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Q: I recently broke my tibia and fibula in the lower part of my shin which has been pinned with a tibial nail. Unfortunately I have also suffered some nerve damage during the trauma which has left me with foot drop. I have numbness along the outer edge of my calf muscle and across my foot. I am unable to move my foot upwards meaning when I walk my toes hit the floor before my heel. I do not experience any nerve associated pain. My question is do you think acupuncture could help with the recovery of the damaged nerve?

Q:   I'm talking about acupuncture in my coursework and would like to know the following:-
-       Is it recognised by the NHS and how? -       Do people use acupuncture instead of using orthodox treatments?      Is acupuncture recognised as having value?

A: These are very large questions, so I'll try to be as brief as I can.

1) Is acupuncture recognised by the NHS and how?

As far as official recognition is concerned this will usually only be through the recommendation of acupuncture in what are called NICE guidelines. There is something of a major argument on right now because acupuncture for the treatment of chronic low back pain was on the existing guideline but has just been removed from the revised one on rather spurious grounds, and we are fighting hard to get this proposal reversed. Generally speaking  if there is a solid evidence base for the use of acupuncture, then NHS professionals like doctors and physios are allowed to use it. So the NHS Choices site will cite a number of things which it accepts acupuncture can treat:

 http://www.nhs.uk/conditions/Acupuncture/Pages/Introduction.aspx

However, what counts as suitable research is also a vexed question. The gold standard is the randomised double blind control trial which is used for testing drugs, but this does not sit well with interventions like acupuncture (or surgery!), so much of the evidence which exists is not accepted in the West.

2) Do people use acupuncture instead of orthodox treatments?

The answer is probably yes, but a typical acupuncture patient will probably have already consulted widely within orthodox medicine and come to complementary medicine like acupuncture when conventional treatment does not deliver. We are not always the  'last resort' treatment, and many orthodox providers often now refer on to us, but it would be unusual for someone to come to us as the first choice. This is starting to happen, though, and this means that all acupuncture practitioners are sufficiently well trained in orthodox medicine to refer patients back to doctors if they spot a condition that needs urgent medical attention. We are also careful not to allow people to substitute acupuncture treatment for conditions which require lifelong medication or orthodox treatment. People with diabetes or thyroid medication are not allowed to alter their medications, and no practitioner would encourage a patient to change any prescribed treatment without the consent and knowledge of the patient's GP, even though a patient might want to make this change themselves.

There is plenty of evidence around now that acupuncture treatment can offer benefits to people whom doctors sometimes refer to as 'heartsink' patients, the ones for whom all conventional treatments have failed and for whom no conventional options remains.

3) Is acupuncture recognised as having value?

The answer will always be 'yes', even if you asked a sceptic. The question is how much value. At the truly sceptical end it is a very limited use intervention for a small number of conditions. At the other end of the scale it is a system of medicine able to bring about changes in body, mind and spirit, and potentially a life-changing intervention. In ancient China its use was always seen as preventative; you went to your doctor to stay well, not to get better after getting ill, which the Chinese said was 'like digging a well when you were already thirsty or forging a spear after the battle has started.' Certainly when acupuncture became more popular in the 1980s and onwards many patients used treatment in this broader sense. In more recent times the growing popularity of acupuncture treatment has meant more people coming to get a named condition treated, so its use has changed a little, but we as a professional body are at pains to remind prospective patients that treating headaches or back ache isn't what we do: we treat people with headaches, and people with back pain. This is why twenty patients with the same condition can be treated twenty different ways; each presentation is unique and individual to the patient with it.

You have to think, though, that after 2500 years of use it is still sought after and successful as a form of treatment, which strongly suggests that its value is considerable!

Q:  I have nerve damage after a hip replacement where my sciatic nerve got nipped with wire.  It was then released with more surgery.  I  now have a lot of nerve end pain -  do you know if accupuntre might help? 

A: This sounds highly unpleasant, but although hip replacement surgery is now pretty commonplace, it remains a complex and relatively dangerous procedure, and there are bound to be occasional accidents, as appears to be the case here.

A great deal depends on the extent to which the nerve was damaged. It sounds as though there has been a quite serious impingement of the nerve, and in most cases this can recover over time if the pressure is released and the nerve has not been damaged structurally. If there has been structural damage to some of the nerve fibres, then it is possible that they are sending out pain signals and will carry on so doing almost indefinitely.

However, a strange parallel with this is phantom limb syndrome, where people who have lost a limb through amputation or injury continue to receive signals from the missing limb, sometimes very painful ones too. There is a growing body of evidence for the successful use of acupuncture to address this problem, and in an answer about this phenomenon we quoted a number of studies which support the possible effect of acupuncture:

  

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:


http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97
Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142
Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112
Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213
Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

We always tread a little cautiously when we discuss things like this, though. As practitioners of Chinese medicine we use a very different approach to understanding the body, mind and spirit as a complex flow of energy, called 'qi', the rhythms, patterns and flow of which determine someone's health. From this perspective operations in particular can be seen as responsible for creating blockages or breaks in the flow, and this alone could cause pain symptoms alongside any actually physical damage which people may suffer. This is often the case in injuries like fractures where the bone heals but the pain remains. This could mean that from a Chinese medicine perspective that the energy flow has been compromised even though the physical structure has repaired.

