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Q:  Can acupuncture help with  someone with severe arthritis in both knees? They are unable to have knee replacements due to having had surgery done on lower legs due to hardening of the arteries,  which results in poor blood flow.  If knee replacements were to be done the healing process would be impaired which could then result in amputation due to infection

A: There is every likelihood that acupuncture treatment may be of benefit to someone with osteoarthritis of the knee. As our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/osteoarthritis.html

there is a growing body of evidence that acupuncture treatment is as effective as conventional treatment and in many cases more so. In fact, it was a source of some annoyance three years ago, including to the medical acupuncturists with whom we meet regularly, that the NICE guidelines for osteoarthritis of the knee did not include acupuncture as a preferred treatment in spite of the evidence available. Its day may well come, however.

From a Chinese medicine point of view the treatment of joint problems invariably involves not simply dealing with the local area but also the constitution, the system as a whole. It is nearly always the case that local arthritic problems are a result either of continued exposure to poor conditions or a local manifestation of a systemic problem. The most effective treatment will always combine local and systemic approaches, because local treatment alone may not buy long lasting relief.

We are a little concerned that a knee replacement has not been offered because of poor circulation. Although acupuncture treatment is extremely safe, there are some circumstances where a practitioner will take extra care and may even want a word with a patient's GP about what is going on. In treating the diabetic patient, for example, there is always a concern when needling the extremities that any minor wound may not heal quickly, and practitioners often take additional precautions to further reduce the risk. This may even involve using alternate points away from the affected areas to achieve the desired results.

Each person is unique and different, however, and the best advice we can givem, and do usually give, is to visit a BAcC member local to you and ask for a brief face to face assessment. Most members are happy to offer this kind of facility without charge, and a well-trained practitioner, as all our members are, should be able to give a very sound estimate about how much treatment may be necessary, and indeed whether treatment is likely to be beneficial.

A:  A great deal depends on what you are having acupuncture for. In China, for example, where acupuncture treatment is an accepted form of care within the national health service and free at point of delivery, it is not unusual to have a course of treatment daily for ten days, and for some conditions this is always the recommendation. In the UK cost and convenience make this less of an option, and most practitioners will only see a patient twice or three times a week for an acute situation for which they believe the patient needs more frequent treatment. This would usually run to two or possibly three sessions a week.

We have heard of colleagues who have treated daily as would be the case in China for conditions like an acute back sprain, but this is quite rare and was not done with any sense of commercial advantage, simply a reflection of the fact that the practitioners had unlimited access to their own clinics and the patients were very local.

We would have some reservations about anyone treating more than twice a week for a long term chronic condition unless there was a clear clinical rationale. If anyone has any concerns about this level of frequency of treatment a reputable practitioner should be able to give an extremely clear explanation of why they are treating this often.

It isn't really possible to overdo treatment, but there would soon come a point with over-frequent treatment, other than for acute conditions, where it was difficult to get sensible feedback. We often talk of throwing a stone in a pond and waiting for the ripples to cease before assessing the impact. Not a great analogy, we have to say, but gets across the message that it takes a little while for the impact of treatment to become clear. If someone is treating with too small a gap between sessions it is not always easy to see what progress has been made and how sustainable it is. It could not do harm, though, and there would be no risks associated with over-frequent treatment.

Q:  What is the BAcC'S attitude to Battleground acupuncture? I suffer from peripheral neuropathy. An acupuncturist known to me offered to give me a free session of battleground acupuncture which I accepted. The result was that I was left with incredibly bad pain in my knees, much worse than before.
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A:  We do not have any formal view about Battlefield Acupuncture. We did invite Richard Niemtzow, the originator of the technique, to address our Conference over a decade ago, and there was a flurry of interest, but from our perspective it is not a mainstream traditional acupuncture technique. Some of our members decided to incorporate it within their work as they would with any other postgraduate training, and all that we can do is to insist that if they use it they are properly trained in the use of the technique to ensure that there is no risk to the patient.

As far as the worsening of your symptoms is concerned, we think that it is highly unlikely that this has been caused by the acupuncture. In our experience, experience which is backed up by extensive research, there are very few side effects from acupuncture treatment which persist for more than a day or two, and most of these are relatively minor. Conditions do occasionally get a little worse, but this is almost always a precursor to an improvement. Short of actual physical damage caused by the needle, which again is very rare, acupuncture does not make problems worse.

