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Q:  I had my first session of acupuncture on Thursday morning, Straight after it finished I got a dull ache in my lower back where I had the treatment.  It just got worse to the point I now can't stand up straight as the pain is horrendous, no painkillers are helping, is this normal and what can I do?

A:  We are sorry that this reply will have taken a few days to reach you - we channel all our responses through a single portal to keep track of replies and this only operates Tuesday to Thursday.

We are sorry to hear that you are in such great discomfort. We are aware that there are times when treating back and neck problems where they can become very much exacerbated when treatment starts, to the extent that it feels as though something terrible has happened. This is never the case; acupuncture remains one of the safest healthcare interventions in use in the UK. It is generally thought, however, that the treatment encourages the body back into better shape and this can cause discomfort or even inflammation when ligaments and tendons are asked to work as they should and not in the often mechanically disadvantageous way they have been doing.  This is by means universally agreed by all practitioners, but whatever the reason if it is a reaction to treatment the chances are that the effects will have worn off by the time you read this and you will be seeing an improvement.

If the pains are a direct result of the treatment this may be because one of the needles has caused minor bruising in the area which may be causing some nerve irritation. This too should subside very quickly.

However, we are concerned that you report that the painkillers are not touching the pain, and in the circumstances if this remains the case when you receive this it might be a good idea to talk to the practitioner and possibly your GP about what is happening. There are two possibilities. First is that there has been some physical damage from the needles, and if so, because accidents can always happen, you need to get this checked immediately. Second is that the pain is not directly related to the treatment but happens to have coincided with it. This is not an attempt to evade responsibility, but we have seen a small number of situations where the arguments have kicked off about whether the treatment did or did not cause the problem while the problem itself has gone untreated. The priority has to be to establish what is causing such pain, and to address it. Causation can be sorted out later.

We hope, though, that by the time you read this the pains will have subsided. The vast majority of side effects from treatment are very short lived, and these themselves are few in number.

Q:  I had acupuncture for the first time a day ago. I am having a stinging pain in my left leg right behind the knee where one needle was put in. It wasn't put in deep. It feels like a bug has stung me. There is no bruise or swelling or redness. Just this slight stinging pain but it is bothering me.

A:  We are sorry to hear of your experience.

The fact that there is no external sign in the form of a bruise, swelling or redness suggests that the needle has caused a small amount of internal bruising which is impinging a nerve slightly as you move. It is quite possible that by the time you receive this reply that there will be some external sign, but in any event it is equally likely that the symptom has already started to disappear. 

The vast majority of what are called transient adverse events from acupuncture treatment disappear within the first 48 hours after treatment, or in the cases of minor bruises sometimes a little longer. Serious adverse events are rare and usually pretty unmistakeable. As far as anything material happening, like a piece of needle breaking off, you can discount this as a possibility. The manufacture of needles, together with the fact that they are used only once and then discarded, has removed any dangers of breakage. Breakages were always rare but when a needle was  re-used (and we are talking pre-2000) it was the heating of the sterilisation process which could make the metal brittle. Since this is no longer done the risk has all but vanished. 

If the stinging sensation does continue it would be a good idea to speak to your practitioner to alert then to what has happened to and see what advice they can offer based on what they know they have done. You could also consider visiting your GP, but they may tell you that a small internal bruise could take a week or two to break down, and only start to investigate more thoroughly then if the symptom persists or if on the short term it becomes more pronounced.

We hope that by the time you read this the stinging has stopped, and hope too that this has not put you off further treatment.


Q:  I have had accupuncture and cupping and electrodes on my back for whiplash and headaches. Second time yesterday and last night a large lump appeared on back of neck right side and severe headache all over

A: Without being able to see the problem at first hand it is very difficult to say what might be happening here. Each of the three types of treatment can generate what are called 'transient adverse events', i.e small things like bruises or lumps which generally persist for no more than 48 hours. Of the three, cupping has the most obvious potential for creating a bump if it causes blistering of the skin. On the neck, however, it may be less likely that you had cups in place (although we are not quite sure where on the neck you mean) and the next most likely problem is a small bruise beneath the surface of the skin.

Whether this is related to the headache is difficult to say. Although transient adverse events are rare, they can lead to secondary problems, especially if a lump or bump presses on a nerve. This may not be the reason, though. Amongst the more frequent of the few transient advents we see headaches are quite common, especially where we have been trying to reinstate the flow of energy through an area like the neck which may have an impact on the channels of energy on the head.

