Q:  I had an acupuncture session to help with my lower back pain and when the needles were inserted into my lower back my bum area I had a spasm in my leg. I also had pain in the other side where the other needle was all the rest seems to be fine. When I spoke to the practitioner he said this was normal as he had use larger Needles. It has now been over two weeks and I’m still suffering from pain at the side of the needle insertion and also from shooting pains and pins and needles especially in the side where the spasm occurred. Please help me is this normal as I have used acupuncture as treatment for my ME and migratory arthritis previously and have never experienced this.

 

A: We would hesitate to use the word 'normal' for anything which a patient might experience which is unpleasant, but adverse effects can happen after treatment. The vast majority are transient and have disappeared within 24 - 48 hours, but some can linger a little longer.

 This can particularly be the case when someone is using a slightly heavier gauge needle and inserting the needles quite deeply. The two go hand in hand; although it is possible to insert a fine needle to a considerable depth it is much more usual to use a slightly thicker needle to ensure that the tip is not diverted and twisted out of true. This does mean, unfortunately, that this can sometimes cause small bruises deep within the tissue but not necessarily visible at the skin surface. If these bruises are near to the passage of nerves there can be some impingement. This can generate sharp pains or even pins and needles. Such bruising can take a couple of weeks to disperse during which time there may be intermittent odd symptoms.

If this does persist, however, then it would be wise to make an appointment to see your GP just to ensure that everything is OK. The chances of something serious having happened are quite remote; acupuncture remains one of the safest modalities in use. It may be worth eliminating other possibilities, though, and a visit to the GP will undoubtedly provide reassurance that this is nothing more than a transient adverse event.

 We are sorry to hear that this has happened, and hope that it has not discouraged you from further treatment. We are confident that your practitioner will be able to ensure by using lighter gauge needles, shallower insertions and less manipulation that there is no recurrence of such unpleasant symptoms.

Q:  A practitioner performed acupuncture treatment on me and inserted a needle on the bottom of my left foot along with other points. I felt some pressure when inserting the needles, but it wasn't too painful. When the needle was pulled out I felt intense pain. The next day, it wasn't quite as painful and I saw a very light bruise on the bottom of my foot. The pain persisted for the week and it was a mild pain and usually comes on when I walk. It was only that particular point that is still painful. I told the practitioner on the next appointment a week after the initial treatment and he told me that its normal for that point to feel discomfort and he didn't seem too concerned. Now its been 11 days, and the mild pain is still there without signs of improvement but the light bruise went away.

I don't suspect any malpractice, but was wondering if this is normal and should I be concerned with anything? Would this mild pain go away on its own? I'm concerned if it could be something more serious like a blood clot, damaged nerve or a damaged tendon as a result of the acupuncture.

A: We think that the advice your practitioner gave you is correct, and that while this seems to have taken a little longer than similar bruising to resolve it will eventually dissipate. It may well be that while the visible evidence of bruising has gone there may still be some deeper bruising which has consolidated and which is impinging a local nerve. This would mean that any weightbearing would be likely to generate a reaction.

 

However, just because serious adverse events are very rare does not mean that they do not happen, and so if the problem persists more than two or three weeks that may well be a good reason to have further investigations. We think it highly unlikely that there has been any permanent damage to nerves because if the practitioner had hit a nerve on the foot you would have known all about it. A blood clot sounds dramatic, but that is all that deep bruising is and it isn't likely to travel from the area. Tendon or ligament damage is possible, but our experience has been that if there are reports of tendon damage the point where they are caused is painful at the moment of insertion. In short, if the problem didn't resolve quietly over the next few days we would be puzzled!

You can discount bits of needle. The standard of needle manufacture has improve dramatically in the last twenty years, and the fact that all needles are now used only once and then thrown away in the sharps box means that broken needles are almost unheard of. The principle cause of what even then was a rare event was the constant autoclaving to sterilise a used needle which made the steel brittle. As we said, now a thing of the past.

 We confidently expect this pain to diminish and go away within the week, but if it does remain into a third week we would certainly recommend that you let your GP have a look to see what may be going on.

