had a heavy ache in the whole length of my left arm. I can use the arm as usual but I am aware of the dull ache, at nightime it seems to trouble me so much more and I have to take painkillers or use ibroprufen gel.

On my 2nd visit 3 days ago the acupuncturist was obviously concerned that I was still suffering this ache, I did not have needles on that occasion in the arm, but she tried massage etc all to no avail. She said she had never heard of anybody having this ache for this long before.

I did have a fracture of the wrist on this arm before, but this was about 9 years ago; no pins or anything so she presumed it was nothing to do with this.

I would be glad if you could be of any help as this ache is now causing me sleepness nights, (it wakes me when the medication has worn off).

A: This is a most unusual outcome. There are a number of rare short term adverse effects associated with treatment, but most disappear after 24 to 48 hours. There are also a number of normal treatment effects, and a dull aching sensation where the needle has been inserted is relatively frequent, but this again disappears within minutes of treatment, although occasionally lasting a little longer.
 
The only thing we can think may have happened is that there has been a slight bruise created by the treatment adjacent to a nerve, and the impingement is causing the sensation you are experiencing. In any event we think that it would be best to visit your GP and ask for a neurological assessment to see whether there is a specific nerve which is being affected.
 
We also need to emphasise that all of our practitioners are fully insured so that if this problem continues and is a direct result of treatment you would be entitled to make a claim for any disturbance or distress this may have caused.
 
However, we hope that it proves to be a consequence of minor bruising within the underlying tissue, and in our experience where this kind of problem does occur it does resolve within a week or two, gradually diminishing in intensity and discomfort. We are sorry that you have had this happen, and hope that it does not deter you from having further treatment. 
 

Surprisingly, there are one or two studies which indicate that acupuncture treatment may have a beneficial effect in helping to restore consciousness in specific circumstances. 
 
http://www.ncbi.nlm.nih.gov/pubmed/21442811
 
http://www.ncbi.nlm.nih.gov/pubmed/19391532
 
We stress the word 'specific', however, because 'coma' covers such a wide range of possibilities, from the extreme coma of persistent vegetative state to the induced coma sometimes used as a therapeutic technique after serious injury. The extent to which someone is comatose and the reasons for the coma would determine whether acupuncture was a worthwhile intervention.
 
As a general comment, there are two issues of substance. Treatment is usually administered on the basis of the informed consent of the patient, and in the case of an adult lacking capacity, it is by no means clear who has the right to give the go-ahead. The consent process does not devolve automatically to the family or the next of kin, even where someone may have made a very explicit request before becoming comatose to have acupuncture treatment. In cases like this there usually has to be a consensus amongst all of the interested parties, from family to medical team in charge of the case and every occasionally also a judge.
 
The second issue of substance is whether a practitioner can be regarded as able to practise adequately in cases like this. Chinese medicine, like its western counterpart, has its own diagnostic techniques indpendent of the patient, the two primary ones being the taking of the pulse at the wrist and the inspection of the tongue. Whether these would be sufficient, in the absence of response from a patient, to justify continued treatment would be very much open to debate. If a patient remained unconscious, there would need to be some very visible and measurable outcomes which justified prolonged treatment.
 
However, each case is unique, and if you do have a specific person in mind, then it would be worthwhile talking to a BAcC member local to you to get a clearer idea of what may be possible. 

Q:  After the first treatment at the acupuncturist for infertility I have experienced what resembles mosquito bites at all points where needles were inserted. The acupuncturist then tried other types of needles for the following treatment. Symptoms have returned the second time as well. It is extremely itchy and only improved after three days. I have had acupuncture at another place before and this has not happened.

A:  This is most unusual. Generally speaking, what your practitioner did was quite right. Although all of the needles we use look the same there can be variations in the metallic mixture, and some contain traces of other metals than stainless steel to which some patients are allergic and respond as you did. Some needles are also silicon coated to make them easier to insert, and people can sometimes respond here too - either the needles you used to have were coated and these aren't, or vice versa.
 
Anyway, the practitioner was right to vary the type to see if this made a difference. If this hasn't worked , then the options are to contact the former practitioner to see if obtaining the same needles as you had before could work better, or to look carefully at anything else which has changed in your overall health by way of medications or similar which may be causally connected to the reaction.
 
If all else fails, then unfortunately it may be a balancing act between the benefits which treatment may deliver in the longer term against the shorter term discomforts.
 
We are sorry to hear of your experience, though. This is quite a rare occurrence, and is probably the last thing you want to have on your mind at this time. We hope that you and your practitioner are able to find a solution this.