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Q: I had acupuncture for the first time on Friday, followed by discomfort, very bad pain in the soft tissues around the knee.  5 days later moving around and then on the eighth night with burning sensation. Five needles 2,5 - 5 mm were placed in the thigh about 5 cm above the knee. The sessions of after pain have made me numb and unable to do much. Can be this from the acupuncture and how long I should expect this to last?

A: We would have to say that the effects are very probably from the acupuncture treatment. It might just be a coincidence, and with over 4 million treatments in the UK every year such coincidences can occur. However, when a symptom turns up exactly where the needles were placed it would be very strange if this were caused by anything else.

The question is, what has happened? The pain sounds like they started pretty much straight away, and seem to have progressed, We could understand it if the pain had levelled out after a couple of days. Occasionally treatment can cause some deep bruising, and this can impinge nerves in the area and cause quite unpleasant side effects for up to a fortnight after the treatment. However, the needle depths would seem to rule this out.

The only other possibility is that there is a slight infection in the area. If the practitioner is following the normal protocols for single use disposable needles, one needle per point,  this won't come from the needles themselves or by transfer from site to site. What can happen, rare as it is, is that bacteria from the surface can be pushed into deeper layers of the dermis and cause what is called autogenic infection, i.e. bacteria which are safe where they are but reactive when they are moved to different or deeper areas of the body.

This is highly speculative, but if you were one of our patients we would send you to your doctor just to be on the safe side. It might be a rare coincidence, and there might be something going on in the area which needs further investigation. If so, then a doctor will be able to offer an explanation and treatment, and in many cases be able to tell you whether the acupuncture treatment may have been involved.

It might, though, simply be an unusually extended post treatment adverse effect which will wear off. The fact that this is causing post pain numbness and limitation of movement, though, suggests something more significant and we would recommend that you consult

Wednesday, 21 November 2018 14:29

Can acupuncture help an overactive bladder

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Q: I have suffered from an overactive bladder for about 12years. I need to go to the toilet about every hour and every two hours at night. I need to get this problem under control, as I have limited abilities to do as I want. I have had to cancel a holiday as waiting at the airport would have been too stressful not to mention being on the plane and needing the toilet so much. I would value your help as I cannot carry on like this. I am 67 and want to claim my life back if possible. 

A: We have been asked about this on a number of occasions, and a typical answer has been:

As our factsheet shows 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/urinary-incontinence.html

there is some evidence to suggest that urgency of urination can be helped by acupuncture, although there is not yet anywhere near enough evidence to make substantive claims here. If you search the internet there are a number of studies such as this one

http://www.ncbi.nlm.nih.gov/pubmed/15994629

which offer some hope.

However, we have to remind ourselves sometimes that traditional acupuncture has been dealing with problems like this for over 2000 years, and has a very sophisticated process for understanding patients' symptoms against a backdrop of an entirely different conceptual framework. The understanding of the body as a system of energy, 'qi', in flow and the concepts of yin and yang to describe its flow and inter-relationships is very alien to the western ear. However, the rather wider understanding of organs as functional units with effects on body mind and spirit, and the underlying premise that symptoms are alarm bells, not the problem itself, can sometimes offer possibilities for understanding a problem in a far wider context. This will often be corroborated by other problems which a patient suffers and by diagnostic signs which the practitioner sees, and can often lead to a situation where a practitioner can tell the patient about symptoms that they haven't yet mentioned. If the problem is a part of a recognised syndrome or pattern of symptoms a practitioner will be able to give a clear idea of prognosis. Even if it doesn't the attempt to re-establish balance in the system can also have an effect on individual symptoms.

We recommend that you talk to a BAcC member local to you an ask for their advice in a brief face to face consultation whether they think that they can help you. We trust that they will give you an honest assessment, and refer you on to other modalities of treatment if they felt that these offered a better prospect of success.

We have had another look at the research evidence which has emerged since we wrote this response, and there are two more papers which make encouraging noises

http://www.ncbi.nlm.nih.gov/pubmed/25399241

http://www.ncbi.nlm.nih.gov/pubmed/25033919

and evidence of a systematic review about to take place. This is a survey of all papers on the subject which is regarded very highly within conventional medicine since it irons out anomalies in smaller samples.

