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Q: I am having an IVF embryo transplant this afternoon followed by another acupuncture session. If I have one more session tomorrow is that safe or is it too much?

A:There is nothing to worry about, as far as we can see. Many of the protocols which have been devised for assisting in IVF are focused on the point of implantation, and the most well known of these, the Paulus Protocol, involves using acupuncture within twenty minutes of the implantation. It would not be at all surprising if someone had developed a protocol which extended this to a slightly longer time frame and to involve multiple sessions. The evidence base for the success of these protocols, especially the Paulus, is good, and even though the treatment is a formula and not the traditional acupuncture which we practise it is a good baseline from which to move forward. You can read the about Paulus here https://www.ncbi.nlm.nih.gov/pubmed/11937123.

As far as frequency of treatment is concerned it is not uncommon in China for someone to receive treatment daily for ten days, and because the treatment is offered in the outpatient departments of hospitals within the national health scheme it is accepted as a viable process for short term acute problems. There is no suggestion that over-treatment can be a problem. Acupuncture is a very safe treatment, and if the body has had enough it simply fails to respond any further. Excessive treatment might make someone very tired or a little whoozy, possibly even a little nauseous, but these effects would be very short lived.

In short it sounds as though you are in safe hands with someone who knows what they are doing, and we very much hope that it has the desired result.

Q: For over a year now I've been suffering with a frozen shoulder. I went to see a specialist who said I had a nerve problem because the pain moves around my neck, arm and shoulder. The pain was really bad and I couldn't move my arm. I was given Morphine for the pain and a steroid injection into a different part of my shoulder. I also have Type 1 diabetes and thyroid problems. After the injections the pain went but after a few months it's back but not as bad as the first time. The doctor has now told me that because I have Type 1 diabetes I cannot have any more steroid injections, so has prescribed me ibuprofen and advised me to go back and see a physio. But the physio said he can't treat me if I'm in pain and the ibuprofen doesn't work, so I was wondering if I could have acupuncture?

A: The very simple answer is that there is no reason why you cannot have acupuncture as a Type 1 diabetic. The only caution which a practitioner will have is that with Type 1 diabetes there can sometimes be reduced sensitivity to the extremities. In our Guide, which we publish for our members, we say:

Diabetes mellitus It is recommended to ask diabetic patients about neuropathies they may have developed. In severe neuropathies the patient may experience loss of sensation. Due to impaired blood circulation to the affected area the patient may also be at a greater risk of developing a localised infection.  

Needling into the affected area should be done with particular care and strong manipulation of the needle avoided. Patients with poorly controlled diabetes, especially if insulin-dependent, may experience greater than normal fluctuations in blood sugar levels.

As strong acupuncture treatment can lower the blood sugar levels and occasionally induce some drowsiness, it is recommended that you treat such patients with particular care, especially on their first acupuncture treatment, and ensure that they have had something to eat before the treatment.

This just about says it all, really. We have come across the very occasional patient in whom the treatment triggers a release of additional insulin and can steer them towards a hypo, but most long term diabetes patients are usually very much on top of maintaining their sugar balance.

The reason for stopping steroid injections may also be that there is an upper limit beyond which most doctors will not go anyway. Three or perhaps four usually represents the safe number, after which there is an increasing risk of local damage to tissue in the area.

As far as frozen shoulder itself is concerned, as our factsheet shows https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1133-frozen-shoulder.html there is some fairly good evidence that acupuncture can be helpful. This is far from conclusive, so we can't make specific claims, but the evidence does suggest some benefit as well as some reduction in pain. The only problem is that it is difficult to stop someone using the shoulder while it improves, so progress can often be hampered by unintended setbacks when people reach out automatically and trigger pain and discomfort.

The best advice that we can give is for you to visit a local BAcC member for an informal chat. Most are more than happy to give prospective patients some time without charge to take a look at what is going on and will be able to give a better informed answer than we can about what prospects there are for benefit from treatment.

Q: I've read that acupuncture raises blood pressure in individuals with normal blood pressure. Does this always happen and if so, after treatment, does the blood pressure go back to normal?