However, this is all speculation. The best person to speak to in the first place is the practitioner who gave you the treatment. He or she will know exactly what they did and where, and can perhaps make sense of the fact that you have a lump where you describe. We hope that they are not defensive about this; accidents happen even in very safe professions like ours, and finding out what has happened and sorting it out is more important that arguing about liability. If this does not provide an answer and the problem persists for more than 48 hours it is perhaps worth making an appointment with your GP to be sure that there is nothing requiring treatment.

Generally speaking, problems like this do tend to resolve quickly, often before someone has had a reply from us, and we hope that this is the case here. The important thing, though, is to gather as much information as you can so that anyone you talk to can make a rapid judgement about what might be happening.

Q:  I had acupuncture today. The practitioner said he wanted to treat metal element and I specifically told him that was not the right thing for me. He went against my wishes and did it anyway and since I have been experiencing terrible symptoms from excessive confusion, dizziness, feeling sick, off balance and feel like all the energy from my body has been brought into my head. I feel worryingly ill. What should I do?  I have of course fired the practitioner as someone who goes against a patients wishes in this way should not be practicing as far as I am concerned. 

A: This is quite a tricky issue. There could be an argument here that by asking the practitioner not to do something, you were effectively withdrawing your consent to treatment. By carrying on in the way that he did he may have been technically in breach of his Code of Ethics. In situations like this, if we come across patients who have specific requests ('don't needle my feet', don't use moxa')  we can discuss with them the reasons why they might not choose to have this kind of treatment but in the end we have to find alternative ways of working with them.

The situation is a little more complex when it involves an aspect of the treatment where some form of diagnostic interpretation is called for. Treating acupuncture students can be something of a trial because they occasionally have a tendency to tell you what needs to be done, and can get quite indignant if you do something different. The bottom line, though, is that someone is paying you to use your skills and experience, and should in theory be left to get on and do what they do best.

However, many patients have now had considerable experience of acupuncture, and many are aware of things that work for them and things that don't. If a patient is reasonably well versed in the system of Chinese medicine they may well have sufficient understanding to be able to say what they can or cannot tolerate. If so, and if the practitioner feels that this is the only appropriate treatment, the only answer left to them would be 'I'm sorry that this is not possible, but in my judgement this is the only appropriate course of action and I would be unhappy to treat and charge you for an alternative treatment which I did not believe was the best possible option for you.' 

We can understand the strength of your feelings about what you consider to be a breach of trust, and we hope that you found another practitioner to help you who can make sense of the symptoms which you now have. This would be necessary to differentiate between those adverse effects which were a part of a process of recovery ('getting worse to get better' as is sometimes said) and adverse effects which may have arisen from incorrect treatment.

It is not our place here to test out responsibility and blame. Each professional body has its mechanisms for investigating what has happened when poor communication has resulted in problems or where a patient may feel that their wishes have been over-ridden. If you need to we are sure that you can find the appropriate conduit to make a formal complaint. We are simply sorry that you have had a poor experience of acupuncture treatment and hope that it has not put you off seeking help with another practitioner.

Q:The Chinese accupuncturist inserted a needle in my forehead and pain shot up into the top of my head like it was travelling in a straight line. is this ok?

A:  It is never OK to feel discomfort when having acupuncture treatment but it is a rather obvious risk from sticking sharp objects into people.

The prosaic answer from a conventional medical point of view was that the needle had hit a superficial nerve, but given what you describe it sounds much more like the kind of reaction we see sometimes when a needle activates a channel or meridian as we call them. These are distinct lines of flow of energy which travel across the body in fixed patterns. When a needle is inserted it can sometimes activate the whole channel, and there are at least five major channels on the forehead which go up and over the head. Needling a point here could well cause a sensation higher up.

If it is a reaction to treatment it will subside within minutes, or occasionally hours if the treatment carries on working. If someone has hit a nerve then the pain may last for a day or two.

It is very important to give feedback to your practitioner about what happened, if they aren't aware already. There is considerable room for adjustment of technique in Chinese medicine, and a practitioner can if need be needle to a lesser depth and also use less manipulation of the needle.

We do find some patients who when needled can tell us exactly where the channel flows across the body, but most do not experience it as a pain. A painful reaction suggests a slightly too vigorous technique for your system.

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