One of our members has studied this problem for several years and given presentations at our research gatherings and conferences, so we are confident that there is something of importance emerging in the use of traditional acupuncture in this field. However, each individual person is different, however similar their symptoms may be, and the strength of Chinese medicine is that treatment is tailored to the unique needs of the patient, not simply offered as a one size fits all option. Visiting a BAcC member local to you would seem to us to be your best option. Here you will get advice for your own unique presentation.  

This is, as you can see, a 'stacked' answer, two together, and when we receive enquiries which we have answered before we often quote them and look at any more recent developments. There is nothing more to add, with the systematic review still being undertaken.

However, there is a treatment which is not really acupuncture as such caller percutaneous posterior tibial nerve stimulation of which we said in reply to someone else

The technique  is called percutaneous posterior tibial nerve stimulation, about which you can read here:

https://www.nice.org.uk/guidance/ipg362/chapter/1-Guidance


It is not really an acupuncture technique as such, at least it certainly is not a part of the ancient traditional Chinese medicine which we all practise. It is a modern technique using needles as electrodes which, as is often the case in modern developments of acupuncture, is described as working 'by a mechanism which is not yet properly understood.' It may well be that a traditional acupuncturist has decided to add this to their repertoire, but it is not a part of our core training.

This is not something which we would normally offer, but there may be practitioners in your area who do. If all else fails this would be worth a go. Another left field suggestion might be NLP hypnotherapy, a specific form of hypnotherapy of which we have often heard good reports. Where a problem starts to generate itself, i.e. the fear of needing to go can often generate the urge to go, there are a number of ways to try to break the cycle. Western medicine offers one or two drug treatments which suppress the urge to go for a number of hours, but we are not convinced of the safety of using this as a long term strategy. Something like hypnotherapy, which can break the cycle of urge and frequency and give a person some control back, may be an option worth exploring.

Obviously, though, we believe that traditional acupuncture may be well worth a go, and hope that you find some relief from this life-changing situation

Q:  My wife suffers with  varicose veins  in both legs. In one leg the veins  are in very projected stage.  We checked with the doctor. Laser surgery was suggested, the other suggestion was surgery..We went to an acupuncturist for advice but this was not satisfactory.It seemed the main interest was money - paying for 15 sessions.   Would acupuncture help?

A:  We don't think we, or anyone else, could give an assurance that 15 sessions of treatment or 15 days of treatment could resolve a problem like varicose veins, especially if they have reached the point where surgery is an option. In reply to a query some time ago about varicose and thread veins we said

There is no research of which we are aware suggesting that acupuncture has been used as  a front line therapy for treating thread veins, although obviously all of us have had patients over the years who have presented with varicose veins and thread veins. Here again, research into varicose veins is not that plentiful, and the results tend to be equivocal.

That said, within Chinese medicine itself all forms of pooling of blood in the lower limbs as a consequence of venous insufficiency have been interpreted within the diagnostic categories for over 2000 years - this is not a new problem! There are a number of well-recognised syndromes which can account for the problem in the terms in which we understand energy flow, and in each case the varicose/thread veins will be a part of a much wider grouping of symptoms which result from a functional disturbance in the body. Some of these may not even be recognised as symptoms; bruising easily or going to the toilet more frequently may just be written off as 'just something funny about me.' To a Chinese medicine practitioner, though, taken in conjunction with some of the independent information we get from taking the pulse at the wrist and looking at the tongue, they can point to pathologies which may be treatable. Functional disturbances tend to generate groups of symptoms which make perfect sense to us although in conventional medicine each might be treated by a different specialists.

The best advice we can give is that you pop along to a BAcC member near you for a brief informal assessment, hopefully without charge, of what may be possible. If there is good supporting evidence of wider patterns a practitioner may well feel confident about the chances of reducing the veins or stopping them getting worse.

We have to be honest, though, and say that our experience is that by the time people are beginning to consider having injections it is not that easy to reverse the trend, and we would be very very cautious about anyone who makes promises in this area. We would tend to say to a prospective patient that maybe three or four sessions would be enough to see if some small changes occur (easy in the days of digital photography), and then take a view about whether to carry on.