However, there is no doubt that your symptoms are worse, and the first person you should consult for advice is the practitioner who applied the needles. Our understanding of Battlefield Acupuncture techniques is that they involve stud needles in the ear, and so we are discounting the possibility that there has been local damage from the needles themselves. If there is no local damage, then the practitioner will be able to assess whether the use of the needles has caused any energetic changes which may result in the symptoms getting worse. If there appears to be no reason for the change, then the next avenue to follow is to discuss the matter with your GP. We know how distressing peripheral neuropathy can be, and there may be treatment options or investigations which your GP can offer which cast light on what has happened to make your situation worse.

A:We think there are two elements to this question. The first is whether it is safe to treat someone who is thirteen weeks pregnant. The answer is that when the treatment is offered by a properly trained and qualified practitioner, as all our members are, then acupuncture in the first trimester is perfectly safe. There are a number of points which are forbidden during pregnancy as a whole and during specific stages of pregnancy, but all practitioners are well aware of these and either avoid their use or find safe alternatives which have the same function. It is fair to say that very few western-trained practitioners use needle techniques vigorous enough to cause any problems, but we have always erred on the side of caution.

There is an increasing number of members who now focus their time and practice on treating women through pregnancy and undertake postgraduate training in all aspects of fertility, conception and childbirth. We are just in the final stages of a process which will define the qualifying standard for laying claim to expertise in this area, after which we may be able to make specific recommendations. In the interim most members who have this treatment focus usually make this very clear in their website materials. The reason we say this is that while all members can safely treat migraines in pregnancy, the later stages can present some interesting energetic changes, and if treatment does continue over the nest few months, there may be some advantage in seeing a practitioner with additional expertise in this field.

As far as migraines themselves are concerned, there is now a considerable body of evidence suggesting that acupuncture treatment may have a beneficial effect. As out factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/migraines.html

there have now been a large number of trials which show that acupuncture treatment does have an effect greater than no treatment or conventional treatment, and once you look at the wider picture of the treatment of all headaches even NICE has now accepted that acupuncture is in some circumstances a frontline treatment. From a Chinese medicine perspective there is actually a comprehensive list of types of headache where the headache/migraine itself will be a part of a wider picture of imbalance in the system, and this will enable the practitioner to do what we think is the real strength of Chinese medicine, treat the person with the illness rather than simply treat the illness as defined by a broad label. There are as many different headaches as there are people suffering from them.

The best advice that we can give is that you look at the websites of BAcC members local to you to see which ones have a focus in their practice on treating the pregnant woman. This may be your daughter's best option, but at this stage of the pregnancy it is highly likely that the problem will be brought under control long before the beginning of the third trimester, and any of our members will be able to offer effective treatment at this stage.

Q:  Please could you forward details of an acupuncturist qualified to treat lingual nerve damage. The nerve was severed during a routine wisdom tooth operation.  I subsequently had microsurgery to rejoin the nerve.  Although the nerve was rejoined I still suffer continual chronic pain on the left side of my tongue

A:  We are afraid that we cannot give specific recommendations for individual practitioners, although using our postcode search function on our home page www.acupuncture.org.uk will generate a significant number of names. The more important point, though, is that from a Chinese medicine perspective, there are very few areas where we acknowledge specialist practice. At the moment the three categories of patient for which we believe it may be possible to define expert practice are children, pregnant women and people with mental health problems. For all other patients, every BAcC member is equally well qualified to treat any patient because the skills of Chinese medicine rest in treating the person, not the named conditon. Indeed, ancient China the generalist practitioner was held in much greater esteem than the specialist who was seen as markedly inferior in the narrowness of the focus of their practice.

As far as your specific problem is concerned, there are many studies for the use of acupuncture in the treatment of chronic pain, as our factsheet shows:

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

but very few studies which we can trace for the use of acupuncture in the treatment of lingual nerve damage. There are a number of studies which look at sensory deficit after dental surgery, but only one which were able to trace which appeared to indicate that acupuncture has been used for this specific problem but with unclear results.

However, it is fair to say that much of the research into conditions like this is conducted within conventional medical research facilities which use a far less sophisticated form of acupuncture than that used by Chinese medicine practitioners. There are a number of different ways of addressing problems such as yours, from a local problem caused by energetic disruption inherent in any surgery through to level of shock caused by the procedure through to a more widespread weakness in the system which impairs healing throughout. The skill of the Chinese medicine practitioner lies in making sense of the complex pattern which each individual represents, and treating with the best focus for achieving sustainable change.

The best advice that we can give is that you visit a BAcC member local to you and ask for a brief face to face assessment of what they think they might be able to achieve. In cases like yours which are quite rare it would be sensible, if you did decide to go ahead with treatment, to set some very clear review stages at set points to assess progress, and also to try to set measurable outcomes. This avoids the course of treatment meandering on without apparent benefit, which in our experience invariably leads to bad feeling.