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Q:  Three years ago my wife suffered a severe cranial infarction which has left her totally incapacitated on her right side permanently bed ridden and doubly incontinent. She is well cared for in a nursing home and is fortunately left handed. There is no prospect of any sort of recovery, but she is troubled by very severe pains which she agrees are of a cramp like nature in her right lower arm and elbow area. These come and go and leave her in agony for hours each day and seriously depressed. Is there any possibility that acupuncture techniques might reduce or remove these sudden bouts of pain?re sorry to hear of your wife's continuing problems.

A:  We are always a little careful when we answer questions based on possibility. Everything is possible. Every treatment works for someone but this falls a long way short of some treatment working for everyone. We have produced a fairly hefty review paper


http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

which details the many studies of post stroke/CVA treatment. In China acupuncture has a much more central place in the treatment of stroke/CVA, especially immediately after the event. Treatment often commences the day of the event itself, and the aim is to restore the proper flow of energy as soon as possible. It is also used quite frequently in this context as well, getting rid of a residual symptom which either does not leave after the stroke or emerges as a consequence of the change of use associated with the problem.

As you probably know from your researched so far traditional acupuncture is based on theories of energy, called qi, and its flow and balance in the body. Pain only arises where the flow is blocked or where it is seriously deficient or in excess, and the needles are used to restore balance. In order to get a really good idea of what may be possible for your wife's problem you will need someone to take a look and make a face to face assessment. At this remove all that we could say is that it is not untypical of the sorts of problems we have addressed, and sometimes very effectively, but we are reluctant to say 'go ahead' because there may be aspects of your wife's condition which a practitioner would see immediately were likely to cause difficulties beyond the scope of acupuncture.

Hopefully your wife's nursing home is near enough to a BAcC member that they could easily pop in and give you a better sense of what is possible. Home visits are not the most popular option for some members because many are reluctant to charge for the additional time it takes to arrive and set up, but there are still enough who do to encourage us that this is a reasonable possibility.


A:  As far as we can tell these refer to a Certificate in Acupuncture and Oriental Medicine awarded by the City College of Acupuncture  and that the practitioner is registered with the British Register of Complementary Practitioners.  This is a register which operates as far as we know under the aegis of the the Institute of Complementary and Natural Medicine.

We are not sure whether the TCM for Traditional Chinese Medicine is a qualifier of the certificate or the section of the BRCP register in which the practitioner is recorded.


Q:   I had acupuncture about 5 days ago with a different practitioner. Almost straight after the session I got a pain in my right side of my stomach which has not subsided. Could this have been an affect of the treatment?

A:  We are sorry to hear of your experience.

Without knowing exactly where you were needled and for what we are a little limited in what we can say. If the pain is at a needle site it suggests that there may be a little internal bruising which is not visible on the surface but enough to put pressure on nerves and cause some discomfort.  Physical damage after acupuncture treatment is quite rare, and usually transient, so it is quite possible that by the time you get this response after the Easter break your discomfort will have subsided. If it hasn't, and it does relate to where you were needled you might need to contact the practitioner to ask for their advice and possible explanation, and also arrange to see your GP just to be sure that there is nothing untoward going on. It is highly unlikely but it is often better to take this step early to avoid unnecessary worry.

There is also a slight chance that the pain is an energetic consequence of the treatment. It is also quite unusual to experience this, but there are occasions when helping the system to function better reveals blockages which a weaker balance was able to cope with. It is also possible that the treatment was badly chosen, although our experience of choosing the wrong treatment is that the system reverts within 48 hours to where it started. Longer lasting disruption is extremely rare.

The best person to ask is the practitioner himself or herself. They will know exactly where they needled you, and will be as concerned as you to understand what has happened and do what they can to correct it or refer you on for further investigation. We rather hope, though, that it is a transient adverse event, and by the time you received this reply after the break it has subsided or gone. 

 

Q:  I've been receiving acupuncture as part of my physiotherapy treatment for golfers elbows - though  I don't play golf. The needle was inserted in my inner elbow and tweaked for about 2 minutes causing immense and intense pain at the time, which I still felt the next day.. This is my gear stick arm and I cannot drive. I've never had a reaction like this before. Is this unusual?

A:  We are sorry to hear of your predicament. While not common, this sort of adverse event can happen, but you are right to say that it is unusual.

