Ask an expert - muscles and bones - back / spine

66 questions

Q:. At the beginning of December I had acupuncture performed on my lower back for the very first time. It was recommended to me because for a few months beforehand I was suffering from a lot of stomach pain which occasionally affected my lower back. 

Anyway, I had the acupuncture on my lower back at the beginning of December and later that evening I was in a great deal of pain and discomfort around the entire lower back area. I contacted the acupuncturist and he confirmed this was normal and it'll take a couple of days to ease. Well it is now the middle of January and is far, far worse.

Not only is the pain far worse and intense but it has spread considerably around my lower back and also now in my upper back, shoulders and even my arms. I am also feeling pain around the 'love handle' areas and some in my upper abdomen.

I have complained to my acupuncturist and he denies all wrong-doing and states it can't still be the result of acupuncture but the fact of the matter is that I didn't have this pain before I had it performed and now I do, and I even felt it come on the very evening of the day I had it done.

It is ruining my life as I am now laid up in bed unable to do anything and have been like this for over 2 weeks. I have been to A&E but they only checked my bloods and urine, which were normal, gave me some strong pain-killers and sent me home.

Hot baths and hot water bottles don't help, neither does resting in bed.
 

Is it possible that this acupuncture session has done something to me or perhaps triggered something?

It almost feels muscular or strained and certainly inflamed constantly. It is tender and there is severe aching all over my entire back.

If you can please put my mind at ease or explain what it could be or even what I should do next?

A: We are very sorry to hear of your problems, but we tend to agree with your practitioner, that it is extremely unlikely that the acupuncture treatment has caused this problem to exacerbate in this way. The overwhelming majority of disturbances caused by treatment are transient and minor. We undertook a survey in 2000, as did the medical acupuncture profession at the same time, which together produced evidence of only 14 minor transient adverse events from 66,000 treatments. A second survey of patients three years later showed a not dissimilar pattern, and where serious adverse events have occurred from the use of needles, these tend to be more to do with penetrating organs of the body, such as in a pneumothorax, and contrary to popular belief these are extremely rare.
 
That said, your symptoms are very real, and our advice in circumstances such as yours, which we see two or three times a year, is to try to get an immediate referral to specialists within the conventional medical system. Your case would probably fall within three specialties: neurology, orthopaedics, and rheumatology. You may need to put as much pressure as you can on your GP to make a referral.
 
We, and our members, are not trying to abdicate responsibility in cases like this, but we have seen several occasions over the years where there has been protracted argument over whether or not the acupuncture treatment could have caused a problem to occur, and our view has been that the time spent arguing would have been better spent tracking down a solution. The bloods will have ruled out infection, and in our experience a spasm in a muscle caused by treatment, unusual in itself, is usually localised and short-lived, usually responding to heat and massage. Since neither have worked in your case, you need to have further and more complex investigations to find out what is happening in order to be given the appopriate treatment as a matter of urgency.
 
We are sorry not to be able to offer you much more than this. If you do hold to the view that the acupuncture was the causal factor, we need to assure you that all of our members are fully and well insured, and that should you wish to make a claim either your practitioner or our Office can give your the full details. However, we think that this is one of those cases where the treatment and your problems are an unfortunate coincidence. 
 

Q: Are 12 needles for 40 mins for my second visit too much? I was lying on my stomach for the full 40mins for lower back pain.

A:  The short answer is not at all. It is not uncommon when treating lower back pain to use a significant number of needles locally, and this can often easily run to a total of 10 or 12 needles. It is also quite common to have the patient relaxed in a face down position.
 
If you felt that it was too much, however, or that the position was uncomfortable for 40 minutes, then it is a simple matter to raise this with your practitioner who will be delighted, we are sure, to adjust the treatment for you.
 
A very small number of patients are very sensitive to acupuncture treatment, and this can often limit the number of needles which a practitioner can use. In most cases, though, this is very clear because the patient feels a little spaced out or woozy after treatment, and not in a particularly pleasant way. Practitioners will always ask how the treatment affected someone and in cases like this would automatically scale the treatment down for the next session. 
 

 

Q:  I have degenerative spondylolisthesis causing severe stenosis for the cauda equina. I want to try acupuncture. However I want to find an acupuncturist who is experienced in dealing with my condition.

A: We are afraid that we cannot give out personal recommendations. From our perspective all of our members are equally well-equipped to deal with the vast majority of patients who come to see them. There are a couple of areas, such as obstetrics and paediatrics, where we are trying to put together guidelines for what defines expert practice, and which may enable us to recommend practitioners in these fields, but apart from mental health issues, which may be the next area of expert practice we touch on, there are no plans to look at specific conditions in this way.

We have been answering questions on all manner of subjects for nearly two years, and we wonder if your internet searches found the following question and answer from some time ago:

Q. Following an MRI scan I have been diagnosed as having "central canal stenosis with degenerative changes at L4-L5 level and moderate disc herniation". I have difficulty walking more than 200 metres. Is it at all likely that acupuncture would have a significant positive effect?

A. We are sorry to hear of your difficulties. We were asked this question many years ago, and our advice has not changed that substantially. Back then we wrote:

Lumbar canal stenosis can manifest in many symptoms dependent on the extent of the stenosis. Our colleagues in America are very upbeat about the potential for success in treating lumbar canal stenosis; if you google 'lumbar stenosis acupuncture' you will see an article on the www.acupuncture.com site which speaks positively of success rates, as well as an 'acupuncture today' listing which also gives good cause for hope.

