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Q:  Yesterday, for the first time , my physio suggested acupuncture to ease my knee pain. He inserted 7 needles in various positions on my leg and one on the bottom of my foot behind the big toe. All went well with no pain until he inserted one in my mid calf on the outside of my leg which was very painful. Once  the pain eased as a side effect
 I could not pull my foot towards me without incurring serious pain.  Every time he moved this needle it produced pain and he had to stop. I asked him why was I feeling this pain and surprisingly he had no answer! The session lasted 10 minutes. Can you give me your thoughts?

A:There are several reasons why this might occur. The most obvious one is that the needle was inserted very close to a larger nerve, and that the needle was retracted slightly after your first sharp pain, either deliberately by the practitioner or more subtly by the body trying to move your leg away from the source of pain. If you moved the leg and flexed the muscles, or if the practitioner tried to manipulate the needle even slightly, there is every likelihood that you or he unwittingly pushed the tip of the needle
against the same nerve. The only sensible option when this happens from the outset is to remove the needle and try again. In medical acupuncture the points are not so critical because the majority of practitioners are using what are called trigger points, knot-like structures in the muscle, which are not quite so precisely defined as traditional acupuncture points. The explanation can be as simple and prosaic as that - needles are, after all, sharp metal objects!

There are a number of sensations which can be associated with traditional acupuncture treatment, ranging from a dull aching sensation called 'deqi' by the Chinese to a much brighter sharp sensation. These can occur during treatment, but they tend not to re-occur once they have happened, i.e. the dull aching feeling is continuous, and the sharper sensation tends not to have any further impact after the initial line of travel.

On balance we think it is most likely the needle getting a little too close to a physical structure. The important issue is whether the sensation continues after the treatment has finished. If it has it could mean that a small subcutaneous bruise has formed which might impinge a nerve slightly for a few days.

As you have no doubt seen from the factsheet on our website http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

chronic pain is often treated with acupuncture. There are good historical reasons for this. When the popularity of acupuncture rose sharply after Nixon's visit to China in 1976 one of the more eye-catching uses was of a man having heart surgery using acupuncture for pain relief and anaesthesia. Many researchers invested a great deal of effort in this area because the neurotransmitters associated with pain are easily measures, and the patient outcome assessment methods are quite sophisticated. Although there is nothing conclusive enough for us to give an unqualified 'yes' in answer to your question, the issue for us is not whether the treatment will work but the extent
to which it will work and how sustainable the effect is.

From a Chinese medicine perspective, pain arises when the flow of energy ('qi' as we call it) in the channels is either blocked, in excess or deficient. Changes in the proper flow always generate symptoms, and the skill of the practitioner lies not simply in reinstating proper flow in the affected area but determining whether it is a local problem or whether the symptom is an indicator that the overall balance has been affected. This can often mean treating the system as a whole and inserting needles a long way from
the site of the pain, which many find a little baffling.

The judgement call which the practitioner has to make with the patient is whether the extent of relief and the time that it lasts justifies the expense of the treatment. It can, unfortunately, come down to finances, and it may well be that if the relief is shortlived (less than a week), and there is no progressive improvement a practitioner might start to look for other options instead of, or as well as, treatment. With osteoporosis proper, this might be a more critical discussion. Once bone density has gone it's gone, and unless it is demonstrable that acupuncture is helping the patient to get worse slower, then it is probably sensible to explore other options. Transient osteoporosis usually spontaneously resolves within 18 months, however, and there may well be some value in looking at combined treatments to help someone through the problem.

The key thing is to review progress at all stages. Treating chronic problems can often lead to a pattern of treatment developing which can often run to several hundred pounds in cost, and it is vital that the patient gets to review whether the continued expense is worth it.

The best advice we can give is that you visit a BAcC member local to you for advice. This will probably give you a better assessment of what may be possible, and means that the practitioner can advise you based on your unique presentation.

Accredited courses are taught at honours degree level, and embody the critical awareness and academic rigour commensurate with equivalent professional healthcare programmes at this level. Each teaching institution designs and develops its own curriculum, based on a total of 3,600 hours, of which a minimum of 400 hours must be spent in a clinical setting. All our courses offer a comprehensive education in acupuncture, but each has its own unique approach.

For more information about studying acupuncture and our accredited courses, check out the British Acupuncture Accreditation Board website www.baab.co.uk

Q:  I am suffering with vocal chord strain, after having a conversation with friends my voice box hurts, I have had all the tests done via ENT and nothing is showing up. This started after I had a trip in India and got larangyeal tonsillitis and at the same time I got vocal strain 4 months ago. Can acupuncture help me?

