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Ask an expert - general - Mystery aches and pains

12 questions

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:  What can I do to help a alleviate the pain at the needle insertion site between thumb and finger, it's normal reaction but lasts several days

A:  The use of this particular acupuncture point should not leave a sensation for several days, so we would be reluctant to classify what's happening to you as 'normal'. What this suggests is that the needle is being used slightly too vigorously for your physical structure in that area and causing deep bruising which may not be apparent on the surface. We have come across cases where points like this can have an enduring energetic effect lasting two or three days, but usually only when they are first used. The body often gets used to the treatment and accommodates the effect of the needles more easily as time goes on.

If there is bruising in the deeper tissues we are aware that many of our patients use preparations like arnica cream to help, but we obviously cannot recommend something like this because it lies outside our scope of practice. If the effect is felt on one side only, then there may well be some advantage to massaging the same place on the other hand. The channels are bilateral and have a close reciprocal relationship of which we take full advantage when we needle one limb to help the other when we cannot needle the site itself (because, for example, it is bandaged or in a cast). There are also points at the other end of the body which may be massaged to good effect. In this case, it might be useful to massage a point on the opposite foot between the big toe and first toe at the tip of the 'V' which if felt as the finger is drawn up toward the ankle. This reciprocal relationship between points on the opposite limb in roughly equivalent locations is also one of the more unusual treatments visitors to China often see (such as needles in the wrist to treat a twisted ankle).

From our perspective, however, if a patient came back and told us that a point was painful for several days after a session, and that this had happened more than once, we would be inclined to needle more gently or to choose another point which had less enduring impact. If the patient said they did not mind, we might still be inclined to do something different. Pain in any form is a sign of blockage or disruption to the flow, and if this is a clear cause/effect relationship, we would be wondering why this carried on.

Q:I have had an ongoing feeling being 'spaced out' for about 6 weeks now.  It seems to take two forms, the first -and worst- a tense, queazy, feeling in my stomach which is accompanied by the feeling almost like flu, without the flu, if that makes sense, This is generally in the mornings and it then seems to revert to a more generalised feeling of being 'spaced out' in the day. It seems to lessen in the evening. I have had blood test, all clear and an MRI scan, again all clear. I was told it could be related to a migraine issue and I have also cut out certain dietary triggers ie caffeine/ dairy. I would prefer not to take medication to try to resolve this. Do you think acupuncture could help?

This is the kind of presenting problem which many of us love to address. One of the great strengths of Chinese medicine is that it can take symptoms such as these and offer several different possible explanations within a conceptual framework which is entirely different from that used in Western medicine. As you probably already know, Chinese medicine is based on the understanding of the body mind and emotions as a flow of energy, called 'qi', the various patterns, flows and rhythms of which contribute to good functioning in the body as a whole. Where this flow is disturbed, for whatever reason, symptoms will begin to appear, although not necessarily where the imbalance
manifests.

If someone were to look at your case history there would be in all probability other aspects of your functioning which, from a Chinese medicine perspective, would probably indicate a wider pattern of which this symptom was a part. There are also some very complex diagnostic signs which would also help the practitioner to refine their view of what is happening.

If the cause is similar, from a western point of view, to vertigo or migraines, there is considerable evidence for the treatment of both of these problems, as our factsheets show

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

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

to suggest that you would not be wasting your time on giving acupuncture treatment a go. However, these are usually precisely defined in western medicine, whereas the feeling which you have is a more indefinite presentation, although none the less disturbing even though it doesn't have a distinct label.

To give you an example of how different the diagnostic process can be, this expert treated a patient once who was experiencing a similar problem, and it turned out that she was eating as much as half a pound of cheese every evening. Given the energetic balance of her body, which was already out of kilter, this contributed to the formation of what the Chinese call 'phlegm' which embraces what we give the same name but can also extend to solid lumps in the body as well as something which the Chinese call 'mist'. This is said to rise and cause all manner of symptoms of which feeling spaced out is one. Other patients can often manifest the same symptom is their work or
personal circumstances are very stressful. This can lead to a condition called the Rising of Internal Wind, again causing the same problem.

Poetic as these descriptions can sound, they are based on over 2000 years of successful clinical observation and experience, and also 2000 years of successful treatment. On that basis, we think it would be potentially very beneficial to give acupuncture treatment a go, but to make sure that you review progress very carefully so that you don't run beyond the first four or five sessions without assessing what progress there has been. This may involve you in trying to get as objective a measure as you can of how
frequent or severe the symptoms are to be able to assess as accurately as possible whether there has been a change.

