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Q:  I had my first acupuncture session for neck and shoulder pain at an NHS Hospital 4 days ago. I felt  dizzy as hadn't eaten so he stopped after 10 minutes . However,  that afternoon I had a shooting pain a few times in my hand then a few twinges behind my eye.  This has past but I now have a recurring pain in the joints just before my fingernails.  Shall i continue my treatment next week ?

A:  We are sorry to hear of your experience. We are not sure whether the practitioner is a BAcC member - in an NHS hospital this is highly unlikely - but we assume not because it is always one of our basic pieces of advice to a first-time patient to make sure that they have eaten something before treatment. In our experience, not eating can lead to light-headedeness and a possible faint. Although we wouldn't want someone to have treatment immediately after a three course dinner, a normal pattern of eating should be enough to ward off any short term adverse effects.

As far as what you have experienced after the treatment is concerned, you need to look at it from two different perspectives. If the acupuncture was undertaken by a physiotherapist or other conventional healthcare professional, the chances are that they would have been looking for trigger points, knots in the muscle, which when needled tend to relax and relieve some of the tension which causes the pain. Western medical acupuncture can be a little more vigorous than traditional Chinese acupuncture, with larger gauge needles and sometimes repeated insertions. Had the practitioner needled into a nerve you would have been very immediately aware; the feeling is unmistakable. What may have happened, though, is that there has been a small bruise formed at the needle site which has impinged on the nerves travelling through the area. This might account for the reactions you have experienced and are continuing to experience. The fact that the initial symptoms were more severe and have abated suggests that if there was internal bruising it is starting to heal.

From a traditional chinese acupuncture perspective it is possible that the treatment has caused some of the blocked energy in that area of the body to move. If the treatment was administered by a traditional practitioner this will have diagnostic significance and they will pay particular attention to what you have to report. This may also be the unintentional consequence of someone using one system of medicine having an effect only recognised by another. There is a point, for example, used in the treatment of tennis elbow which if over-vigourously needled can reduce someone's blood pressure quite dramatically, although the practitioner working with Western Medical Acupuncture would be unaware of this consequence.

On balance, though, this does sound like a minor physical injury caused by the needling itself, and whether or not you decide to have treatment, it is important that you keep your appointment and describe what has happened in great deal to the practitioner. If as is likely the symptoms have continued to abate you would probably benefit from continued treatment. However, the choice remains yours and if you are not reassured by the explanation or worried by the continuing symptoms you can simply decline the treatment which cannot be undertaken without your consent.

Can acupuncture work for meralgia paresthesia?  I have seen Mike Cummings in the past. Would it be possible to see him again?

A: First things first, Mike, although a long-standing and respected colleague of ours, is not actually a BAcC member. He is the medical director of the British Medical Acupuncture Society, and his contact details can be found by logging on the BMAS homepage and using the find a practitioner function.

The problem you have, meralgia paraesthetica, is not one for which a great deal of research has been conducted. There has been rather helpful systematic review

and a study published last year

which seems to offer considerable encouragement. In all honesty, if your health is otherwise good, Mike is probably the person you need to see, based on the fact that he is known to you and we are sure that he uses the electroacupuncture which this trial seems to find so effective in dealing with the problem.

That is not to say that traditional acupuncture in the hands of a BAcC member is not going to be equally effective! The great strength of traditional Chinese acupuncture is that it looks at the symptoms which the patient brings to us in the round, and while in many cases the symptom is what it is and no more, there are equally many cases where the symptom is a sign that other parts of the system are struggling. Our belief is that if someone simply treats the symptom in these cases it is like turning off an alarm bell because it is uncomfortable. Sooner or later it will ring again or ring louder.

If Mike is unavailable in the short term we would recommend that you contact a BAcC member local to you to have a brief face to face assessment of what acupuncture may be able to offer you. The symptoms you have, although usually the consequence of nerve entrapment, are explained in Chinese medicine as a weakness or blockage in the flow of energy, or 'qi' as it is called, and the use of needles to reinstate the flow has a two thousand year history. There is often a considerable overlap between the two systems, the traditional acupuncture which we use and the medical acupuncture which Mike uses, but it's all the same body so that is not a surprise. The points are often the same one; it is simply the rationale which is different, although we are aware that medical acupuncture would not claim to look at the symptom in its wider context within acupuncture.

