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I've been having migraines for years but in January this year I had a 14 day session (triptans helped me) so I decided to try acupuncture.The doctor is one of the best ones in my country and she gave me homeopatics (Corpus callosum and some others) as well. I had needles in my head, ear and some other parts of my body to stop having migraines. It really helped and I don't have them anymore, but since the second meeting (1st needles in my head) I had some strange feelings. First I felt tingling in my head every single day and then after the 3rd meeting I feel very strange - no tingling but like a pressure in my head which seriously never stops and I have some eye troubles sometimes (one eye has a blurry vision etc) but always for a while. Also I have dizziness sometimes. It seems that I have it close to the places I had the needles and I am now wondering what can be the cause. Could it be the acupuncture/the homeopatics or anything else? I study medicine and I was going to a neurologist before (because of the headaches) and there was no problem found accept the migraines. But I got a bit scared now as I really feel strange every day.Today I stopped taking the homeopatics and at least I stopped feeling the dizziness I hope. What would you say might be the reason of the whole strange head problems?

A: We are very sorry to hear that you have had these problems, although we are pleased to hear that your migraines have cleared up.

The one possibility that comes straight to mind is that what you are experiencing is something which has been a component of the migraine itself for a long time but hidden by the much greater pain which you must have been experiencing. This may mean that you have to continue with treatment for a little longer in order to clear the energetic problems which were the root of the migraine, some of which we have heard described in the terms which you use.

We have given careful consideration to the range of odd symptoms you have had, and we don't think that there is much likelihood of these being as a result of treatment. The vast majority of what we would call adverse effects are transient. Someone might feel dizzy after treatment, but this would last for 24 to 48 hours at most, after which the system would recover to the initial starting point. The only occasions where this would not be the case would be where there was some actual physical damage to the body, and we would be very surprised if inserting needles on the skull could do this. It is just possible that there has been a small bruise which is causing a minor energetic blockage, but you would be able to feel this as a tender point on the head.

We are, however, a little concerned that you are experiencing eye problems. We don't think for a moment that this can have been caused by the acupuncture, but were it to happen to one of our patients we would be recommending that they saw their optician or optometrist fairly soon. It may be that this problem has nothing to do with the acupuncture treatment as such but has by coincidence arisen at the same time. Whether it is or not, it would be important to get this checked as soon as possible.

We are interested to hear that you are also using homeopathic remedies, and that some of the symptoms have abated now that you have stopped using them. We think that it may be a good idea to take stock of the situation with your homeopath/acupuncturist. She, after all, is the person best placed to understand what is going on, especially since she will know exactly what your energetic balance is and was, and how she hoped to treat it. This will be far more informative than anything we can offer here.

The bottom line, though, is that if the various neurological tests have shown nothing untoward, then there is very little chance that acupuncture has caused any physical damage to generate the symptoms you are experiencing. This would imply that the effects are energetic, and your practitioner should be able to add these to the diagnostic mix and deal with them. However, we would advise that you get your eyes checked anyway, just in case this is a contingent problem.

Q: Can acupuncture help or make it worse for pain related with severe disc degeneration and acute inflammation Modic type 1 to the endplates? I've had my condition for three years, with no pain free moment ,which is common with Modic type 1 inflammation. I tried all types of treatment for the condition and the pain, but nothing helped. I was told this is the case with people with my condition, as it is nothing like any other back condition since the most pain is caused by the bacteria in my spine. Recently I was referred for acupuncture treatment and I had two sessions. After each one I felt much worse including pain in the affected area, aches all over the body and massive headache lasting for a week or so. After the second session I experienced a huge relapse with my back problem, with severe pain not going away for days, even with increased dosage of prescribed painkillers, Tramadol. While it's been scientifically confirmed that there is no proof that acupuncture can help with the type of condition I have I still wanted to try. My concern is that I have been much worse after treatment and it takes a week to go back to my 'normal' days when I can somehow manage the pain, which is not possible after acupuncture. Would you recommend continuing with the treatment in my situation?

