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We are sorry to hear of your problems. It must be disheartening to have a symptom for which no adequate explanation can be given.

We have been asked about reflux many times, and a typical answer has been:

There is surprisingly little research on the use of acupuncture for the treatment of acid reflux even though it is a very common presenting condition in our clinics. There are one or two studies like this

http://www.ncbi.nlm.nih.gov/pubmed/20697939

http://www.ncbi.nlm.nih.gov/pubmed/17875198

and occasional articles like this one

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4080874/

which suggest other possibilities for the appearance of heartburn symptoms, but not the solid body of evidence one might expect based on the usually quite effective treatment of this problem.

Obviously there are physical problems such as hiatus hernia where there has been a physical change in structure of the oesophageal tract which can cause heartburn. If this is the case, then it will seriously limit the possibilities for treatment in any system of medicine. If investigations show that this is not the case, however, then there may be some value in using acupuncture treatment.

From a Chinese medicine perspective the classic presentation of reflux or heartburn is described as Stomach Fire or Rebellious Stomach Qi where the energy of the Stomach does not follow its normal pattern of causing food to descend but lets it stay in the Stomach or reverse its flow to create the classic symptoms with which people suffer. Knowing the immediate precipitating cause, however, does not mean that one goes straight to this for treatment. The flow of energy in the body, called 'qi' in Chinese, is a complex interweaving of channels connecting Organs whose functions are also inter-related. The art and skill of the practitioner lies in determining what the primary underlying imbalances are, in the belief that treating here will cause the symptom to go and stay gone rather than be treated simply as a symptom.

This is one of the primary differences between Chinese and conventional medicine. From the Chinese medicine perspective the symptom is an alarm bell telling the practitioner that the system is out of balance. Thus twenty patients with the same symptom could have twenty different underlying causes and therefore twenty different treatments, in contrast to the standard western procedures which have two or three main strategies for a problem. In Chinese medicine the balance of the system is unique in every patient, and this means that each treatment plan is also unique.

It follows that this does limit what we can say about individual cases and why we invariably advise people to visit a local BAcC member for an informal assessment of what is going on and whether treatment would be of benefit. Most practitioners can get an idea in a very short time of what is going on and as a consequence give a good informed view of what might be possible. This would invariably take into account other changes in the way that everything functions which are perhaps not significant enough to concern anyone but from our perspective enrich the picture which we have. Reflux and heatburn are often accompanied by changes in bowel habit, and secondary information can refine the diagnosis a great deal. A practitioner can take all sorts of other factors into account, including mental and emotional ones, to offer you a much more precise assessment of what may be possible.

This remains pretty good advice, even if we say so ourselves! Your description does tend to the fact that this is a physiological problem of the 'containment' structures not working, and that, as we have said, may limit what the possibilities are. However, traditional acupuncture is based on restoring functional integrity to the system, and that may have some impact on the way that the body controls the contents of the stomach. There are other imbalances besides Stomach imbalances which interfere with the steady downward progress of digested food, and a skilled practitioner might well recognise something like this straight away and be able to assess how treatment might well help.

There are also some new treatments which offer possibilities if the existing remedies fail to work. One of our patients has just had this device fitted:

http://www.toraxmedical.com/linx/

and his experience after fitting has been extremely positive after many years of suffering. There comes a point where long term reflux starts to cause serious damage to the oesophagus, and investment in these kinds of treatment are much more cost effective than managing the consequences of tissue damage in the longer term.

We hope, though, that you give acupuncture a try to see what it can achieve. This isn't a blank cheque, and it would be well to set a target of, say, five treatments to see what can be done. If there is no change then it may be sensible to explore other alternatives.

We suppose the underlying issue here is whether the mitral valve prolapse is actually connected to the symptoms which your son is experiencing. The ones which you report are not the standard problems noted in these cases, and if this is a separate and unrelated problem then it substantially changes the advice we can offer.

