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Q: I've been having treatments for hip bursitis for about 8 weeks and  getting on really well until the last one. Now I am finding I'm back to where I was at the beginning;  dreadful pain on walking and climbing. This happened 2 days after my last treatment -  is this normal? 

A:  We wouldn't use the word 'normal' but it is not unknown for a condition to re-occur in the middle of a course of treatment.

Generally speaking this kind of flare-up is more common at the start of a course of treatment. We routinely warn patients with back and neck problems that the first couple of sessions may lead to an increase in their discomfort, as indeed most osteopaths and chiropractors also say to their patients. It would be more unusual for something like this to happen a little further down the path, and if this were to happen the first thing we would do as practitioners is to go carefully through the patient's last week and see what might have happened to disturb progress. This may not necessarily be a major event like a twist or fall. It can sometimes happen that people start to experience greater freedom and mobility, and occasionally get slightly ahead of their own rate of progress.

If there is nothing in the case history to suggest that this has a physical cause, the next possibility to explore is that the treatment may only be offering short term pain relief and that it is not so much progressing towards resolution as being held at bay. This is why we eventually start spreading treatments out from weekly to fortnightly and monthly to see if there is sustainable progress. If the treatment runs out of steam we tend to re-appraise what we are doing in case we appear to be offering a successful but non-enduring palliative.

The most likely reason, though, which is probably not helpful to hear is that sometimes these things just happen for no apparent reason. What you will know is that treatment can get you from this place to a better state, and hopefully you will continue and experience the same level of relief. However, it might now call for a much more managed recovery where the effects of treatment and the management of the case as a whole needs more focused attention.

In our experience bursitis problems can be problematic, because from a Chinese medicine perspective they involve not just a local reaction but usually a systemic change which allows the accumulation of fluids in a more widespread fashion, and there are broader factors like diet and sleep patterns which can have an impact on a physical problem as much as movement or jarring. This, though, is the strength of Chinese medicine, treating not just the problem

Q:  I have been diagnosed with a rotator cuff tear. Whilst I wait for a operation I am thinking about trying some acupuncture for the pain and deferred  pain after my recent cortisone injection. I have had 2 injections and they have helped with my shoulder pain but not stopped the deferred  pain.

A:  There are two questions here: is acupuncture any good for deferred pain in rotator cuff injuries and can it be done alongside cortisone injections.

As far as the deferred pain is concerned, a great deal depends on what is causing it. In answering a question on rotator cuff injuries a while ago we said:

There are a number of trials which have shown encouraging results, two of which can be found at

http://www.ncbi.nlm.nih.gov/pubmed/10534595
and
http://www.ncbi.nlm.nih.gov/pubmed/19489707

but a review of all the trials was less than conclusive

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0013397/

Acupuncture has been used as a form of pain relief in both eastern and western/medical traditions for many decades, and there is no doubt that there is sufficient evidence to demonstrate efficacy in relieving pain. The question, however, is whether that relief is sustainable and for how long, and whether it promotes eventual healing or simply operates as a non-pharmaceutical alternative for pain relief. If it is the latter then it may be a prohibitively expensive option unless someone cannot use conventional pain-killing medication.

Having said that, the theory of Chinese medicine treatment is based on the premise that pain arises from malfunction or blockage, and pain is treated not so much as a thing itself but as a symptom of a failure of function or flow in the system. By restoring flow or balance the practitioner would hope both to encourage healing and reduce pain.

There are a number of strategies involving both local needling and systemic treatment, depending on the nature of the pain and the injuries or strains which people have experienced. There is no real alternative, though, than to seek face to face advice from a BAcC member who can give you an accurate assessment based on the specific presentation you have.  
 

From a Chinese medicine perspective we would normally be classifying deferred pain in terms of blockages or disruptions in the flow of energy to the area where the pain occurs. This may have been caused by the injury or may in some cases result from the cortisone injections themselves. It would be extremely important to have sight of the areas of pain to make sense of them, and be able to offer a more definitive view. If it is a case of blockage or change in the flow, then there is a good chance that treatment may have an impact. However, if this is really a case of referred pain in the conventional sense it means that the pain trigger still exists elsewhere, and until that is resolved the pain may continue.

As far as cortisone injections are concerned, there is no definitive answer from the research literature or from conventional medicine about the use of acupuncture after a cortisone treatment. There is nothing which indicates that it should not be done, but you will probably find that most practitioners will not needle in the area directly around the injection site until a week or more after an injection. This is mainly for energetic reasons, with most practitioners taking the view that until the area has stabilised again it is better to wait and see what effect the injection has both on the primary condition and on the tissue in the area itself. Once everything has settled down, there is no reason not to have acupuncture treatment.

We strongly recommend having a face to face chat with a BAcC member before committing to treatment. In our experience rotator cuff injuries can present unique challenges, not least in that it is a very difficult joint to immobilise and lead an ordinary life, so continued aggravations of the initial injury are quite common. Most BAcC members are happy to give up a little time without charge to assess a problem and give a more balanced view than we can offer at a distance.

 

Q:  I received acupuncture today from a new practitioner. He was treating me for a hormonal disorder. . He inserted a needle into my spine and  I felt a  sharp, painful sensation in my spine and down the back of my right leg. The practitioner saw that I tensed up and  after I told him what I felt but he didn't seem concerned. Now I have pain and stiffness in my lower back, if feels like it did when I injured it a few years back.  It's very painful. TDo you have any advice for me?

