Q: My 3 weeks old baby has been diagnosed with moderate hearing loss due to issues with inner ear. We found some articles talking about benefits of acupuncture treatment in such cases. Can you please advise if this is something that is proven to work and whether this can be done on babies?

A:  There are no age restrictions on treatment, and we have known people to have treated babies that are a day or two old. However, we do increasingly take the view that it requires slightly more specialist postgraduate training to approach treating the very young. However, in our specialist guidelines which are still under development treatment on children under the age of six months is not favoured because of the unreliability of many of the usual diagnostic signs at this age. We don't simply stick needles in where the problem is, and trying to work on the extremely young would be only undertaken if there was a very clear syndrome with some very specific treatments.

As far as the research itself is concerned, we have seen one or two studies which suggest that acupuncture may have a role to play in treating inner ear issues, but none which we would regard as robust enough to underpin a recommendation.

Indeed, this expert, if faced with a request like this, would almost invariably recommend that a parent took their child to a cranial osteopath. Many of the problems with neonates can arise from the pressures on the skull during delivery, and the treatment itself is extremely gentle as well as being effective for many birth problems. If you did decide to try acupuncture, however, we would recommend that you seek out someone who has attended a structured postgraduate training in the treatment of children. There are two or three course providers, whom we cannot unfortunately name, who are recognised by our community as the acknowledged experts in the field. Someone who has trained with them will know their limitations, and that is the most important thing to consider, whether it is appropriate to use acupuncture with a child so young.

A:  We have a factsheet on the treatment of menopausal  symptoms

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/menopausal-symptoms.html

which makes some very encouraging noises about the treatment of some aspects of menopause. Hot flushes always feature heavily in these trials, and meet with some success, but most trials are conducted testing 'real' treatment against 'sham' treatment, which we are far from believing is a satisfactory way of assessing the benefits of treatment. We don't believe for a moment that the sham treatments have no effect!

The studies cited in our factsheet are quite old, and there have been some more recent ones which have been very positive. Examples such as

https://www.ncbi.nlm.nih.gov/pubmed/27023860

and 

https://www.ncbi.nlm.nih.gov/pubmed/25003620

make just as interesting reading.

However, hot flushes are not the only menopausal symptoms, and unless we had more specific information it would be foolish for us to be too definite. What we can say, though, is that menopausal treatments have been a part of Chinese medicine for over 2000 years, and the Chinese view of the energetic transformations which take place as women age can really help to inform treatment in a way that is much more sophisticated than simply using set protocols for specific symptoms, which is how most trials are conducted. Traditional Acupuncture treats the individual and seeks to understand the ageing process by looking at how generic changes in the system affect someone's unique balance. This can have a significant bearing on how successful treatment might be.

Our advice in these situations is always to visit a local BAcC member to discuss your particular presentation. This will give you the best possible chance to make an informed decision about whether treatment may be beneficial. We suspect that the answer will be that it could well be, but sight unseen it is not proper for us to make a recommendation.

Q:  I had an acupuncture session to help with my lower back pain and when the needles were inserted into my lower back my bum area I had a spasm in my leg. I also had pain in the other side where the other needle was all the rest seems to be fine. When I spoke to the practitioner he said this was normal as he had use larger Needles. It has now been over two weeks and I’m still suffering from pain at the side of the needle insertion and also from shooting pains and pins and needles especially in the side where the spasm occurred. Please help me is this normal as I have used acupuncture as treatment for my ME and migratory arthritis previously and have never experienced this.

 

A: We would hesitate to use the word 'normal' for anything which a patient might experience which is unpleasant, but adverse effects can happen after treatment. The vast majority are transient and have disappeared within 24 - 48 hours, but some can linger a little longer.

 This can particularly be the case when someone is using a slightly heavier gauge needle and inserting the needles quite deeply. The two go hand in hand; although it is possible to insert a fine needle to a considerable depth it is much more usual to use a slightly thicker needle to ensure that the tip is not diverted and twisted out of true. This does mean, unfortunately, that this can sometimes cause small bruises deep within the tissue but not necessarily visible at the skin surface. If these bruises are near to the passage of nerves there can be some impingement. This can generate sharp pains or even pins and needles. Such bruising can take a couple of weeks to disperse during which time there may be intermittent odd symptoms.

If this does persist, however, then it would be wise to make an appointment to see your GP just to ensure that everything is OK. The chances of something serious having happened are quite remote; acupuncture remains one of the safest modalities in use. It may be worth eliminating other possibilities, though, and a visit to the GP will undoubtedly provide reassurance that this is nothing more than a transient adverse event.