There was a major review two years ago

which summarised all of the trials which had been conducted, both on animals (what we sometimes refer to as 'ratpuncture') and on humans. The conclusions are cautiously positive, although as you can see the treatment rarely involves acupuncture alone. There is an interesting study just in the offing

but it will be some time before any results are available.

As we said, though, it depends in large measure what you or your consultant believes to have been the cause of the problem, and given that you think your consultant will disagree, what course of treatment is being proposed instead of or as well as which you would like to try an alternative approach. In our view there is nothing to lose by trying acupuncture, and since it can be used alongside conventional treatment no reasin why your consultant should take umbrage. It certainly won't do any harm, unless you seriously delay conventional treatment while seeing whether alternative treatments work.

Our best advice, which must seem a little repetitive to anyone looking at several answers, is that you should visit a BAcC member local to you for a brief face to face assessment if what may be possible with acupuncture treatment. They will be able to look at the condition with the benefit of being able to get more medical and lifestyle background, and may well get a very clear handle on what from a Chiense medicine perspective appears to be the underlying cause of the changes

This is a very difficult question to answer. We have checked the databases but there are no records of research trials or even case studies. Given that this is quite a rare condition, with only 1 case per 100,000 population this is not entirely surprising.

We are working on the assumption that you are under the care of a consultant and that you have been given all of the relevant tests. This is important; one of the less pleasant consequences of the condition is blindness if the pressure is not controlled, and we would be very keen to ensure that someone did not delay or abandon conventional treatment in favour of alernative treatments.

One of the great advantages of traditional Chinese medicine is that it has an entirely different theoretical framework based on the flow of energy, or 'qi'. It is possible that a skilled practitioner may see signs of disruption to the flow of energy or blockages which may, from a Chinese perspective, be responsible for a build up of pressure at the top of the body in the head. Some of the classifications in Chinese thought may appear simplistic but often accord with how people experience their conditions - 'feel like I'm sinking inside', 'feel like my head is about to explode', and so on. The clear understanding of the various flows and how they are disrupted can often point to systemic problems which treatment may help to alleviate.

This is, however, a rare problem, and we would be very hesitant to give a recommendation sight unseen. The only thing we can suggest is that you visit a BAcC member local to you and seek their advice in a face to face assessment of your problem with some basic Chinese diagnostic methods. We are sure that acupuncture treatment could not do any harm in the hands of a skilled and trained practitioner, but we could not be sure whether it would do any good.

We have produced a fact sheet on osteoarthritis

and as you can see, research into the treatment of arthritis in the feet is not that common. There are many hundreds, if not thousands, of studies published in Chinese every year, but only a small percentage are translated, and we are sure that there has probably been research but we are unlikely to see it.

Although acupuncture has a reasonably good record for offering relief in cases of osteoarthritis, it would be fair to say that arthritis in the feet can be much more difficult to treat. The very tight 'fit' of the foot bones means that where osteoarthritis starts to develop it can be very difficult to overcome the constant rubbing and inflammation which this causes in order to break the cycle of pain - inflammation leads to pain leads to more inflammation and more pain, and so on.

However, one of the great strengths of Chinese medicine is that it looks at symptoms as a part of a much wider pattern of energy flow in the body, and can sometimes make sense of systemic conditions which manifest in specific areas. Treatment may involve not just the affected area, but also points elsewhere on the body which can begin to put right the underlying imbalances which are the true cause of the problems. Arthritis has been around as long as men have walked upright, and the ancient Chinese had their own ways of differentiating the various types based on the nature of the symptoms - better with heat or cold, movement or rest, etc etc. This has led to some well-established protocols which may offer some benefit.

However, each person is as unique and different as their symptoms, and in some cases the deterioration will have gone beyond the point where treatmentt will be of benefit other than as short term pain relief. The best advice we can give is that you visit a BAcC member local to you for an informal chat and brief face to face assessment of what they think might be possible. We are confident that they will give you an honest and realistic assessment of what they think acupuncture treatment might offer.