AThere are a relatively small number of studies which report successes in treating vocal cord paralysis, two examples of which are

http://www.ncbi.nlm.nih.gov/pubmed/2741280

http://www.ncbi.nlm.nih.gov/pubmed/848460

The abstracts of the papers do not cite the exact treatments used, and both speak of acupuncture being used in conjunction with other forms of treatment. In one paper, as is commonly found to be the case, the use of acupuncture alongside the conventional treatment appears to speed up the patient's recovery. However, it is best to consider these papers as indicative rather than conclusive; there are no large scale studies which make a confident prediction possible. A great deal will also depend on the extent of
the cordotomy. The operation is not supposed to interfere with a patient's vocal capacity if they recover naturally, but as with all surgical procedures there is an inherent risk that some of the changes are not reversible.

We suspect that some of the treatment offered in the studies was local, i.e. in the area near the problem, and this can often be very effectively in stimulating a return to good function. However, a practitioner may well want to establish whether this is simply a local problem or whether this is the tip of a much larger iceberg - this would have implications for how much treatment may be required and whether it is worthwhile attempting to address this as a local issue if there is a backdrop of much more extensive imbalance.

If we were being brutally honest we would say that treatment may be more in hope than in expectation, but acupuncture treatment has a reputation for occasionally achieving unexpected but significant results,. so we would be happy to advise you to seek a face to face assessment with a BAcC member local to you who can give you a much better assessment by looking at the problem and your father's health in the round.

Your situation is not quite so drastic as this case, and there may be some greater hope that treatment may encourage a return of some of the lost function.
Acupuncture treatment will certainly not do any harm, and since there are a number of functional disturbances seen from a Chinese medicine perspective which impinge directly on the effective use of the voice, it may be that an experienced practitioner can see a direct intervention which may help. Even in the absence of a direct connection, the underlying premise of Chinese medicine, the treatment of the patient rather than the illnss, may offer some possibility of a speedier recovery.

It is best to talk to a BAcC member face to face, though, to get a more accurate assessment of whether acupuncture treatment may be of benefit, and we
are confident that you will receive honest and impartial advice.

Although your problem is not quite as advanced as this, we believe that the same advice holds good. There may well be local treatments which can help to improve the
energy flow in the affected areas and reinstate better function. There may well also have been functional disturbances in the system as a whole brought on by the tonsillitis and which treatment may be able to help. However, in both of these cases you would need to have a better qualified view from someone who sees you face to face to determine whether there is something in the energetic patterns which they believe would indicate that improvement would be likely. At this distance it is difficult to say and without solid research to go on, even of the anecdotal and less formal type, it is hard for us to say more. If you did find a practitioner who felt it was worth a try we would advise that you set regular review periods to ensure that you do not invest a great deal of time and money in something which isn't achieving very much.

A:  We tend to be a little downbeat about the possibility for success in treating tinnitus. One regularly used answer, for example, reads:

Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. There has also been a recent systematic review which concludes that there may be some subjective benefits but no positive conclusions sufficiently robust to be able to make firm recommendations.

It is fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. As we can see from your husband's history of
treatment, it is quite easy to spend considerable time and money and be no better off than when you started, and the individual case reports in the tinnitus sufferers' magazines often have the same shape.

We are not aware of any member who specialises in the treatment of tinnitus. However, what many practitioners do find when treating people with tinnitus is that while the noise remains largely unchanged their ability to cope with it seems to improve. Evidence for this is largely anecdotal, though, and it would be wise to discuss carefully with any future practitioner whether they think that they might be able to help. In all events we would recommend that frequent and regular reviews of outcomes and progress are essential.

We don't think you can say more than this. There are two or three clearly identifiable patterns in Chinese medicine, described as syndromes, where tinnitus is a specific named symptom which frequently appears, and it is possible, if your tinnitus has arisen as a part of the syndrome, that there may be some help which acupuncture treatment may offer. An experienced practitioner should be able to make a very straightforward determination on whether this is the case. Overall, however, there is not a great deal of cause for optimism about getting rid of the unwanted noise.

We don't think there's a great deal more than can be said. We have come across cases where people have persevered for dozens of sessions in order to try to get on top of the problem, but without success, and there is always a danger that after investing a four figure sum for treatment which hasn't worked some patients may feel a little aggrieved. If someone really wants to give it a go we always advise members to set regular review periods and remind patients of where they are and that it is a freely made choice to continue.

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