Your best bet is to visit a BAcC member local to you to seek an informal face to face assessment of what may be possible. Even a ten minute chat will probably give significant clues about what is going on and whether treatment would be of benefit.

 

Q:  I have had chronic pain in the testicle and area of repair following a mesh repair of an inguinal hernia 4 years ago.  9 weeks ago I had the mesh removed and a neurectomy of the illioinguinal nerve, which was supposed to sort the problem out but has not. Would acupuncture help and if so is there any particular type that would be best. Can you recommend anyone in the Leigh on Sea area who would be appropriate.

A: A great deal depends on what may be causing the pain. We are assuming that the neurectomy was selected after a very thorough neurological examination; it is not common practice to start cutting nerves unless there is a very good and clearly diagnosed reason. On the assumption that this nerve corresponded to the area in which you were and still are experiencing pain, then there may be a small chance that acupuncture treatment may be of benefit.

Acupuncture treatment does have a general pain-relieving effect which has been the object of a great deal of study over the years, as our factsheet on chronic pain shows:

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

The chemical markers for pain relief, the neurotransmitters, are easily measured to provide an objective marker of whether something is happening. The main question with treating at this kind of generic level is how much relief the treatment may give and how sustainable the relief is. In many cases this comes down, unfortunately, to a financial question: is the treatment affordable and worthwhile when the cost is set against the relief.

However, the understanding of the body as a system of energy in flow which underpins traditional Chinese medicine does afford other possibilities for consideration. Like any enclosed and self-contained system, if there is damage then where the flow is impaired pain will arise, either from a deficiency or excess of energy in the area, or through the stagnation in the flow. Using needles this flow can be reinstated, and the pain reduced or removed. Sometimes the very fact of surgical incision can create a blockage, as can the formation of scar tissue. This can sometimes have effects some distance away from the scar tissue itself. Treatment is often a mixture of local treatment and treatment some distance away, although we can reassure you immediately by saying that there are no acupuncture points on the testicle or scrotum! There are, however, points on the lower leg a which refer directly to this area, and these may come into play.

The best advice that we can give is to visit a BAcC member local to you for an informal assessment of what may be possible. Although we can be quite confident about the treatment of conditions which we often see it is far more difficult to offer opinions on unique presentations like yours. However, a skilled practitioner may well be able to make a few diagnostic soundings which can tell them how likely it will be to help your problem.   

Q:  My farther has had his leg amputated 4 years ago and still has very painful phantom pains, can this be treated with acupuncture?

A:  Phantom limb pain can be a very distressing phenomenon.

There have been a number of studies over the years which describe the use of acupuncture in individual cases, and if you google 'acupuncture phantom limb pain' you will find examples such as:

http://www.ncbi.nlm.nih.gov/pubmed/6972207

We are also aware of a paper published in the Journal of another acupuncture association which cites the following papers about phantom limb sensation.

Bradbrook D (2004) Acupuncture in Medicine Acupuncture Treatment Of Phantom Limb Pain And Phantom Limb Sensation in Amputees. 22; 2; 93-97

Hecker H. -U et al (2008) Color Atlas of Acupuncture 2nd Ed. Thieme, Stuttgart

Hill A (1999) Journal of Pain and Symptom Management Phantom Limb Pain: A review of the Literature on Attributes and Potential Mechanisms. 17; 2; 125-142

Johnson M.I. et al (1992) Pain Clinic Treatment of Resistant Phantom Limb Pain by Acupuncture: A Case Report. 5; 2; 105-112

Liaw M.-Y et al (1994) American Journal of Acupuncture Therapeutic Trial of Acupuncutre in Phantom Limb Pain of Amputees. 22; 3; 205-213

Monga T.N et al (1981) Archives of Physical Medicine in Rehabilitation Acupuncture in Phantom Limb Pain. 62; 5; 229-2321

The mechanism by which the treatment works is not at all clear from a Western medical point of view. From a Chinese medicine perspective it is perhaps easier to make sense of the appearance of the pain from the fact that the channels which run through the affected area spread out across the body, and even in 'conventional' Chinese medicine treatment it is not unknown to treat a problem in the lower left limb by using points in the upper right limb. The fact that the opposite limb is missing would not necessarily render the treatment useless.

The best advice we can give, especially when there is so little case evidence to point to, is to visit a BAcC member local to your father for advice on his specific circumstances. There may be a number of initial soundings which he or she could make to determine whether treatment may be of benefit.

The problem with conditions like this is that there are case studies which offer encouragement, but nobody publishes the results of case studies where things don't work, so for the small number which have been successful there may be ten times as many where treatment was tried and failed. It is best not to over-excited by the fact that some treatments work. Everything works for someone, but that doesn't mean that somehing works for everyone.

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