What you report is a little unusual but not unknown. We have come across patients who have been treated for several sessions and only then shown a reaction to needles. Sometimes there is an obvious cause - change of needles, slightly deeper insertion in muscular areas - but most often it is an unpredictable reaction. The only concern would be if the blister/bite like bumps were a potential source of infection if they became open, or if they increased in severity. At this point a practitioner might just refer on to a GP for an onward referral to a dermatologist. In the vast majority of cases, however, this tends to be a short-lived phenomenon.

The other issue to consider is whether the reaction is not a physical one but a sign of some kind of energetic release. It is very much a part of Chinese medicine theory that some of the physical problems which affect the body are the result of pathogens entering the body or pathogens which have built up in the superficial tissues because of blockage or excess. When treatment 'bites' this can sometimes cause the skin and superficial tissue to become quite reactive, as well as in some cases generating rashes and areas of heat. If this is a treatment reaction it will be short-lived; the majority of what we call adverse events are transient and minor.

The best thing to do is to ask your practitioner if there has been any change of equipment or style from the first to the second session, and if so revert to the former. If not, then it is simply a matter of keeping an eye on the small bumps to ensure that they recede as swiftly as they came. We have come across patients in whom this is a benign and continuing reaction to treatment, and as long as it is managed with common sense there won't be a problem.

It is not unusual for people to experience a slight return of some earlier symptoms when they begin acupuncture treatment. This is more often the case with long standing chronic problems like migraine or skin disorders, and we always warn new patients that it is possible they may experience a slight return, sometimes quite extreme, of problems which they may have had many years before. Indeed, in some other similar professions this is known as the law of cure, a return of earlier disorders in reverse chronological order.

The energetic reasons for this are quite complex, and not all practitioners agree on the exact causation. Most take the view, though, especially with traumatic injury, that when it happens it allows some form of disruption to travel into the system and become dormant within the body, so that when the body starts to heal it is then expelled in a similar way to the way it was experienced when it happened. Chinese medicine abounds with expressions like 'releasing the interior' or 'expelling a pathogen' and such like, and they all carry a sense of kicking things out of the system.If this is the case for you, then it is a very heartening response, especially if the process also gets rid of any residual tendency to fibromyalgia at the same time. However, when people get these kinds of reactions we are always careful not to be blase and assume that it is a positive outcome. The key element of a 'good' return of symptoms is that they are usually short lived. If the symptoms return for an extended period of time, then they need to be looked at carefully, especially if they were associated with an accident less than a month ago. These may still be a response to what happened then, and it would be remiss of a practitioner not to point someone back to their GP if the problem persisted for a week or more.Hopefully by the time you read this the pains will have subsided and gone, but if they continue it would be worthwhile to contact your practitioner to discuss what to do and to arrange an appointment with your doctor as a precaution.

This is an interesting question and comes hot on the heels of one answered earlier today about whether a certain type of ear piercing could have an effect on migraines as a form of acupuncture. The answer to this question was 'not really', and at first glance we would have to say that the same sort of overall logic applies in your case - there are unlikely to be unwanted acupuncture-type treatments caused by the insertion of hypodermic needles. Insofar as this is extremely unlikely to happen we wouldn't really consider it necessary to isolate 'safe areas' for someone.

Indeed, one of the main problems which bedevils attempts to test whether acupuncture works by the use of what is called 'sham' acupuncture points, i.e. places not recognised in classical texts, is that from an energetic point of view there aren't lines of points traversing a kind of inert space. What you really have are places where the energy is very lively and contactable, the points, and areas where the energy is not quite so active. This means that a needle off piste, as it were, is still going to have an effect. In that sense it means that there is no neutral place to stick a hypodermic.There is a great deal more that we could say about intention and technique - it isn't just a matter of finding a specific place and putting a needle in - but the bottom line is that we would have serious doubts that you could be self-treating by accident in giving yourself injections. However, if you wanted to play very safe there are innumerable charts of acupuncture points on the internet showing the flows of the four main channels through the abdomen. It should be fairly straightforward to identify area where the energy is less focused. If it feels more reassuring to inject here, then we can see no harm in so doing.