A: It is always difficult to say in the first 48 hours after treatment whether there is a permanent problem or a short term adverse effect which will wear off shortly. We tend to advise patients having treatment for a back problem that things can be exacerbated a little by treatment, and this can mean on occasion a return of symptoms or even an increase in symptoms. This can often be a normal healing response which can often feel like a more intense version of an original problem

However, there is a great deal of delicate tissue and blood vessel in the back, and if someone has needled a small blood vessel and caused minor bruising this can often put pressure on local nerves and cause a quite nasty and prolonged pain until the bruising subsides. This is the most likely cause, and you may find that the bruising becomes apparent on the skin surface within the next day or two.

We have to admit to a slight amount of concern about the fact that you felt a reaction down the back of your leg. This might suggest that the practitioner has caught the sciatic nerve, which would be very painful and could cause a slightly longer lasting sensation. We don't think that this would cause any lasting damage, but we would certainly want to know if the needle was inserted in the midline into the spine or just to one side. Great care has to be taken for midline needling.

We are confident, though, that this will prove to be what we call a transient adverse event, which means that it should have disappeared within a couple of days. If the pain continues beyond that, or if you get any return of the sensations down the back of the leg, it would be a good idea to pop along to your GP just to let him or her have a look. You might also want to call the practitioner and ask for advice. He or she will know exactly what has been done, and can advise you with a little more accuracy than we can here with only a basic account to go on. 

Q:  Memory loss as a result of acupuncture. My 18-year old granddaughter had pain therapy by using acupuncture in a recognized hospital. After the second session, the loss of memory for a period of one month. When she came out of the hospital she did not know where she was. She  did not remember having acupuncture.  All events and  study matter last month have been deleted. .Are such cases are known, and where can one  find them? 

A:This sounds a very distressing and unpleasant case.

We have looked through all the adverse event literature we have and there is no mention of anything similar. Most of the adverse events involve physical damage, but where they are psychological or mental, they tend to be very short lived. There is certainly nothing of which we are aware which has had such a profound effect on someone.

There are really only two possibilities. First, if the acupuncture has not been delivered with proper care and has either managed to penetrate the scalp or cause a minor infection in that area there is a remote chance that this has caused the problem. This would be unique in the history of modern acupuncture, but it remains a theoretical risk. The other more likely reason is that the treatment and the symptom of memory loss are not directly related, and that the problem arose while the grand-daughter was having treatment but not caused by it. With the millions of treatments now being provided each year there is always a possibility that someone will have a strange or serious episode at the same time as the acupuncture treatment but having no connection with it. It is often hard to convince someone the two are not related, and this can occasionally mean instead of getting orthodox treatment a row starts about who caused what.

We are not sure what the email means about everything being deleted. We can only assume this is not in the UK, where deleting patient files and records within seven years would be illegal. If the records have been deleted it would be very difficult to offer a view about what might have caused a problem. The points used would be the only indicator of potential physical damage.

 

Q:  My husband has been told that his eustachian tube in his ear remains open when it should be closed would he benefit from acupuncture?

A:  We have spent some time researching your question about Patulous Eustachian Tube (PET) because we have to be honest and say that it is not a frequently presented problem. We have found no studies of its treatment with acupuncture, although we have no doubt that they exist in China. The problem is that only a very small percentage of studies are translated, and these are usually for the 'headline' named conditions, back pain, headaches, and so on.

From a Chinese medicine perspective, any failure of function should theoretically be amenable to treatment unless there has been a physical change in the structure of the body which it would be unrealistic to see reversed. As we understand it PET can range from a birth defect often found in people with Downs through to a shorter term problem generated by excessive weight loss and consequent loss of fat in the tissues of the Eustachian tubes. Depending on the putative cause treatment aimed at establishing the overall balance of the body may have a chance of restoring function to a degree. A practitioner might also be interested to see whether there are any local blockages in the flow of energy set against a general backdrop of energetic weakness which might have caused the condition to appear or worsen.

Generally, however, with conditions such as this there are fewer guarantees than usual, and we always recommend that treatment undertaken in a 'let's see' mode is carefully monitored. It is always worth trying acupuncture treatment because we have seen unexpectedly good results on occasion for conditions like this, but we have also seen situations where someone has had a course of twenty sessions with no change, and this can often lead to dissatisfaction. Regular review periods are essential.

The one small ray of hope is that there was some excitement about the use of a Chinese herb Jia-Wei-Gui-Pi-Tang following a Japanese study found here

http://web1.incl.ne.jp/ishikawa/PET/art1.html

which achieved some remarkable results in some patients, although the study itself was terminated because of adverse effects on other patients. We are not Chinese herbalists, but a small proportion of our membership are jointly members of the Register of Chinese Herbal Medicine (RCHM) and it may well be that if you can find a dual-registered practitioner near you, they might be able to offer you a very good assessment of what is possible by using a combination of acupuncture and herbs. There is also an association of mainly Chinese practitioners, the Association of Traditional Chinese Medicine, whose members all use acupuncture and herbs. Most members of all these associations are usually happy to give up a small amount of time to see someone briefly in order to assess whether treatment may be beneficial. This will enable a slightly more in-depth view than we are able to offer at this level of generality.

 

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