Ask an expert - about acupuncture - side effects

134 questions

Q: I was in a snowmobile accient about 12 years ago. I started having  acupuncture in my knee which has had a screw in it for about 5 months ago. I have it once a month and a couple days later I have the worst burning and aching in that knee. is that normal?

A: We always hesitate to use the word 'normal' in cases like this. It is always possible that acupuncture can trigger a reaction, but the vast majority of these are short term, what we call transient adverse events. When they do occur we try to work out whether there is some aspect of the treatment which we can adjust to prevent their re-occurrence, or simply to understand why they occurred in the first place. This helps us to build up a comprehensive picture of the kinds of adverse events about which we might choose to warn prospective patients.

 The fact that this happens every time is a little unusual, and we would perhaps need to know whether the treatment was manual acupuncture or electroacupuncture. Some practitioners do use EA quite regularly for musculo-skeletal problems, and if this is the case then some for of interaction with the metal in the knee is possible, although still highly unlikely.

 Usually when heat is released from the body in this kind of way we tend to see it as a good thing, and it is just possible that the trauma to the knee has caused internal disruption which is clearing slowly as the needles are applied every time. Our practice is based on an understanding of the body as a system of energy, called 'qi', and if the knee has been extremely badly injured (being pinned suggests it was) then the energetic trauma may have been very considerable. If this is the case then it is possible that inserting needles is allowing this to be released on a regular basis, but if this is so we would expect the effect to reduce with time.

 We think the best thing to do in this case is to discuss the matter with your practitioner. We are intrigued by why this is happening and we would strongly suspect that he or she is too. Acupuncturists are by nature very curious about how things like this arise; our whole tradition is about making sense of disparate or unusual groups of symptoms. If your practitioner is aware of what is happening then we think it very likely that they will be actively trying to understand it and working out how best to refine the treatment to make sure that it gets addressed and doe not recur.

 Of course, the other factor we have to bear in mind is that the damage to your knee has sensitised the area to the metals of the needles. Some contain nickel in the steel, and others are silicon coated for ease of insertion. If the area has been disturbed by the accident it may have become hyper-sensitive to one of these substances. Again, your practitioner would be able to explore this as a possibility and see if the treatment can be adjusted accordingly.

 

Q:  I had acupuncture on  my lower legs and feet for chronic leg pain. The pain seemd to be  worse the following day is this normal it was done on the nhs both legs feel prickly and achey .

A:  We hesitate to use the word 'normal', but it is not unknown for the day or two after a treatment to cause a certain amount of reaction. Most of these reactions are what we classify as 'transient adverse events', and while some are the result of the physical act of needling (bruises, ect) an equal if not larger proportion are a positive reaction to treatment. This can often be the result of improving the energy flow in an area, and for those of us old enough to remember the prevalence of chilblains, the restoration of circulation can be a painful business. In the same way restoring the energies of the body can be a little uncomfortable.

 We are also mindful of the fact that you received your treatment in the NHS. This usually means that the person administering it is a physiotherapist or occasionally a doctor using what is termed western medical acupuncture. This can often be a little more vigorous than traditional acupuncture, with slightly larger gauge needles and more manipulation. While effective this can generate unintended side effects like residual pain which, because the practitioner is not working with a concept of energy, is usually put down to bruising or the re-arrangement of muscles and tendons as the needles encourage better function.

 In any event, there is nothing to worry about. If the effect is short lived and not too uncomfortable, and your lower legs and feet are feeling the benefit, then all well and good, as long the improvement outweighs the discomfort. You can always ask the practitioner to tone it down, though; a great deal can be done to reduce the impact of the treatment itself by using thinner needles, less manipulation and less depth of insertion. This is not necessarily going to have any impact on the success of treatment, and simply recognises that some people have slightly more sensitive systems than others.

 

Q:  Would acupuncture cause a rash in a totally different part of the body where the acupuncture was done?

A:  Generally speaking we would say that the answer is 'no.' The most common cause of a rash is some form of reaction to the treatment itself and in a few cases an allergic reaction to the needles or other modalities used. This is almost always where the needles have been inserted, and in almost all cases will be a short lived reaction.

 That is not to say that a rash elsewhere is not possible. This 'expert' has seen a number of cases where the release of heat in the body has meant a rash appearing along the line of a channel or meridian, the lines of energy recognised in Chinese medicine. What is again almost always the case is that if this is a reaction to treatment then it will be a transient reaction lasting for perhaps 24-48 hours and then subsiding.