This remains the best advice that we can give. As far as the practitioner's request is concerned, it is not uncommon in China itself for someone to have daily treatment for 10 to 15 days for a number of conditions, although this is usually reserved for acute problems like back pain and sciatica where it is believed that a burst of treatment gathers momentum better than more spaced out sessions. Whether this would be suitable for a long term and chronic condition like varicose veins would be a professional judgement call. Without a face to face assessment of the problem we wouldn't really be able to say.

The bottom line in all cases like this is that if you are not completely satisfied with the first opinion you receive, seek another. It would be hard to believe that there is only one acupuncture provider in your area, and we would always suggest that unless someone felt perfectly

Q:  I am 71 years old man.At present I have two lungs problems, emphysema brochieatasis since five years. Before these problems I got tueberculosis which was cured with one year treatment with allopathic medicines..I want to know if my dieases are treatable with acupuncture.

A: We would have to be honest and say that although anything is treatable with traditional acupuncture, in the sense that we aim to restore balance to the body's energies and maximise the performance of the whole system, the more precise use of the word 'treat' meaning have a confident expectation of positive results would not apply. The combination of the TB and the bronchiectasis have probably permanently affected your ability to gather the oxygen you need, and we have never seen any studies which suggest that using acupuncture treatment could improve this exchange or reverse any physical deterioration which has taken place.

Obviously if you search the internet you may well find case studies where someone will claim that they have used acupuncture to great effect, but in general these are usually in cases where the problem is relatively fresh and has not caused too much permanent damage.

That said, one of the consequences of a part of the system being affected is that the imbalances ripple through the whole system, and people can often feel very much under the weather in areas where the problem does not directly sit. Because we believe that body mind and spirit are all interconnected physical problems can often lead to mental or emotional issues like anxiety or worry, and we do often treat people with problems which aren't going to get better to great effect. Many of us have helped to improve the quality of life for people with Parkinsons or MS, and from that perspective it may well be worth considering treatment.

What we invariably recommend is that you visit a practitioner for an informal assessment of what may be possible. The chances of an improvement in what has been lost are very small, so if anyone makes large claims for what they can do you should be careful. A responsible practitioner will always give you an honest answer so that you can make a properly informed choice about how to proceed.

Q:I have had three session and I think things are improving but I cannot bare the needle at the colon 4 point. The depth of the ache when it goes in is dreadful and my anxiety levels increase. The practitioner says he has never known someone with such sensitivity. I suffer with a degree of anxiety and depression, maybe this has something to do with it. Should I continue with the acupuncture?

A:  If you feel that things are improving they probably are. A wise practitioner once said to us that in order for change to be noticeable it has to be quite considerable, so this sounds encouraging. The important point to stress is that in the treatment room you have a greater degree of control than perhaps you realise. Treatment can only happen with your consent, and if you don't like a particular point, then you can simply ask the practitioner not to use it. This expert used to tell his practitioner not to needle a point on the base of the foot.

The wonderful thing about traditional acupuncture is that we are treating the person, not simply the problem, so there are no exact prescriptions for treating specific conditions. The fact that we are treating the whole system means that we are able to address systemic problems in several ways. Sometimes we have no choice. If someone has had cancerous lymph nodes removed we aren't allowed to needle the limb below the affected area, so that means we have to be creative in how we work, and one of our colleagues, Beverley de Valois, has undertaken some fascinating research to show that you can achieve just as good results from elsewhere on the body.

Even when it comes to using the same points, it is possible to make life a great deal easier for the patient. A point can be needled to less depth, manipulated less vigorously or even needled with a finer needle, all of which can greatly reduce the impact. The dull aching feeling, called 'deqi' in traditional acupuncture, is believed to be a requisite in mainstream Chinese styles but completely avoided in many Japanese styles. A practitioner usually has the versatility to suit the needs of the patient.

The best advice we can give is that you discuss this with your practitioner and ask them what they can do to take away the anxiety you are feeling. Our advice if they say that they can't is to decide whether the short term nature of the discomfort is offset by the gains. If the discomfort is going to stop you having a treatment that works, then you'd be better off finding someone who worked in a way you could get on with. We strongly suspect, though, that your current practitioner will find a way around the problem.

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