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Q:  My father is 87 and suffered unstable c1c2 neck fracture 8 months ago due to falling. He has no paralysis and has refused most medical interventions (including wearing a collar which he finds too painful) as his desire to live was reduced by recent bereavement. He has severe chronic neck and head pain ever since, with little or no relief even on opiate medicines. Please could l ask if acupuncture might perhaps give him any relief or reduction of pain if it is safe for cc2 fracture?

A: There is no reason of which we are aware why acupuncture would be absolutely contra-indicated for your father's problems. However, there are degrees of relative contraindication, but these depend on the professional judgement of the practitioner and the specific circumstances of the case.

 The one caution of which we are aware is one which mainly appears in the literature of physios who perform acupuncture. We have seen them say that there are rare occasions where the muscles of the back or neck brace themselves to maintain stability, and any treatment which relaxes muscle, even unwittingly, might make the joints of the spine more mobile and thence cause pain. However, we recently put together an acupuncture safety website with the main physio and doctor acupuncture associations www.acupuncturesafety.org.uk and this was 

not thought to be significant enough to warrant mention. Indeed, the fact that your father is wandering around without a neck brace is probably an indicator that while painful the neck is not that close to giving way.

 We do publish a fact sheet on neck pain

 http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/4076-neck-pain.html

which quotes a number of encouraging studies, and certainly neck pain is one of the more frequent reasons why people seek treatment. Since the greater majority of referrals are by word of mouth res ipsa loquitur, as solicitors say - we wouldn't get the referrals if it didn't work.

 The best advice, which we invariably give, is to see if your father is willing to drop in to see a local BAcC member who can assess his specific presentation. Most members are happy to give up a little time without charge, and seeing a problem first hand gives a much better idea of what may be possible. We also are very emphatic that we treat the whole person - body, mind and spirit - so it may even be that your father could derive some benefit in other ways to help him deal with what must have been a very painful bereavement for him.


Q:  Had acupuncture more than 30 years ago and STILL have pain and some numbness on the site of a wayward needle. However, I now have chronic back, hip pain with the neck and referred pain to the testicles thrown in from time to time.

A:  Without knowing exactly where the needle was placed we find ourselves a little restricted in what we can say.

 Clearly, the one possibility which you need to rule out is that there is a piece of needle still inside your body. In modern times this would be almost unheard of. The use of disposable needles has eliminated the one main cause of pieces of needle snapping off, and that was the use of autoclaves to sterilise and re-use needles. The constant heating and cooling tended to make the steel in the needles a little more brittle, and there was a risk that a small fragment could break off. Possible as this was we have no records of any such occurrence in the BAcC (formed in 1995) or in the five precursor bodies. We did hear, however, over twenty years ago about a legal case involving a claim that a piece of needle tip had broken off and 'travelled', but we suspect that the matter was settled out of court because there is no trace of it that we can find from our searches.

 The other possibility is that the needle caused physical damage. It is hard to imagine what this might be to have endured for 30 years and to be causing secondary symptoms. However, we think that the best, and perhaps only, thing that you can do is to go to your GP and ask for an X-ray of the area to determine whether there is any physical object in place, and then to discuss with him or her whether the other symptoms to which you refer could be a consequence of physical damage in the area. This might involve a referral for an MRI if there is a chance that the damage is in deeper tissues.

 It may well be the case that you have already done what we suggest; thirty years is a long time, and if you have been experiencing discomfort for this length of time it is highly likely that you have. However, the spread of symptoms needs to be investigated anyway, whatever the root cause. 

 We are sorry not to be able to offer more help or advice than this, but with the information you have sent us this is the best that we can suggest.  

Q:  I am a registered midwife with the NMC and have been personally been a patient of acupuncture for years. Recognising the benefits I am very interested in completing training in acupuncture so that I can benefit pregnant women and ideally support women trying to conceive. Are there any courses for midwives which you would recommend. I have found a few advertised but only want to gain the correct qualification

A:  This puts us in a rather difficult position. There is currently a great divide in the BAcC between those members who are suspicious and at times downright hostile to the idea of anyone learning a small number of acupuncture skills in order to be able to practise in a defined and limited area. In their view it is only possible to use TCM safely and well if the treatment is given on the basis of a full training in traditional acupuncture. At the other end of the spectrum we have an equally forceful group of members who believe that as long as people work within the scope of practice which they have learned and are aware of the contraindications from a Chinese Medicine perspective, then it is a benefit to patients who might not otherwise have been exposed to acupuncture. It also may well encourage them in the future to use acupuncture treatment in other circumstances.