 If you have a rash which has developed away from the needle site and which has lasted for more than a week, then there is very little reason to suspect that it has arisen from the treatment. There are very few recorded cases worldwide of infections from treatment, and in most cases, with nearly four million treatments being offered in the UK each year, it is simply a coincidence that a problem develops after a treatment.

 If it is a bothersome or worrying rash which is raised and red/inflamed then it may well be worth booking an appointment with your doctor just so that he or she can assess what is going on.

Q:  I have been receiving treatment through the NHS for fibromyalgia and chronic lower back pain. I have had 5 sessions and have had needles inserted into my mid and lower back, buttocks and the backs of my knees. During sessions 2-4 I also had needles to my ankles. Following session 4 I developed an extremely uncomfortable right ankle, with a lump under the ankle bone which is quite evident by feel and very painful to touch. I cannot recall any injury, trip or fall, and at today's session we had to avoid using needles to my ankles. Could this pain and lump be related to the acupuncture I have received so far?

A:  While we could never say for certain that it is, there is no doubt that if a lump or bump appears where someone has placed needles the usual assumption is that it has happened as a consequence of the treatment. Put the other way around, if you had said that the acupuncture definitely caused the problem, we wouldn't be able to say that it didn't.

 The most common form of lump like this is a deep bruise which has resulted from a slightly over-deep or over-vigorous insertion of a needle. This can sometimes show no signs on the surface, but because the ankle is a very narrow and 'crowded' space, it can put pressure on surrounding nerves and blood vessels and be really uncomfortable. There are other possibilities to do with needling in or near joint capsules which can cause similar problems, and in all cases these usually subside within a matter of days. They should certainly be gone within a couple of weeks. The other outside possibility is that there has been an allergic reaction to the needle in this specific place (we have seen one rare case of this) but it would be most unusual to react only in one place and not in equivalent areas on the other limb.

 If the lump is showing no signs of reducing, or the pain and/or discomfort remains the same, then perhaps it would be wise to contact your GP and have the lump assessed. Although there is a strong probability that the treatment is the cause, it is always best to consider the possibility that it is entirely contingent and just happened to appear at the same time. People sometimes get involved in arguing about whether acupuncture caused a problem, or sometimes simply assume that it did, and leave it uninvestigated longer than is beneficial. A lump is a lump, and needs checking.

 We hope, and expect, that it will resolve quite quickly.

Q: One of my friends had an acupuncture treatment to gain height. He is now worried whether it'll effect his life after marriage as he is still 25. And wants to know what are the most serious side effects of acupuncture.

A:  We're not quite sure what exactly your friend is worried about, but also a little uncertain about the treatment he had. Although we know of several clinics, mainly in India, where treatment is offered to help people gain height this is not something which any of us would tend to accept as a primary focus of treatment. As practitioners of Chinese medicine our principal focus is the treatment of the person, not the condition, and if this meant correcting functional disturbances from a Chinese perspective which had the corollary of making a conventional function change, then it is possible that someone might gain height as a consequence. One immediately thinks of the various growth hormones and the fact that acupuncture treatment might have the effect of stimulating a general improvement in their levels.

 There are a number of experiments on rats like this one

  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3748745/

 which offer a view that treatment may have this effect, but no studies on humans from which it would be possible to draw conclusions.

 What we are pretty sure of, though, is that this will have no residual effect after his marriage. Where he is now is where he will stay unless his constitution is affected by age and lifestyle. We are not aware of any outcomes from treatment which create long-term lurking problems which emerge at a later stage. 

 As far as safety is concerned we helped to put together a safety website some while ago and this page 

 http://acupuncturesafety.org.uk/safety-research.html

 refers you to several studies which show the kinds of adverse events which have been reported in the UK and western Europe. You will see from the figures that adverse events are rare and usually very mild and transient. The World Health Organisation study here:

 http://www.who.int/bulletin/volumes/88/12/10-076737/en/

 provides details of much nastier outcomes which our critics are often happy to trot out, but the reality is that these only occur when people lack proper training and equipment, and simply reflect that any medical treatment, complementary or conventional, where someone is not properly trained will lead to poor outcomes. In the UK the safety record is far better than nearly all forms of conventional medical treatment.

 



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