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134 questions

Q: I've had some recent obvious mild trauma to my lower back resulting in 4 weeks of pain, reduced mobility and marked disinclination to stand for any length of time. The context for this is that 30 years ago I underwent discectomy at L4.   I have been mercifully pain free for the majority of the intervening years. In an attempt to expedite recovery I saw a registered chiropractor yesterday who augmented manipulation with three acupuncture needles: two into my right upper buttock area [pain free] and one directly into the centre of my surgical scar. The pain as the needle went in was immediate, sudden and shocking. My right leg went 'heavy' and horribly achey and the needle was withdrawn immediately. Today, with utter dejection and a feeling that I've made a huge mistake, all vestiges of recovery have gone. Walking has become agony, sciatic pain courses through my hip, knee and ankle and toes, standing up requires assistance and my usual excellent core stability has gone. I'd love some reassurance that this is a transient reaction to one nerve-irritating needle in tandem with system-jolting chiropractic manipulation and not signs that far from having recovery on the horizon I now face months of salary-impacting sick leave and rehabilitation. For the record,

 

We are very sorry to hear of your experience, and very much hope that by the time you read this the severity of the symptoms has subsided.

We often warn patients with back and neck problems  that the days following treatment can see a return to some quite painful symptoms. We understand that osteopaths and chiropractors tend to do the same,. From our perspective this is all about the body re-arranging itself into better shape, and the consequential change in position of the muscles and tendons which have become used to working in an incorrect way. These effects are always transient, though, and within a couple of days the patient often begins to see real improvement.

However, what you have experienced sounds like a very different level of experience, and we are somewhat concerned. At the level at which the needle was inserted it is highly unlikely that there has been any involvement of the spinal cord itself. We tend to avoid needling into scar tissue, and this article from the equivalent US acupuncture organisation's magazine

http://www.acupuncturetoday.com/mpacms/at/article.php?id=27842

describes what many traditional practitioners do needling just off the perimeter of the scar. Although it is not backed up by any significant research there is a common perception amongst many fields of complementary therapists that scar tissue can lock in both physical and emotional reactions which were current at the time of the operation. The argument is often advanced that treating the scar can sometimes 're-awaken' this sort of reaction. Although we cannot show any published evidence to support this view there have been occasions in clinic where treating scars has had this effect of a kind of 'release', often to good effect.

More likely, however, given the manipulation and other treatment applied is that the combined effect has been to change the physical structure slightly and as a consequence cause some localised inflammation which in turn in impinging a nerve or nerves. With anti-inflammatory medication this should settle down quite quickly.

That said, these are powerful and disturbing symptoms, and if they have persisted until you read this you need to be seeking medical advice sooner rather than later. There is a possibility that the treatment may have caused the displacement or rupture of another disc, and although it will not do any further harm if left untreated for a few days there is no doubt that earlier intervention could make recovery quicker.

It is also important that the chiropractor is alerted to what has happened and is also asked to provide some sort of explanation and advice. He or she will have a much better knowledge of the specifics of your case than we have at arm's length, and your experience may well make sense within the paradigm of their treatment.

Q: I had a cervical myelopathy in 2002. I am now undergoing a course of acupuncture as my neck & arms are extremely painful due to osteo arthritis. Will the fusion be damaged by the acupuncture needles?

 

A:  There is no evidence of fusions being indirectly affected by the use of acupuncture. We keep a very close eye on all of the adverse events reported after acupuncture treatment, and we have never come across an account of any disruption which has been caused. There is also nothing we have ever come across to suggest that an overall healing effect would impact on a surgically created outcome like a fusion and lessen its stability.

The only caution which we would advise in our members is that great care be taken if needling in the affected area. There are a number of acupuncture points over the cervical spine and narrowly to each side, a number of which might be used in the treatment of neck and shoulder problems. If the structure of the neck has been at all altered, then a practitioner would need to be careful in case the location of a point is now slightly shifted. Having said that, all points used on the upper back and neck are needled with great care, to superficial depths and usually obliquely to avoid problems with the deep structures of the body and to stay away from the spine.

If you have concerns about the treatment it is best to be as open as possible with your practitioner. There are many ways of treating a problem, and a practitioner can use what are called distal points, points well away from the affected area, to great effect. This is commonplace, especially in patients with areas which cannot be needled (as,for example, in post-mastectomy patients whose lymph nodes have been stripped and whose arms beneath the stripped nodes cannot be needled).


Q: My acupuncturist placed a Chinese herbal plaster on my shoulder after treatment. I was advised to remove and replace it once a day after my shower. On the 2nd day the plaster removed all the skin on my shoulder which appeared to have burnt and blistered. The packaging I received was all Chinese. On further investigation it appears these plasters should not be applied for more than 12 hours. My question is do I have any recourse as my acupuncturist admits a. They have seen this before with another patient and b. What was supposed to provide pain relief resulted in extended and additional pain.

 

A:You certainly do have recourse in a number of ways:

1) if you have suffered injury as a consequence of treatment, then all BAcC members, and all reputable acupuncturists, have high levels of insurance cover to protect the general public. If you wish to make an insurance claim then all you have to do is to write to the practitioner concerned outlining your case and asking that they forward the letter to their professional insurers.

