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Q: I have had buttock pain (and sometimes leg pain) for the past 4 months.  It started on my right side and now is on both sides. I have seen many doctors and each one tells me something different (piriformis, disc, hyper mobility...). I really can't stand it anymore and am very worried.. Should I try acupuncture or dou think it won't help with that?

A:  In our view there are very few conditions where it isn't worthwhile trying acupuncture, but we would say that, wouldn't we?

The key thing about the difference between conventional medicine and traditional Chinese medicine is that Chinese medicine is premised on an entirely different view of the body, mind and emotions as a flow of energy, called 'qi', whose flow, rhythms and balance determine the state of someone's health. Symptoms remain the same whatever system of medicine you practise, but they can mean very different things in an entirely different system of medicine. A practitioner of Chinese medicine would try hard to understand what was happening in the area where the symptom presents, because blockages can be local, and also the backdrop of the whole system against which the symptom sits. There may, for example, be constitutional reasons why a symptom is not improving; if the whole system is running below par, then all healing in the body will slow down.

There are a number of possible interpretations of what is going on, and there are several factsheets on our website www.acupuncture.org.uk under the 'research' button which set out the evidence for the efficacy of acupuncture. For back and sciatica related problems the evidence is fairly good, good enough for NICE guidelines to make acupuncture one of the treatments of choice for chronic long term back pain. However, we are reluctant to point to a single definition, partly because we don't want to second guess what a practitioner may find and partly because the western labels do not always overlap very well with the presenting symptoms when seen in a Chinese medicine context, and as we said, Chinese medicine looks at problems as they present in the unique individual. That is why ten people with the same western disease label may get treated entirely differently in Chinese medicine. To an extent this will also be the case for eastern labels; how something manifests is not necessarily the root cause of a problem. If the child is screaming, said the ancient Chinese, feed the mother.

The best advice we can give you is to visit a BAcC member local to you and see if they can arrange a brief face to face assessment of your problem. This will enable them to give a far better estimate of how much benefit acupuncture treatment may offer, and also give them a chance to assess whether other modalities like osteopathy might work as well or better instead of or even in tandem with acupuncture treatment.

Q:  My friend got acupuncture yesterday and in the evening after the session felt extremely overwhelmed and was upset and crying. She is being treated for anxiety and general overwork/stress over the last 4 years at least. She said it was painful when the needles wherein her. This is not her first session. Is this a normal reaction, and if so, is it a good sign?

A:  The first and most important thing to say is that serious and continuing adverse effects from acupuncture treatment are very rare. When things do happen after treatment, be they unusual headaches, a slight feeling of dizziness, extreme tiredness after the first session, and occasionally a significant emotional release, many practitioners will take this as a very positive sign that the balance of the system is being restored. The accepted belief is that when the body is not in balance it retains areas of disturbance or blockages, and once balance begins to be restored the disturbances surface as short term, and sometimes quite unpleasant, effects.

When these are physical, we tend to keep a close eye on what happens. The usual extent of a disturbance like this is 24-48 hours. Anything more than that we would look carefully at other possibilities. One is that the treatment has uncovered another blockage which wasn't noticeable to begin with and this is now generating symptoms. It's only when the rain falls that you find out that your gutters are blocked, and in the same way, when someone is very depleted it is only when the energy flow is much stronger that a pre-existing blockage surfaces as a problem.

The other main issue is that the symptom may not be anything to do with the treatment, and we are very clear with our members that they should not waste time arguing whether acupuncture did or did not cause a symptom but first and foremost ensure that someone gets the treatment they need. There is very often a temptation to succumb to the 'post hoc propter hoc' fallacy, that because something happened after treatment it must have been caused by the treatment. This is often not the case - after all, the practitioners spends one hour of the 168 in a week with a patient, and the patient's life carries on with all its normal complexity around that. However, there are ways and ways of making this point, and if this is not done adeptly, it starts to sound like 'it wasn't my fault' which is often taken as a refusal to admit liability.

In your friend's case it may well be that the treatment has uncovered something which she is now experiencing as an outpouring of a none too pleasant emotion, but if this is the case, then the treatment should be moving her forward, and future treatments will help her to move beyond the feeling of being overwhelmed. It is also possible, however, that there are other factors in life which may also have had an impact. We are certain that her practitioner will explore this with sensitivity when she goes to her next session.

As for the needles being quite painful, there is often a correlation between how people experience the needles and how settled in themselves they feel, and although this is a comment based on experience rather than research, people with anxiety issues are often highly reactive to the physical impact of being needled. However, the fact that she experienced these particular needles as more painful than ones she has had previously, and the effect being much more tangible, there is just a possibility that the treatment may have been too strong for her. We do find a small number of patients for whom too many needles or too vigorous a reaction can wobble them for a few days, and an experienced practitioner will know to reduce the number of needles and strength of needling if the feedback makes them suspect that a person is sensitive in this fashion.

All of these issues are worth discussing with the practitioner, and we are often surprised that people feel any diffidence at all about confronting practitioners with these sorts of questions. Our members are perfectly happy to go through all aspects of treatment with their patients, and believe that good communication is essential to good treatment. 