Personally we tend to take a slightly more guarded view of the chances of success, and base our own prognoses on gathering as much information as we can about the condition - how long the person has suffered from it, is it degenerative, does it have peaks and troughs, has it been exacerbated by accident or trauma, and so on - before committing to treatment. Even though we are working with entirely different diagnostic systems, if a condition has some very severe manifestations based on irreversible physical change, the expectations of a 'good' result have to be lowered accordingly, even what might count as a 'good' result.

The best advice that we can give is that you discuss this with a practitioner whom you might consider seeing and ask their advice. Many of our colleagues are happy to discuss someone's concerns with them rather than book them straight in, and a significant number are happy to set aside a few minutes to meet someone and offer a more informed view of whether they can help based on a rapid assessment of the actual presentation.

Since we gave this advice there have been a number of studies such as this one

http://www.ncbi.nlm.nih.gov/pubmed/22534725 :

which give some cause for optimism, although finding a UK practitioner able to deliver this particular form of treatment may take some doing. The most recent systematic review

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3373659/

is much more guarded in its views.

However, it is often possible that the symptoms from which people suffer are not directly related to a physical change in the same area. We find that many people are told that arthritic changes in the lower spine are responsible for their chronic low back pain, but we often see the pain reduce or vanish without any accompanying physical change. Acupuncture has, in fact, been accepted within NICE guidelines as an effective treatment for the treatment of chronic low back pain, and the evidence base is certainly more compelling than for many other western named conditions. Our fact sheet on back pain

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

gives more background.

The best advice we can give remains the same - visit a BAcC member local to you for a brief face to face assessment of whether they think you might benefit from acupuncture treatment

We don't think we would change this advice, and hope that it helps you in deciding what to do. Our searchable database will generate practitioner names by postcode, or you can ring our office for hard copy of names and addresses of practitioners to be sent to you.

 

 

Q:  I' ve got pain in my back L4 & L5.  Will I get rid of some of the pain after a first session of acupuncture? How quickly  does acupunture work?

A:  Without knowing exactly what kind of pain you have, how it has developed, what may have caused it and what else has happened to bring on the pain, it is very difficult to say!
 
This kind of question highlights the problems that we have using a different system of medicine from the one which is all around us and embedded in our common culture. People have 'bad backs', 'migraines', 'asthma', and so on, and a great deal of conventional medicine deals with this named condition in a very specific way. By contrast, the individual symptoms which piece together to define a named condition in conventional medicine are interpreted in Chinese medicine in an entirely different conceptual framework, so that there is no equivalent of a NICE guideline for a lower back problem because there are as many variations in the exact nature of the problem as there are people with it. A truism of our work is that twenty people with migraines may have twenty unique and different diganoses in Chinese medicine which would be treated in twenty different ways. We treat the person, not the disease.
 
However, clinical experience usually follows familiar patterns, and with back pains in this area there is often some change relatively quickly, and the question is how much and how sustainable it is. We usually warn our patients that for the first 48 hours after treatment it is possible that the pain and stiffness may increase a little, but after that there should be progress. The NICE guidelines for treating lower back pain recommend ten sessions, but most BAcC members would be reviewing a patient's progress at four or five sessions, at which point it is often possible to determine how well someone may respond. What you want to avoid is a pattern where there is some improvement for a short while which then reverts to the status quo. If this happens more than four or five times then the short term relief may not warrant the expense of treatment.
 
Each case is unique and different, though, and there may be other factors in play which would determine how much change and improvement you might experience. Have we had people for whom one treatment did the trick? Yes. Have we had patients who have not responded at all? Yes. The best advice is to visit a BAcC member local to you to get a brief face to face assessment of whether acupuncture treatment may be of benefit to your specific problem. 
 

 

 

Q:   I have had twp  sessions of acupucture to help me with lower back pain and sciatica. Before the first session my symptoms were not too bad. The following day my sciatica appeared to be more agitated. After the second session my back started to ache. It's been 3 days since my last session and both symptoms are causing me trouble. Is this normal?

A:  We would not go so far as to say that this is 'normal', but it can happen. Acupuncture can cause minor transient adverse events, and it is not unknown for people to have a day, or two at most, after a session where the system is in a state of flux and symptoms can become a little worse. In some cases this can be quite marked, but in all cases this should stop after about 48 hours.
 
If a problem continues after this, there are a number of possibilities. First, and this has to be expressed with great care in order not to offend a patient, the deterioration or increase in discomfort may have nothing to do with the acupuncture treatment. Many lower back problems have a 'tipping point' after which the symptoms become quite severe, and often what is happening at the time this takes place is unconnected to the change. A more positive therapeutic outcome, and very commonly experienced after osteopathic treatment of lower back problems, is that as the body reasserts its proper form some of the muscles which have been operating in a distorted structure are now forced to accommodate the better structure within which they should function. This is rather like the pain people sometimes experience after sitting in a restricted legroom seat at the theatre and then standing up.
 
In any event, the important thing is to discuss the problem with your practitioner and get their advice. They will know what treatments they have given and will be able to interpret what is happening to you better than we can at this remove. If they are concerned they may well invite you in for a flying visit just to take a look at the overall picture, and see if any short term adjustment is necessary.
 
Our expectation, however, is that by the time you read this the paim will have subsided considerably and you will be starting to feel the benefits of the treatment for your lower back.   

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