A: When someone has a problem such as yours it can be quite difficult even in conventional medicine to predict what might happen with treatment. We have conducted a database search for treatment with acupuncture specifically aimed a Modic Type 1 and there is no evidence of any trials which focus on this specific diagnosis. However, until recently NICE used to recommend acupuncture as a valid treatment for chronic back pain of over six months duration on the back of some very strong evidence, and we strongly suspect that many of the thousands of the patients in these studies had Modic Type 1 problems alongside the chronic degeneration of the lumbar spine and discs which may have been assumed to be the cause. The estimates of between 20% and 40% of patients with chronic low back pain being troubled as you are would seem to make this a reasonable conclusion to draw.

We often warn people with back and neck problems to be aware that the next 48 hours after treatment may be a little rocky. We are not alone in doing this; many osteopaths and chiropractors similarly warn their patients, and many of our patients report feeling worse after manipulation. There are various reasons which we have heard advanced for this phenomenon, and the most compelling is that trying to encourage structural or postural changes associated with good function is bound to bring muscles into play which have been relatively untested for years. From a Chinese medicine point of view there is an equally compelling picture of stagnant energy and its renewed movement. This can often be quite unpleasant, rather akin to having cold hands or feet and warming them in front of a fire to restore circulation. This can often be slightly unpleasant to begin with.

The key thing about these reactions to treatment is that they tend to occur for the first one or two sessions only, after which the body had made its initial changes of direction and is now moving forward in a more predictable fashion. Hence sessions three and four and onwards will often have none of the more challenging outcomes as the first ones. If it carries on being painful, then it is just possible that the patient is too sensitive for the treatment. If so, there are only two options. One is to reduce the impact of the needles by using less needles, inserting them less deeply and manipulating them less. Practitioners can do quite a great deal to 'turn down the volume' so to speak, and some forms of acupuncture treatment, especially Japanese style needling, are barely perceptible.

There is, however, a small minority of patients whose sensitivity to needles is such that treatment is a bit of an ordeal and will continue to be so. This can manifest as you describe it, and unless the overall trend is upwards after the first two or three sessions then it would be wise to sit down with the practitioner and discuss how best to carry on. If it has no impact on the pain, then there would seem little point in carrying on. In our experience, though, most people do begin to enjoy lower levels of discomfort, and the usual question is how much pain relief and how sustainable it is.

Of course, the factor which we haven't mentioned is that the acupuncture treatment and the relapse are entirely coincidental. In practice we have to be careful when we broach this because it sounds like the beginnings of an 'it wasn't me' denial. In reality, though, with over 4 million treatments a year in the UK we are going to see a number of occasions where an increase in symptoms has nothing to to with the treatment, and our main aim then is to find out what is happening rather than getting involved in arguments about whether acupuncture treatment was the cause. We find that getting to the bottom of what is happening usually establishes that very quickly so there is nothing to be gained by delaying further investigation.

We do hope, however, that this is a typical pattern of things getting slightly worse before they get better, and that the next few sessions bring you the relief from pain which you would like to experience.



Q:Because I cannot lie for any length of time I was treated first on one side then the other. I noticed that the she re used the same needles having placed them on the cupboard whilst I had cupping in between Also I got home to find a needle still in my head. Should I be concerned?

A: We don't think you have any reason to be concerned for your safety; even in the hands of the untrained and incompetent the incidence of serious adverse effects is very very low in comparison to the number of treatments performed, and in the UK, where it is rare to find untrained practitioners, the rate of serious adverse events in the 4 million treatments a year is so low that acupuncture is one of the most statistically safe medical interventions.

We, however, would be very concerned if what you are reporting is completely correct. Leaving a needle in a patient is something which should never happen. The BAcC has very clear guidelines to ensure that this never happens, and we take a very dim view of practitioners who, through negligence or poor record keeping, leave needles in a patient. This is equally because of the risk to the patient and also because of the risk to any other member of the public if a forgotten needle drops out and is trodden on or handled by a third party. This would require what is called PEP treatment, post exposure prophylaxis, because without knowing where a needle came from one has to assume the worst and check for blood borne viruses over a six month period.

More concerning is the possibility that needles are being re-used. In the BAcC members are expressly forbidden to re-use needles, even on the same patient, and anyone doing so would be subject to serious disciplinary action. As we said above, the risk of infection is so small as to be largely theoretical, but even a small risk is too much to entertain if it can be prevented by simple safe practice guidelines. Needles are very cheap, and there is no excuse for using them more than once on any level.