 We are sorry to hear that this has happened, and hope that it has not discouraged you from further treatment. We are confident that your practitioner will be able to ensure by using lighter gauge needles, shallower insertions and less manipulation that there is no recurrence of such unpleasant symptoms.

Q:  I've read the BAC fact sheet about Moxibustion.
I have a couple of questions regarding Moxibustion to treat a slight muscular ache in R/H shoulder of a male px, 70kgs, 54yrs old.
What is this specic training a practionerer must have undertaken to be considered compent under BAC guidelines and how does a patient verify qulifications?
How many points would be a recomended treatment for Direct Non Scaring Moxibustion?
Could there be any side effects or damage to muscle or nerves (ie: neck or spine) surronding shoulder if too many points are treated in 1 session?
If patient complains of strong pain deep in shoulder joint half way through treatment should the practioneer stop?
A:  All members of the BAcC will have undertaken training in the use of moxa as a part of their undergraduate training. The most accessible assembly of documents can be found on the website of the British Acupuncture Accreditation Board

https://baab.co.uk/downloads/key-accreditation-documents.html

notably the SETA and SPAS documents which outline the basis of what an accredited college must provide students who graduate with automatic eligibility to join the BAcC subject to health and criminal record checks. These spell out what student must learn, although the precise method if training will vary from institution to institution. All students usually practise on each other when training, and tend to be the harshest of judges. No-one whose competence was in question would be allowed to proceed to graduation. A patient can verify qualifications by contacting the BAcC who can say where and when a practitioner trained. If necessary, the patient could then contact the teaching institution directly.

There is no recommended number of points. The usual deciding factor is the patient's tolerance of the treatment and the amount of heat being generated. Most practitioners would err on the side of caution to avoid burning a patient. There are no accounts or records of which we are aware on secondary damage to muscles and tendons as a consequence of moxibustion. The only adverse effects of which we are aware are burns. By its very nature moxibustion will always cause a small number of burns each year, and the practitioner's main challenge is to reduce the risk as much as possible. We do not believe it would be possible to completely eradicate all risk. We have never seen case reports suggesting that moxibustion has caused the problems you mention, and as you can imagine we do monitor all reports of adverse events across the world very carefully. 

If someone complains of a pain arising during a session it would be a matter of professional judgement whether the treatment was stopped then and there. By their nature some treatments can cause pain to increase slightly, and there are occasions when the effect of treatment on the body's energies can cause a dull aching sensation, called 'deqi', to arise. This is very much sought after in Chinese styles of treatment, although Japanese styles tend to be more conservative. A practitioner might judge that this was evidence that treatment was working. Of course, it someone directly asks the practitioner to stop, then stop they must. To carry on in the face of requests not to continue might be construed as assault, and would certainly indicate a withdrawal of consent without which treatment cannot take place.

If you are dissatisfied with the standards of treatment which you have received, this page from our website

https://baab.co.uk/downloads/key-accreditation-documents.html

details how you may go about making this known and seeking a more formal account of what has happened to you.

We hope, however, that any side effects which have arisen through treatment are transient and have already started to resolve while this reply has been in transit.

Q: I’ve had two acupuncture sessions recently, my first ever. I’ve found that the needles put in my toes are really painful and just wondered if this could be indicative of anything? I should add I’m 9 months pregnant. 

A: At the risk of sounding facetious we would be quite surprised if needles in the toes didn't hurt. While the vast majority of points on the body (there are 365 main ones and dozens of recognised 'extra' points) do not cause much sensation when they are used, the ones near the toenails and at the base of the toe can fee disproportionately painful when they are needled. We say 'painful' but in many cases it isn't quite pain so much as a very intense feeling which seems altogether too much for what is a small needle.

 Part of the explanation for this comes from the way that the energy of the body circulates. The anatomical position is very similar to that famous Da Vinci cartoon of the man with his arms and legs outstretched. When energy travels to the ends of the arms and legs and returns it has a kind of slingshot effect as it recoils, which means that points on the extremities have a great deal of kinetic potential. When they are needled it is like a surge of energy. What people often describe as a dull ache or mild tingling for most points can feel like a very large nail sending a shockwave along the limb. Fortunately it is usually very shortlived, and most people acknowledge that the short measure of discomfort is more than offset by the benefits of treatment.

However, if it really more than you can take at this stage of your pregnancy then your practitioner should be able to use other less painful points to achieve much the same effect, or use the tried and trusted ways of making treatment more benign - fewer needles, shallower insertion, less manipulation.

Hope all goes well with the birth!