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Q:  Recently I had a broken t7 in my spine.  This has left me with bad pains around my ribs which I am told is nerve damage and could last longer than 12 months, Would acupuncture help and can I get this on nhs or if not can you recoimmend anyone  in my area, kt152fd Addlestone surrey? 

  

A:  A great deal depends on the way in which the nerve damage has occurred and whether there is any residual impingement which will keep generating pain. If the damage has caused long term inflammation which in turn presses on nerves and creates a cycle of further pain and inflammation, then the acupuncture treatment may well help to break this cycle and allow the area to settle down. This is essentially what conventional medicine does with the prescription of painkillers and anti-inflammatories.

Acupuncture treatment first found greater prominence in the West after Nixon's visit to China and the extraordinary scenes of people having surgery without anaesthesia while under acupuncture treatment. This led to a focus on researching on the painkilling effects of acupuncture, and there is considerable research on this which shows convincingly that it works. The question is really not whether it does or not, but how long the pain can be controlled and to what extent. If acupuncture is like a short term medication which wears off then unless someone has really deep pockets and the trade-off is that they get a reasonable amount of pain free time, it's not really a viable option.

Chinese medicine, though, is all about restoring balance in the system in the simple belief that a system in balance will heal itself better and quicker. On that basis we would have to say that traditional acupuncture is geared to helping the person as a whole to recover, and our clinical experience of treating people after injuries or operations is that they do appear to heal more quickly than their counterparts  If you google 'ncbi acupuncture post-operative recovery' you will see a number of studies which seem to show that there are some very good reasons to think that treatment may be of benefit.

Since each case is unique and different, however, your best bet is to seek a brief face to face assessment with a BAcC member close to where you are. Most are happy to give up a little time without charge, and can advise you far better by actually seeing what is going on. Using the postcode function on our home page www.acupuncture.org.uk will identify several practitioners near where you live. We can't recommend individual practitioners, but we can assure you that all our members are trained to degree level and work to high standards of safety and conduct.

As far as getting acupuncture treatment on the NHS is concerned perhaps your only hope would be your local Pain Management Clinic where acupuncture is quite often a part of the offer they make. Otherwise there is very little prospect of getting treatment free at point of delivery; NHS funds are very tight at the moment and even where there is a proven evidence base and a NICE recommendation there are very few of our members who have managed to find funding.

Q:  I have morton neuromas on both my feet affecting the toe next door to the little toe in both cases. I have had steroid injections in the past but want to look into alternative treatments and thought acupuncture the best place to start. Can you advise me if it is affective please?

A:  We have to be honest and say that there is not a great deal of evidence for the effective treatment of Morton's neuroma with acupuncture. We published an answer through this same section three years ago to a question from a patient who was convinced, and with some justification, that treatment with one of our colleagues has been wholly responsible for a complete improvement in his condition.

We have to say, though, that our clinical experience runs counter to this, which is why the very upbeat tone of webpages like that of this American practitioner

http://acuroots.com/mortons-neuroma-treatment-plan-with-acupuncture-and-tui-na/

(informative as it is) raises a wry smile. If only... Having said that, what he describes in the formation of the tissues which cause the condition is something with which we deal elsewhere on the body, and in theory there is no reason why treatment should not be able to reduce some of the discomfort. However, we would be very surprised if this could be done without the aid of orthotics which reduce some of the pressure on the affected areas while any treatment beds in.

Each case is unique and different, however, and the only real solution is to seek face to face advice from a BAcC member who can look at exactly how the problem manifests in you, and more importantly, can see the overall context in which it is occurring. One of the great strengths of Chinese medicine is that it looks at the whole system, not simply at a symptom which is regarded as merely a warning sign. Thousands of people with identical foot structures to you will walk thousands of miles without getting neuromas, and there may be systemic problems which have predisposed this to happen.

The other recommendation we would make, and we are sure that you have done this already, is to find a good chiropodist or podiatrist who can work alongside any other treatments you try to help to maintain improvements. Working in partnership with other health professionals for problems like yours can often be extremely powerful.


Q:  I am currently in a significant amount of pain in my back, shoulders and neck due to arthritis. I was going to book an appointment for a session of acupuncture today but don't think I would be able to bear it at the moment. Is it best to wait for the flare up to subside slightly before trying acupuncture or be brave and do it whilst in this amount of discomfort?