As far as the treatment of MVP itself is concerned there is no evidence that we can find that acupuncture treatment has been documented in helping to reduce the symptoms associated with MVP. There are several complementary medicine articles which point to the use of magnesium, which has been linked to the muscle weakness, but nothing which mentions treatment by acupuncture. Whether magnesium is effective as a supplement is beyond our scope for comment.

If, however, the symptoms are of a different problem related to a weakened immune system, i.e. not directly resulting from the MVP, then there may be some reason for cautious optimism. There have been a number of studies which have shown effective increases in immune response and immune system body chemistry as a consequence of treatment, and a greater number of studies of of successful treatment of some of the emotional disorders associated with a weakened immune response, anxiety being one of the primary ones. The research is far from conclusive, but suggestive of the fact that there may be a chance that change will happen.

The bottom line with complex presentations is that it really needs someone to take a look at the individual to see how the symptoms present against the backdrop of all aspects of the person's health. Not only does the traditional acupuncturist treat the individual rather than simply treat the condition, but the health of the individual can seriously affect the speed with which something can clear up, or indeed whether it can clear up. The best advice is to see a local practitioner for this kind of informal assessment before committing to treatment.

The one caution about treating anyone with MVP is that there is thought to be a known increase in risk of endocarditis if the skin is not cleaned before needles of any kind are inserted, and there is an absolute embargo on the use of any form of retained needle. This is occasionally disputed, as in this paper

https://www.ncbi.nlm.nih.gov/pubmed/14620303

but we always advise our members to treat people with heart valve problems as though they were immuno-compromised

File under general - uncategorised

We are very sorry to hear of your problem.

Long-lasting side effects from acupuncture treatment are very rare. Where these happen they are generally to do with the 'wound' of the needle, i.e. puncturing or touching a part of the body. Surface responses are usually transient, lasting no more than 48-72 hours. Where these occur it can result from one or two special cases. First is a possible allergy to the stainless steel of the needle. Needles are usually composite material, and one or two types contain a small amount of nickel to which some people are very allergic. This can trigger a response which can last for some time. The other possibility is that the needles has a silicon coating. This has been a modern development to make the needle insertion smoother, but again there are some patients who find silicon can generate nasty side effects.

Leaving aside the technical causes, there is a small chance that this is a reaction to the treatment in terms of the stirring up of energies which have raised but not removed an internal pathogen. It depends to some extent on the kind of acupuncture you were having - traditional or medical - but in our experience a medical acupuncturist can generate what we call an energetic reaction without having any idea that this is what they are doing. If this does happen, though, it does tend to dissipate relatively quickly, so it would be unlikely to be causing longstanding pain.

Another possibility is that there has been a failure of hygienic practice, and there has been some form of transfer of surface material to areas of the skin where it is not checked. We advise members to take extra care where someone has just had surgery, and to treat them as though they were immuno-compromised because the chance of infection is a little higher.

Finally, there is also a possibility that this has got nothing to do with the acupuncture and may simply be a coincidence. With over four million treatments a year there are going to be a number of cases where something just happens to start at the same time and a spurious causality is assumed. This always sounds overly defensive - 'it wasn't me' - but we have seen a number of cases where the problem simply could not have arisen from the treatment, however it may have appeared to be the cause.

The most important thing, though, is to find out what is happening, and for this you will need to get a referral to a dermatologist via your GP. It would be helpful if you can provide information from your acupuncture practitioner about where needles have been inserted because this will help to establish potential causal factors.

More than this we are sorry to say we cannot say. Sight unseen it is very difficult to give a definitive view when an adverse effect arises, but we hope that we have given you enough information to consider what might have been the case and to find an effective way to get rid of the irritation and pain.

Accidents and adverse events following acupuncture treatment are quite rare. Where they do happen the majority are caused by a needle damaging a part of the body directly and immediately, and there is usually a very clear cause and effect relationship between the two, like puncturing a lung or causing a large bruise. As we said, though, in the UK these sorts of accidents and adverse effects are very unusual, as our insurance records show.