 Clearly it is not for us to endorse either view; we're all for the quiet life. Suffice it to say that we are pretty sure that you will not find a traditional acupuncture training course, at least not one associated with the BAcC, which will offer a bite-sized chunk of training. However, if you switch paradigms you will almost certainly find training courses if you look at the website of the British Medical Acupuncture Society. They offer training to statutorily regulated healthcare professionals, and we seem to recall that some time ago they offered training in this particular field in partnership with UCLH. It should be a relatively simple matter to track this down.

 We are sorry we can't be more explicit than this, but as well as providing a service to the general public we also have to be aware of the kinds of issues which are inflammatory for members, and the issue of cherry-picking, as it is perceived, is a particularly vexatious one.

Q  I have no upward movement in my big toe joint following an operation to remove a lump in the base of my foot. Can acupuncture help with muscles and nerves? 

A: A great deal depends on the extent of the damage caused by the operation.

 We do not intend any criticism of your surgeon or podiatrist, but any operations to remove lumps or growths carry a small but real risk of interfering with both the nerves which supply the foot 'downstream' and also the muscles which sometimes have to be cut slightly, or may even have become fused to the lump and become collateral damage when the lump was taken out. It would only be fair to say that if the damage is permanent then acupuncture treatment will not make a difference.

 However, traditional Chinese acupuncture operates on an entirely different theoretical basis from western or conventional medicine. The basic premise is that the body, mind and emotions are all one interconnected flow of energy, which the Chinese call 'qi' and which does not translate well into English. Health, vitality and proper function all depend on a good flow, rhythm and balance of energy. When someone has an operation involving cutting through tissue there is always likely to be some break in the flow. In severe cases, especially when someone has a great deal of keloid scar tissue, the blockage this creates can cause significant trouble. In more confined areas it can result in symptoms such as you describe, loss of sensation or loss of movement.

 

Of course, if everything in life were that simple it would be an easy thing to fix; just pop into an acupuncturist's clinic, have a few needles and all should be well. In reality, some cases respond well and others don't respond at all. There are all sorts of factors which influence this, not least of which the overall balance of energies in the person in whom the problem occurs. This will mean that some people will heal faster anyway, and others will struggles. A skilled practitioner would take this into account when making an assessment.

 In any event, where the outcome is rather uncertain it is vital to set a limit to the number of treatments which someone has before drawing a conclusion about whether it is working. Having a measurable outcome makes life much easier because progress will be visible, not just based on how someone feels on the day. We tend to suggest that four or five sessions at most are a good chance to tell whether treatment will work. If there has been no change at this point it may be good to look at other options.

 The best advice, which we invariably give, is that someone visits a local BAcC member for an informal assessment of what may be possible. Actually seeing a problem is a far better basis for offering advice, and most members are happy to spare a short time without charge to see if it is something they think they could help with.

Q:  Can acupuncture for lower back pain cause imbalance and dizziness . The next day I spent in bed because when I moved I felt I might fall over and and everything was moving especially when I bent down or moved quickly.

A: We are sorry to hear of your problems.

 The first thing we have to be clear about is that acupuncture, whether performed as traditional acupuncture or one of the versions of medical/symptomatic acupuncture, treats the person as much as the condition. To that extent even a symptom elsewhere in the body may have been triggered by treatment aimed at something entirely different. The same applies even if the person thinks they are 'only treating a bad back', and we have registered our concerns over the years about people using formula treatment having unexpected effects on the patient.

 That said, the reaction which you have had is a great deal more severe than we would normally see. We warn patients that they may feel a little odd for 24 to 48 hours, but the 'normal' reactions of this type are relatively minor - a slight headache, additional tiredness for a while, and occasionally a slight return of an earlier symptom as the body reverses the process of disease. To have to spend a day in bed feeling dizzy after a treatment would be highly unusual; we gather statistics on what we call adverse events, and this is not one we come across before. That does not mean that it hasn't happened, only that it hasn't been reported to us. However, we find that patients are usually very keen to tell us when something has happened.

 We think the most likely reason is that you have had the misfortune to have a viral infection which has by chance coincided with your treatment. With over 4 million treatments a year in the UK there are going to be a few cases where something happens after a treatment which has nothing to do with it, and this may well be one. It does sound rather unpleasant, however, and if it has persisted into a second or third day we think you might do well to consult your GP. There are other possibilities, none of which you should worry about but which treatment may be able to help. There are a number of problems associated with the inner ear, for example, which can generate these symptoms, and your GP may well be able to help you deal with this.

 We shall definitely keep a record of what you have reported, though. The fact that we have had very few reports like this in the past does not mean that there isn't a theoretical risk that it could happen, and if we find over time a cluster of cases we would always update our information to the public to make them aware of the potential risk.

 In any event, we do hope that the problem has already resolved, and that it hasn't put you off having further treatment for your back. As you may be aware from our literature back pain is a problem which really does seem to respond well to acupuncture treatment to the extent that it forms one of the recommended treatments in the NICE guidelines for NHS patients.

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