A: This is quite a difficult question to answer. We would probably say that if you think you couldn't bear the treatment at the moment, the best course of action is to wait until you feel that you can. There is a very strong feeling in many patients that letting the practitioner see things at their worse is a good thing, and they struggle into clinics when they are feeling very unwell. This expert tends to take the view that if getting to treatment becomes an ordeal on top of the pains which are already bad, it is not a sensible thing to do.

There is, of course, the counter-argument that the treatment may well be of immediate benefit in reducing the pain. Our experience, however, is that with long term conditions like this such changes are short-lived, and it is far better to wait until the pain has become more manageable so that the whole experience is a pleasant and upward moving one.

There is no doubt that from our experience when the pain of arthritis is very severe any kind of intervention can become immensely painful in itself. Oddly enough, the one thing which always seems to be helpful in these sorts of situations is reflexology. It has been a common experience in those patients with severe arthritis, especially those of mature years, that they report that as a short term palliative this treatment works very well. For the long term, however, Chinese medicine has an increasingly impressive track record of helping people with arthritic pains, and a growing body of research to underpin it.

 

Q:  Unbearable pains of body, muscles,nerves.bones,sprain,numbness,twisted feeling from head to toe due to acupuncture treatment over  30 days @twice a week,half hour each for diabetes,bph-prostate enlrgd. A tv doctor in Bangalore advised me to continue acupuncture treatment inspite of severe  kinds of pain.

A:  We have to be careful how we express this, but the first thing to do is to seek conventional medical advice about what is happening to you. These would be most unusual adverse effects of acupuncture treatment, the majority of which are transient and rarely have any impact after the first 48 hours. For something to continue for this long and to such effect would be unusual, so it needs investigating soon. We say this because we have come across a number of cases over the last few years where some really extreme symptoms have started at around the same time as a patient has started having acupuncture treatment, and it is a natural and obvious assumption to make that one has caused the other. Rather than spend time arguing about whether there is a causal connection or not, it is vital to get the problems analysed in case there is treatment which would help or even be necessary.

If, however, it is a result of the acupuncture treatment there are only a few reasons which we can think of where something like this can happen. Physical damage I think we can rule out; you do not appear to have had a single treatment after which everything went wrong. The possibilities are that the treatment is done too vigorously for you, the frequency of treatment is too much for your system, or more rarely, you are one of a small percentage of patients for whom acupuncture is not a good treatment.

In the last case we do find on occasion that there are patients who react too strongly to acupuncture treatment, and it stirs up far too much in the way of reactions. In these cases all that we can do is advise other forms of treatment which are less disturbing to the system. Gentler manipulative therapies like cranial osteopathy or regimens like homeopathic treatment may the best option.

If the treatment is too frequent this can sometimes cause problems. Since the system is a self-enclosed whole, anything which stirs things up could cause all sorts of apparently unrelated problems elsewhere. One of our old teachers used to use the analogy of cleaning a muddy pond. When you do this the water becomes cloudy and you really can't see how well things are until the residual mud has settled. If you keep stirring things up the water will be perpetually cloudy. Reducing the frequency of treatment may help matters settle down.

If the treatment is too vigorous this is simply a matter of discussing with the practitioner whether he or she could use fewer needles, less vigorous needle action, or less powerful acupuncture points. Treatment always has to take into account the patient's overall health, and just as you wouldn't give a sports massage to a 90 year old, there are treatments which may be too powerful for a person to deal with. 

This really comes down to communication with the practitioner. If he or she can say with confidence that what you are suffering now is on a pathway to better health, then you could choose to continue. If your own doubts are growing, then simply take a break from treatment and see if the symptoms relent, in which case you have your answer. In any event, we still think that getting a conventional medical perspective is important. These symptoms may be indicative of another as yet undiagnosed problem, and we would be remiss if we did not direct you to your GP for advice and direction. 