We sincerely hope that this is not a BAcC member, but given the fact that there are two serious defaults from basic safe practice we would be very concerned about the overall standards of practice in someone who was not attentive to these basics of safe practice. It is not our job to encourage people to complain, but if the practitioner does belong to a professional association then we believe that they should be required to give an explanation of what they have been doing. This can often be done anonymously, i.e. you could report the matter without letting your name be known to the practitioner, but in most cases this would mean a professional association could not take formal action. However, if it prevented the practitioner from behaving in this way because they were under notice, so to speak, the public interest will have been well served.

It is possible that what you thought you saw isn't what actually happened - we have had a small number of cases where a practitioner has followed the rules to the letter but from where the patient lay it didn't appear so - but our Codes are very clear that a patient must be able to see everything that is done in plain sight. This means seeing a practitioner open up a fresh needle every time, not suddenly appearing with one in their hand. This is the easiest way to assure patients of good practice standards.

We are sorry that you have had this experience and hope that it hasn't discouraged you from continuing to have treatment, even if not with this practitioner.

A: Let's start with the relatively easy part of the question. Charges for acupuncture treatment vary across the country, and also vary within a region. As with all businesses, if the surroundings are in the more expensive area of town then the overheads will be greater and the cost will reflect this.

A first session of acupuncture can take up to an hour and a half while the practitioner gathers a great deal of information. In the Greater London area the cost of this is probably going to fall within a band from £50-£70. Subsequent sessions can be anything from half an hour to an hour, and the charge will be in the £40-£60 range. Outside London this might be close to £40-£60 for the first session, and £35- £50 for subsequent sessions.

There is an increasing number of what are called multibed clinics to try to make acupuncture more accessible to people who might find the costs a little steep, and while the treatment will be very similar it will take place in a group setting. Some people like this, others want a greater deal of privacy.

The number of sessions is impossible to say; each case is unique and different. What we would expect is that a practitioner reviews progress after the first four or five sessions, and proceeds from there with the full agreement of the patient. What has to be avoided is a kind of habit energy which leads to weekly bookings extending over months. It does happen! It is also important to try to establish effective measures of progress. Anxiety sufferers have good days and bad days, and it is helpful if there can be something which will let both patient and practitioner know that things changed. Otherwise it might depend on how someone feels that day, which is not a good marker.

As far as the value of treatment, we answered a similar query recently as follows: 

We produce a number of factsheets on the treatment of named conditions with acupuncture, one of which is on anxiety

The evidence is fair, and would appear to justify giving acupuncture treatment a go. It certainly won't do any harm, and will very possibly help.  Most of us treat a substantial number of patients with anxiety, although it would be fair to say that many come along for a different problem and find their anxiety lifting against their expectations. This does not surprise us; traditional acupuncture treats the person, not the condition, and it is quite common for people to feel 'better in themselves' after treatment for something as prosaic as sciatica or headaches. Obviously some of the 'feeling better' will be 'not being in pain', but people are very good at recognising the difference between not feeling pained and having a renewed spring in the step.

We wrote an article for Anxiety UK a couple of years ago, and we reproduce it here because it is a worthwhile summary of what we are trying to achieve:  ANXIETY AND ACUPUNCTURE

Anxiety is more than just being anxious. Just as migraine sufferers get righteously indignant when someone claims to be a fellow sufferer but can still get to work, eat and stand the daylight, so anxiety sufferers know that they bear only the slightest resemblance to people who feel a bit nervous or have ‘butterflies in the tummy.’ Clinical anxiety is a crippling affliction which can sometimes defy all of the medications and talking therapies that someone can throw at it.

Why, then, has acupuncture been found to be successful in treating it? The main reason is that in conventional medicine, there is no single treatment for each sufferer as each person has differing symptoms. However, in traditional acupuncture every patient is considered to be unique, and this means that the practitioners will be looking and listening very carefully to everything that the patient says to establish a diagnosis and find the specific keys to unlocking the patterns of the symptoms the patient is suffering. They will aim to identify the imbalances which cause the symptoms of anxiety, not just treat the symptoms themselves. This whole ‘package’ – taking the patient’s individual story seriously and giving them time to tell it, trying to hone precisely the diagnosis, and selecting the optimum way to use the least needles to achieve the greatest effect – has been found to be very effective.