Chinese medicine is based on treating the individual, not simply the condition. Each case will be unique and different, just as each person is unique and different, and for a really clear assessment of whether acupuncture can help you you might meed to pop in to see a BAcC member local to you. This will enable them to have a good look at what is going on and offer you a much better idea of what acupuncture might be able to do for you.  

Q:  My osteopath used the same needle on me twice while doing  acupuncture. When asked, she said it's safe since it's the same blood & not used on someone else. I wanted to know if it was safe to use the needle twice. 

A: Although the British Acupuncture Council's existing Code of Safe Practice allows the use of a needle more than once, the new draft Code, now in its consultation phase, does not. The only reason this was allowed under the existing was because one of the main teaching institutions made strong representations about its style of practice which involved the insertion and removal of needles in paired points in quick succession as a part of the rhythm of treatment. The only very slight risk of infection would be what is called 'autogenic infection where bacteria from the skin surface could be transferred to another area of the body which did not have the same bacterial balance. There had been, and still have not been, any examples of this kind of infection arising in this way, and the exception was allowed.

However, since many of the restrictions which apply to practice are about theoretical risk, and since the theoretical risk of infection does increase if a needle is re-used, the new Code will make one needle/one point mandatory. We have to explain to members that even where there is no evidence that infection has ever been caused by this practice, it would not be possible to rebut successfully a claim that it had been the cause if someone did report an infection at a needle site. Of such niceties is modern healthcare practice made. 

In practical terms there is often good reason not to re-use a needle. If you have ever seen the damage that a single insertion can do to a needle tip, you would not want to knowingly re-insert it into a patient. The average needle shaft  is about 0.18 - 0.25mm, so the tip itself is far smaller than this. If it encounters hard tissue - bone, tendon, even knotted muscle - then the tip can get deformed. This does not make a difference when removing it after a single use, but if it is then re-inserted it can make both insertion and removal painful.

It is fair to say, though, that you have very little to fear from the re-use of a needle. When we are talking theoretical risk we are often up in the hundred thousands or millions, but we have to be alert to the fact that, as one famous researcher put it, absence of evidence is not the same as evidence of absence. There may have been cases of infection which were not recognised as being caused by the treatment. In the circumstances best practice, as agreed by all of the major acupuncture associations, is to use one needle on one point only and then dispose of it. 


Q:  I was looking for some advice or reassursnce..I had t accupuncture 5 days ago and ever since I am  having tingling sensations in my  hands and feet and burning up arms.  i did have the needles in both hands and shins.  It  still feels like i have the tight sensation that the needles are still  there. I am slightly concerned as. I am also sensitive now to heat eg if take a  hot bath my body skin seems to burn.  Can you advise?

A:  It depends to some extent whether this was your first session or whether this has occurred in the middle of a longer course of treatment.

There is no doubt that first sessions, or early sessions in a course of treatment, can have some rather strange effects. Chinese medicine deals in diagnostic categories which sound rather odd to the western ear, like 'heat trapped in the interior' and the like, but most people make sense of this when treatment releases heat and the experience is literally one of heat travelling to the outer surfaces of the body and being let go.

However, reactions like this tend to be short lived and transient, perhaps lasting no more than a couple of days. The fact that you not only have a heat sensation but also tingling in the hands and feet suggests a more complex reaction. The first person you should speak to is your practitioner. He or she will know exactly what they have done, and hopefully be able to make sense of what is happening in Chinese medicine terms. We can think of a number of possibilities to do with heat in the system, but without knowing the exact patterns of your energy we can't really say a great deal.

If this is your first session, we do have to say that there are a number of patients who are remarkably sensitive to treatment and for whom we have to use the most gentle techniques to avoid reactions which can be like yours. This is utterly unpredictable, but once someone has thrown a large reaction to a simple treatment we always scale back what we do and build back up slowly. This doesn't sound quite right for what you describe but it remains a possibility.

The third possibility is that there is something going on which has nothing to do with the treatment itself. This is always difficult to say without sounding like evasion, but with three million treatments performed every year there are going to be a number of occasions when an unexpected problem occurs just after a session by chance. The key thing, if it persists, is to visit your GP for a conventional view rather than get involved in discussions with a practitioner about whether or not the treatment caused it. This can sometimes waste time when a solution is readily to hand, and inevitably treatment usually establishes causation.

We think the most likely cause, though, is an energetic reaction arising from treatment itself, so it would be wisest to contact your practitioner and if possible see them as early as you can so that they can see the problem for themselves. This may have a significant impact on how they carry on treating you and is bound to offer useful diagnostic advice to help them treat your more effectively in future. 

We hope that the experience has not put you off treatment, and hope that it addresses your problems well in future.

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