Q:  I have had 10 treatments from an acupuncturist who treats your 'element'. It has had mixed results and her decision on which element I am has changed. Although I pay for an hour my treatment typically now takes 10 minutes and consists of one needle being put into and out of my wrist very quickly and then inserted into the back of my wrist the same way using the same needle. When removing the needle she uses a piece of cotton wool to press against the needle as it is taken out. 6weeks ago I had a treatment and left with great pain in my right wrist where the last needle point was. It didn't go away and got worse so that if I moved my hand in a certain way I experienced a tearing sensation inside my wrist. I felt there was a piece of needle left inside my wrist. I went to my next appointment two weeks later and asked if there was a possibility of a piece of needle being left inside me. I was pretty much dismissed and told there was nothing wrong. (There clearly is as i am frequently in agony). A month passed and I have made an appointment to see my gp. I have waited several weeks for the appointment and still have another 4 days to go but my wrist is still really bad. I don't know whether to go to casualty and if so whether an X-ray would show up a tine fragment of needle or if I would need an ultrasound? I am now very scared and worried as the point the needle went in is in line with major arteries and nerves. Can you advise best course of action and if you think anyone will take me seriously? There is no inflammation and my wrist looks entirely normal from the outside.

 

A: This sounds very distressing for you, but we can say straight away with some confidence that it is highly unlikely that you have a piece of broken needle embedded under the skin of your wrist. Although all practitioners are trained in what to do if a needle breaks, in modern times this is virtually unheard of. The most recent report of a possible break to the BAcC was over fifteen years ago. The main cause of needle breakage, rare as it was even then, was when needles were autoclaved to sterilise them for re-use. Modern needles are used once only and then disposed of, so the constant heating and cooling which made the steel brittle does not happen.

The most likely cause of your discomfort is that there has been some bruising beneath the skin surface which has caused a hard clot to form and which impinges a nerve when you move in certain ways. We have seen this before, and it can take several weeks for something like this to clear. There is a small possibility of damage to a tendon, which might also account for the symptom, but the needling would have to be rather more vigorous than sounds was the case for this to happen. If the practitioner is using the style of practice which we believe they are, then very fine needles are the order of the day, and damage from the needle itself would be unlikely.

We think that going to your GP is a very wise move. He or she may have a precautionary X-ray or ultrasound done - just because needle breakage is rare doesn't mean that it can't happen - but there will be a number of investigations they can undertake on the spot in terms of range of movement and pain on movement which should alert them to the probable cause.

As far as the style of practice is concerned, this sounds like the Five Element system which is one of the two more common  styles in use in the UK. The diagnostic certainties of this are open to re-assessment and change, and for all sorts of complex reasons a person might be initially treated on one element and then find that another element presents itself as the core of the problem. This is the not the difference between right and wrong so much as between good and better. All treatment will have a beneficial effect because in a closed system of energy any attempts to improve the flow will have impact everywhere. Treating the heart of an imbalance, though, will get better results and can lead to much more profound change. It is heartening to hear that the practitioner is making adjustments; it is often said that immediate certainty is not always a sign of good diagnosis. People are very complex.

In terms of technique, the schools which teach this system tend to use mainly 'in and out' needle insertions which can take up a very small amount of a treatment session. We occasionally hear rumblings of discontent from patients who think that this doesn't seem quite right, and we have to explain to them that the time spent up to that point is all a part of the diagnostic process. All of this preceding work -  investigation, pulses and conversation - refines the diagnosis so that when the points are chosen their effect can be all the greater.

Having said all of this it is a concern to us that the practitioner appears to you to have made light of what you have experienced. We try our hardest to ensure that practitioners pay particular attention to what their patients experience and to respect what they have to say. While we would probably not consider something like this actionable under our professional codes it is certainly something which the practitioner would benefit from knowing so that they can look at how they have addressed the issue. Unfortunately the only person who can really address this is the patient, who is not always inclined to get involved in setting a practitioner right and more likely to want to walk away from the situation. If you do raise it with her, however, we hope that your concerns are properly addressed.

Just to re-iterate what we said above, we think that it is highly unlikely that a needle tip has broken off in the wrist, but we are happy to know that you have a GP appointment within the next few days to make the necessary investigations. We hope that you understand that we have taken your account very seriously, and we are a little disappointed that you do not feel as though you have been listened to. For us acupuncture is a daily way of life, and we are used to what happens. For most patients it is still a largely unknown area, and for this reason we have to remember to acknowledge that in what is already an unusual situation anything untoward which happens is likely to cause great anxiety.

We hope that it is as we a transient adverse event which resolves soon without the need for any medical intervention. 

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