The theory of traditional acupuncture is very straightforward. The free flow and internal balance of energy (Qi) is seen in eastern medicine as essential for good health. Any prolonged exposure to extremes or intense situations, be they physical, mental, emotional or spiritual, will cause the flow and balance to be affected. This disruption in balance then ripples through the whole system, causing symptoms which sometimes bear little apparent relation to the underlying causes. An acupuncturist’s skill lies in making sense of seemingly unconnected symptoms and understanding the unique nature of someone’s energies in such a way as to restore balance. A treatment plan may simply involve needles and moxibustion, the use of a warming herb, and tui na, a form of traditional Chinese massage, but can extend to address issues in someone’s diet, their exercise patterns and their lifestyle.

People sometimes ask why, if acupuncture is so successful, there isn’t much research to back up its claims and make it more freely available within conventional care. A major reason for this is the unique nature of treatment which resists putting people in pigeon holes and which changes as the person’s balance begins to improve. Both of these confound attempts to organise research according to western models where a named condition receives a single treatment and all other variables are taken out of the equation. In Chinese medicine the variables are called patients!

Where do our patients with anxiety come from? Word of mouth still remains the most common and most reliable form of referral, and more people have had acupuncture than you think. If you ask around your support groups you are almost certain to find someone who has tried acupuncture and found that it works. Perhaps this time it’s your turn!

People also usually want to know whether the treatment will ‘stick’, whether they have to keep on having acupuncture. Some don’t – a single course of treatment can set them on a good path which, as long as their life remains well-balanced and relatively stress-free, means that they will stay anxiety-free. Many, though, like to keep ‘tuned up’, and realise that spending a fraction of what they spend on keeping their cars roadworthy keeps the driver in good shape too.

As far as the number of sessions  is concerned it is very difficult to say.  Some people respond quickly and well, while others make only very slow progress. The key thing is to ensure that there really is some progress rather than just treating away month after month, and for this it would be important to set down some measurable outcome markers to know if things have changed. Anxiety is not consistent; sometimes people feel OK, sometimes they don't. Trying to find something which is based more on intuition and feeling is hard. The main thing is to establish when and whether to stop if the treatment is not producing much in the way of change.

Invariably we advise people to visit a local BAcC member. So much depends on the individual nature of someone's balance and energy that it is very hard to give generic answers offering precise advice. Most members are happy to give up a little time without charge to discuss what treatment may offer, and we are sure that you will enjoy talking to someone about what treatment may be able to offer you. 

Q:  My son, John aged 31 years, has just been diagnosed with a very large ganglioglioma tumor 9,5cm x 6cm x 4,5cm on the right hemisphere. He has been living with this tumor since a child. So far  he is only suffering headaches, no convulsions. We understand that he will need neuro surgery which may take a couple of months to organise. Our question is what can we reasonably expect from acupuncture whilst waiting for the operation?

A: As you might expect there is no research save a few case studies which we can find about the treatment of ganglioglioma itself with acupuncture, so there is nothing we can usefully add about the treatment of the problem. Surgical resection, especially in the young adult otherwise in good health, shows a reasonably high rate of success, with recurrence levels being quite low unless the tumour has been difficult to remove fully because of its location.

 We are aware that there are ways of looking at problems like this from a Chinese medicine perspective which might give someone expectations that acupuncture treatment will offer a 'cure'. The ancient Chinese did not have the benefit of MRI and X-ray images, and from their perspective any accumulation of fluids or tissue in the body represented a functional disturbance whose origins could be traced to particular Organs of the Body (capitalised because this means something specific and different in Chinese medicine). If this were the case then there would be other signs and symptoms to guide the practitioner, and some hope of dealing with this as a systemic functional disturbance.

 However, it is very dangerous to translate between 'oranges and apples' medical systems because there will be unintended implications that working in one will deal with a problem in the other. What we can say, however, based on our own experience is that acupuncture treatment can have a demonstrable effect in reducing someone's anxiety levels, and anecdotally appears to aid recovery after surgery. The early systems of acupuncture were largely asymptomatic but aimed primarily at establishing balance and harmony in the body's energetic flow and functions in the simple belief that a system in balance was best placed to address any health issues it had. 

 On that basis we would certainly be happy to recommend that your son has treatment in preparation for what might be some very difficult times ahead, but not with any expectation that it would reduce or delay the need for surgery. The fact that he has been carrying this for over twenty years suggests that it is not rapidly growing, and that surgery will be successful. We certainly hope so for his and your sake.  

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