There are no age restrictions on acupuncture treatment. The only limiting factors are the informed consent necessary for treatment and relatively small number of clinical circumstances where treatment is contra-indicated or inadvisable.

At the 'lower' end of the scale, children under the age of 16 have to be accompanied by a parent or guardian, and consent lies with the parent. A child of 14 or 15 is now deemed by case law (this used to be called 'Gillick competent') to be able to refuse to have treatment, but we have not yet encountered any cases where a 14 or 15 year old has sought treatment when accompanied by a responsible adult who is not their parent or guardian. We would take legal advice should this question be asked of us; it is a highly technical argument.

At the other end of the scale the question of competence is just as important. From a Chinese medicine perspective based on the balance of energy and the enhancement of the quality of life there is never a stage where treatment would not be deemed beneficial. However, if someone is starting to exhibit clear signs of dementia or other forms of mental incapacity, a practitioner may need to proceed with caution. The issue of who has authority to give consent is a tricky one, and questions of a highly technical nature abut power of attorney start to present themselves. It is not, as is widely believed, simply a matter for the next of kin to decide.

The other factor in the treatment of children, especially the very young, is that although we do not require members to have undertaken specialist training, we have now published recommendations for what we would regard as minimum levels of postgraduate training and experience for treating children. While it is perfectly safe to treat children of any age with generalist skills, we do recognise that optimal treatment sometimes requires additional training; children are not simply small adults, and there are variations in children's energies which is it valuable to understand.

Q:  My husband has diabetic lumbosacral radiculoplexus neuropathy. Please advise if he should find an acupuncturist specializing in this condition. .We live in west wales and would be grateful if you could recommend a practitioner.

A:The first thing we have to say is that you are unlikely to find an acupuncturist who specialises in treating this condition, but that is in the nature of Chinese medicine which is inherently generalist. In fact, in ancient China the specialist was regarded with disdain because they were restricted to treating a small number of conditions, whereas the generalist could treat all. Chinese medicine treats the person, not the condition from which they suffer. It would not be unusual for twenty patients with the same presenting conventional named condition, say migraine, to be treated in twenty entirely different ways.

Symptoms, what the patient experiences, are the same whatever system of medicine one practises, however, and it is the sense which a practitioner can make of them which determines whether treatment is possible. The normal symptoms of this form of diabetic neuropathy - pain, weakness in the limbs, muscle wasting and so on - would be seen by a Chinese medicine practitioner in the context of the Chinese medicine system which is premised on an understanding of the body as a flow of energy, called 'qi'. How qi flows. The balance and rhythms of this flow determine whether someone is healthy or not, and unsurprisingly where the flow is blocked or out of balance, pain and loss of function will result.

This is a rather long-winded introduction to saying that the Chinese medicine practitioner will be less interested in the name given to the condition than in how it presents, and will try to make sense of that both as a local disturbance and as a manifestation of the balance of the whole system. This can mean on occasion that acupuncture treatment can achieve changes where people thought change was impossible, but this has more to do with the fact that the causal relationships on which conventional medicine relies can be misinterpreted. Nearly everyone over the age of 60 has some degeneration of the lower spine visible on X-ray but that doesn't mean that every backache is caused by it.

In the case of diabetic lumbosacral radiculoplexus neuropathy, however, the diagnosis tends to be more precise and what we can say is that there is a limited amount of evidence for the use of acupuncture in the treatment of neuropathy and considerably more evidence for the treatment of chronic pain wtih acupuncture to suggest that acupuncture treatment may be able to take the edge off your husband's pain. Working at this remove, though, and without being able to see exactly how it manifests we are somewhat limited in what we can say. The best advice we can give is that you go to see a BAcC member local to you for an informal face to face assessment of whether acupuncture treatment may be of benefit. A skilled practitioner should very quickly be able to tell you based on what they can observe whether they think that treatment applied locally may help, or indeed whether balancing the whole system may help the body's own mechanism's to function better and take charge of its own recovery.

As far as finding a practitioner is concerned, there is a 'find a practitioner' feature on our home page www.acupuncture.org.uk which should be able to provide you with a list of names of working in or near your postcode area. We always recommend using postcodes; the search engines are very specific and if you name a county you may find that someone works just over a county border who is far closer than the practitioners operating in your own town or county.

A few days ago I had acupuncture for the first time can you please tell me if it is normal to have swelling & bruising in a particular site that has been treated?

A:  We wouldn't go so far as to say 'normal', but occasionally bruising and swelling at a needle site can happen. This is a relatively infrequent occurrence, and indeed in a major survey we conducted a decade ago there were only seven such instances in over 34,000 treatments.
 
However, what matters is that it has happened to you, and it can't be very pleasant. Generally such bruising and swelling subsides within the first 24/48 hours, but if the area continues to be visibly inflamed after 3 or 4 days it is wise to contact the practitioner for advice. If someone came back to us with what you have and it had persisted for more than a few days we would probably be inclined to advise you to consult your GP.
 
Of course, a great deal depends on where the bruising is. Some areas heal more quickly than others, and your practitioner should have a very clear sense of what you might expect, given the areas treated.
 
We have to say, though, that serious adverse events after treatment are very rare indeed, so there should be no reason to be unduly worried.