In the majority of cases like this, the problem arises because the practitioner has inserted the needle too deeply or too vigorously, and the needles has either slightly damaged a nerve or more likely caused some deep internal bruising.This small haematoma will 'saw' a nerve each time that the arm is move or the muscles tense. Given that this joint is rich in nerves and blood vessels in transit, resting the area is rarely possible,

If this is what we suspect, the effect should wear off in about 48 hours. If it does not, then it would be prudent to make an appointment with your GP to see what is going on. Permanent damage is rare; we receive very few reports in each year of adverse events which are more than transient, but it is always worthwhile placing yourself within the system early in case it doesn't clear up quickly.

We are assuming that the treatment was administered by a physio who also does acupuncture rather than a professional acupuncturist. Most physios base their work on what is termed western medical acupuncture, which has a different conceptual basis from that which we do. The treatment is usually aimed at reducing muscles knots and inflammation based on a conventional diagnosis. It would also be fair to say that the techniques used by most are a little more vigorous than most traditional acupuncturists employ. However, a needle is a needle in anyone's system, and if there is an unintentional energetic effect as we might understand it, then a dull aching sensation could be stimulated and persist for about twenty four hours.

It is much more likely, though, that there has been minor physical damage and it is well worth discussing this with the physio before any further treatment is done. They may even be able to help resolve some of the pain which you are experiencing.

Golfer's elbow, by the way, is  the generic term for problems on the inner aspect of the elbow, whereas tennis elbow is usually the generic name for problems on the outer aspect. Windsurfer's elbow is also starting to appear more frequently.

We should add that treatment is not an endurance sport. We always remind our patients that if something hurts and continues to hurt they should tell us immediately and we can either adjust the depth and vigour of insertion, or simply remove the needle. Gain through pain may be an old adage, but not to the point where the treatment hurts more than the problem. 

Q:  have been diagnosed with tendinitus in my shoulder.  I have had physio four times but I am  no better. On my  last visit he suggested acupuncture. Needles were put in in my neck, shoulder and arm. After a few minutes I started to feel dizzy ..My shoulder has been worse since and also my muscles in my legs feel weak causing me to have trouble with getting up from a kneeling position and up and down stairs.  Would this be side affects from the needles? 

A:  We can understand that you might feel a little dizzy after having treatment, and also the slight aggravation of the shoulder problems, but the more general feeling of weakness is a bit of a puzzle.

On the leaflets we hand out to patients about aftercare advice we mention that there may be some minor adverse events after treatment, and a slightly dizzy or 'spaced out' feeling is certainly possible. This can happen during treatment too. We mean no disrespect to our physiotherapist colleagues, but the techniques they use for musculo-skeletal problems are often a little more vigorous than those we employ, and this can sometimes cause what we would describe as a disturbance or stirring up of the energies which can make people feel a little woozy. This usually passes off quite quickly, but there are some patients who are quite sensitive to treatment, and for them treatment will always have to be slightly more gentle to avoid over-excitement of the system.

'Getting worse before getting better' is a potentially dangerous principle; sometimes people are simply getting worse. However, in the treatment of necks, backs and shoulders we tend to routinely tell new patients that there first 48 hours after treatment can sometimes see an aggravation of their symptoms. There is no commonly accepted explanation for this, although many believe that the pains arise from the muscles and tendons starting to re-gain their true positions, rather like the pains you get from warming your cold feet in front of a fire when the circulation returns. However, whether there is a simple explanation or not it is a common enough experience that we tell patients that this might happen, and if often does.

The weakness in the legs is an entirely different matter, however. There is no obvious connection between treatment in the neck, shoulder and arm which would impact on the strength of the whole system, at least not in the conventional medical terms under which treatment has been given. We could perhaps make a case in traditional acupuncture for a temporary and transient event of this nature, but it would almost certainly be a short term problem. Our best advice is to monitor this and see if it starts to dissipate. If it doesn't there may be a case for going to your GP and just getting things checked. What we always advise patients to do is not to get over-focused on establishing how something has happened to the detriment of getting proper treatment. Things can happen contingently, and it is always worth getting an unusual symptom checked, arising from treatment or not.

Of course, the first person to whom you should address your concerns is the physio himself. he will know far better than we can what he has done and we are sure that he can out your mind at ease about some of the problems you have experienced.

 

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