A: We have looked carefully through all of the research databases and checked for anecdotal accounts on the web, but apart from people who have experienced a raised blood pressure as a nervous response to having treatment itself, there is no evidence to suggest that acupuncture would raise blood pressure in someone with a normal blood pressure. Clearly if someone has low blood pressure, treatment might have the effect of normalising it, but the primary effect of acupuncture on blood pressure is to lower it. This is a well attested outcome, and we have have seen thousands of patients over the years who have hypertension as a primary or secondary problem, many of whom have seen considerable improvements after treatment.

That is not to say that it cannot happen, and if you have come across some research which we have missed we would be very grateful for the reference. Things do change, and surprising results do emerge, but something as important as this would generally bubble to the surface quite quickly.

Our own fact sheet on hypertension is not as informative as some others we produce, and the evidence is not to the standard where we would be making specific claims for the benefits to be derived from treatment. Most of the studies, however, fail on methodological grounds, but all report a lowering of blood pressure with treatment.

Q: Can acupuncture help with post herpetic neuralgia?

A: As you might imagine we have been asked about this many times over the years, and a recent answer was:

Shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/herpes.html says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

We have had a good look through the research databases to see what further evidence is available (the fact sheet seems to stop around 2008) and we have found a few which are positively encouraging, such as:

https://www.ncbi.nlm.nih.gov/pubmed/21639941

https://www.ncbi.nlm.nih.gov/pubmed/22502623

but the systematic review proposed in 2014 has still to be completed (at least we can find no trace of a publication by the principal author).

The advice we gave earlier holds good, and that is to visit a local BAcC member for an informal chat about what may be possible. This is by far the best way to get a clear idea of your prospects, and most members are only too happy to see prospective patients in this way.

Q: My doctor advised me to contact a physio as I was experiencing joint pain in my knees. I had acupuncture on my first visit and after three days my shoulder blades and upper neck are in excruciating pain. Painkillers are not even helping and I don't know what to do. I can't deal with this any longer. Why Am I experiencing this and will it ever stop?

A: We would probably need a little more information before we could give a definitive view. The first question we would ask would be where the needles were inserted. Acupuncture is a very safe treatment with very few serious adverse effects, and most, when they do rarely occur, are the result of damage caused by the needles themselves, hitting nerves, causing deep bruising, etc etc. If someone throws a very specific pain then the first thing to check is whether the treatment as a physical act of needle insertion could have caused it.

The second thing to check is whether the treatment has caused a change in your posture, especially if needles have been applied to the lower back as well as the knees. The physios pay particular attention to this, often because they use slightly more vigorous techniques than we do as traditional acupuncturists. Occasionally a muscle might be tense and 'guarding' because it is supporting an inherently unstable spine. If this relaxes then it can generate problems locally or even higher up. It can even be the case that the correction of gait problems can affect the spine which in turn can make a change higher up for which the muscles are not yet prepared. The physio may well be able to recommend some exercises if this is the case.

Of course, a third possibility is that by using  acupuncture from a physical/medical perspective only the treatment has caused systemic effects in a wider way of which the practitioner may be unaware. It has been one of our constant themes with western medical acupuncturists that using points within a medical context does not mean that you can switch off the effects they have from our perspective in Chinese medicine. Why this might have resulted in neck and shoulder pain would very much depend on the nature of your energetic balances from a Chinese medicine perspective.

What we think is very likely, however, is that unless a needle has caused physical damage in the area where your pains are they are very likely to subside within the next few days. You would be well advised to contact the physio anyway to ask what it going on, and any of our members would in the same circumstances be only too happy to discuss the problem and perhaps invite you back to take a look at what is happening. Nobody wants a patient to be in pain after treatment. It may well be that further discussion reveals why this is happening and also go a long way to ensuring that the same thing does not re-occur.

The other thing we should say, though, is that although it looks fairly likely that the treatment was causally implicated in the pains it may not be the case. If by the time you get this response the pains continue and are beyond simple pain control you would be well advised to see your GP in case this is something different which has by pure coincidence happened at the same time. With over four million treatments in the UK each year there are bound to be occasional coincidences, and the key thing is to get problems checked out first before getting engaged in discussions about what caused what.

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