We do, though, often see people get a little worse after an initial session, sometimes for up to 48 hours and especially where we are treating a back of joint problem. The increased stiffness is quite common, and while there are several possible explanations for why this occurs, there is general agreement that the effect will wear off quite quickly and be replaced by a gradual improvement in the joint or back function.

Could acupuncture do done wrongly? Well, yes. It is always possible to needle too deeply or too vigorously, and this can have longer lasting effects. When someone has a pre-existing condition this becomes almost impossible to prove, because a practitioner will always claim, often legitimately, that this is just a worsening of the original condition which could have happened anyway. We have some sympathy with this argument; with over 4 million treatments a year there are bound to be times when treatment happens to coincide with a deterioration which is has not caused. However, the fact that one of the needles was wiggled and caused pain could indicate that there has been some deep bruising which is taking a long time to recover, especially if the joint is somewhat 'stuck' anyway. We would always expect this to clear up eventually, though.

We don't think that acupuncture per se would exacerbate an existing condition, though. Certainly from a Chinese medicine perspective we are trying to change patterns of stuck energy, and our experience is that if we do a treatment which the system does not accept it merely reverts to how it was before. This is, indeed, one of the challenges in treatment, because the 'habit' energy can be quite hard to dispel. We have rarely seen a condition get worse directly because of treatment, as we said at the beginning. 

We are sorry to hear that you are still being troubled in this way, and understand if you are not too keen on acupuncture treatment as a consequence. We do believe, though, that the use of traditional acupuncture rather than western medical acupuncture might still offer a solution to your problems and we would be happy to suggest that you visit a BAcC member local to you for informal advice on how best to proceed. Most of our colleagues are happy to give up a little time without charge to prospective patients, and this would give you a far better idea of what may be possible.

Trigeminal neuraligia is a very painful and quite often intractable condition. We have been asked about it a number of times, and  we have factsheets about both facial pain and neuropathic pain

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

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

There evidence underpinning a recommendation for acupuncture treatment is limited, but as you can see from the evidence button on the neuropathic pain sheet acupuncture has on several occasions been shown to be superior to the standard drug treatment, which suggests that it is worth trying. 

In a previous response on the same question we said:

If you look through these various responses, however, you will see much the same advice in each one. The evidence is encouraging but far from conclusive, although it would be fair to say that the gold standard of research in western medicine, the randomised double blind control trial is not the most appropriate tool for assessing traditional acupuncture. However, there are a number of treatment possibilities within the paradigm of Chinese medicine, to do with blockages or deficiencies in the flow of energy, or 'qi' as it is called, which a practitioner might be able to identify and correct. Your best bet here is to contact a BAcC member local to you and seek a brief face to face assessment of whether they think acupuncture may be of benefit.

We have to say, however, that trigeminal neuralgia or neuropathy does appear to be a rather intractable condition, and we are usually relatively cautious about the prognosis when we take on patients in whom this is their main complaint. You will note that in one or two replies we have suggested that cranial osteopathy may offer another treatment option. The pathway of the trigeminal nerve is easily compromised by some of the physical structures around the tempero-mandibular joint, and subtle manipulation may offer possibilities.

We think that this remains the best advice that we can give. We have no doubt that acupuncture treatment can deliver temporary pain relief, and the amount of research which has been done to investigate this aspect of acupuncture's effects has been very considerable. However, as with all forms of pain relief, it is relief, not removal altogether which is what the treatment delivers, and even when treatment works the extent of the relief it can give and its sustainability do not seem to us to be sufficient to warrant making a recommendation to try to use acupuncture as a long-term pain relief option.

If you did decide to visit a practitioner local to you, we would recommend that you are very clear about the review periods at which you can assess how successful the treatment has been, and also that you try to establish very clear outcome measures, i.e. changes which you can actually measure rather than simply soundings based on how you feel on the day. With conditions like this there are good days and bad days, or more accurately bad days and worse days, and it helps to try to bring a measure of objectivity where possible to the proceedings.

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