2) if the practitioner has not given proper instructions about the use of the plasters, or has made a mistake in giving instructions, or has fallen below the standards expected of a professional practitioner you may have a case about their professional conduct. If the practitioner belongs to the BAcC, then the details for making a complaint are clearly spelled out on the website. If the practitioner belongs to another professional association, then it is almost certain that this will too have details of how to make a complaint. Most associations are either accredited with or seeking accreditation with the Professional Standards Authority, and a condition of accreditation is that the public has clear details of what they can do if treatment fails to meet satisfactory standards.

We are sorry to hear that you have had this experience. It is cold comfort to be told that the practitioner has seen this before, but we had better refrain from further comment out of sensitivity to the fact that an insurance claim or conduct case, or both, may arise from this matter.

Q: I went to an acupuncturist for treatment for anxiety/panic attacks. The  first 3 treatments were fine & needles were put into my back,legs & feet.  However on the 4th visit a needle was put into the inner side of my left wrist & the pain was instant & excruciating. I really thought that there would have been blood spurting every where which of course there wasn't. The pain now radiates up into my hand,little finger & the next one,.  I cam't bend these fingers without pain & it is not improving.  This happened about 4-5 months ago. 

A:  We think the first and most sensible advice is to see your GP and possibly get a referral to a neurologist. At very least you may need to have a scan of the wrist. Four or five months is far too long to be suffering from a transient adverse effect, and it suggests something more serious has occurred.

Accidents from needle insertion in acupuncture are quite rare, and the adverse effects are mostly transient. It is not uncommon for there to be a small bruise where a needle has been inserted, and especially in the wrist, where there are any number of blood vessels and nerves traversing a narrow channel, it is sometimes possible to hit a nerve. Here again, the effect is usually short-lived, no more than 48 hours. Where this could change would be if the needle had done physical damage to the nerve, or where there has been some quite deep bruising to the tissue which has created a small blood clot which has 'solidified' and is now impinging the nerve. 

A great deal depends diagnostically on whether the pain is constant, or what specific movements make the pain appear or get worse. This is why you need to see a GP or a specialist because they will have the training to make this kind of determination, and then be able to point you to the right treatment.

Sometimes when we answer questions about adverse effects we open up the possibility that the problem may not be the result of treatment, and we do so not to deflect responsibility but because we have seen pointless arguments about what caused something while it remained untreated. In your case, however, it seems fairly clear that it is a treatment related injury, but from your description does not appear to have been the result of negligent practice. There are many well-used points in that area, and always the chance that a minor accident, however rare, may happen. It may be cold comfort to point this out at this stage, but BAcC members, and all other practitioners of whom we are aware, have very good insurance for the protection of the public in cases like this. Should you at some point wish to make a claim for compensation all you have to do is write to the practitioner outlining your problem and ask them to forward the letter to their professional insurers.

However, we are sure that this is the last of your concerns at the moment, and that finding out what has gone wrong is the paramount issue. As we said at the top of the reply your first port of call is your GP. If it is of any reassurance we have seen two or three similar cases over the last twenty years where it has taken up to six months for a problem to resolve, but resolve they all did, so we are sure that this is not likely to be a permanent situation.

 

Q:  I had a C4 cervical corporectomy and anterior column reconstruction C3-C5 in April 2014. This initially gave me better movement than I had been experiencing following a broken and dislocated neck in 1999. However,  since then it has become increasingly stiff and so I have been for 2 sessions of physiotherapy so far and the physio has given me acupuncture putting 2 needles into the bottom part of the neck, 2 below the back of the skull and 2 in my hands. He warned me that I would be a bit knocked out by this and I was. The second time I felt hung-over all the next day. Please can you tell me if this is a suitable use of acupuncture, the right application and if there is any danger in view of the type of operation. 

 

A:  Strange as it may seem, we are not necessarily the best people to ask!

The reason we say this is that we are the largest professional body representing traditional acupuncturists in the UK, but there is a considerably larger number of physios in the special interest group for acupuncture within the physiotherapy profession, the Acupuncture Association of Chartered Physiotherapists, who use a different form of acupuncture within their scope of practice. This is widely referred to as Western Medical Acupuncture, and while it can involve using the same points that we might use, it is very different in its conceptual basis and in its techniques. The needles are often heavier gauge and manipulated a great deal more vigorously than we might do, and the main underlying principles are derived from conventional medicine. Hence trigger point work, segmental acupuncture and neuro-physiological treatments are all based on western medical concepts of neurological effect and muscle presentation.

There is no doubt that this kind of treatment can have some quite dramatic effects, such as you have experienced, but the rationale for the treatment is well-founded, and the research underpinning what they do is considerable. Of course, the wider range of traditional acupuncture and its more systemic approach to what is happening in the body is very attractive to people who have seen the benefits that musculo-skeletal work can have, and many physios extend their practice by looking at Chinese medicine. Theoretically, however, they are supposed to remain within their primary scope of practice and only used treatments for which an adequate evidence base exists.

There should be no danger at all. Physios are trained to very standards in anatomy, physiology and pathology and should all be perfectly aware of the cautions in what they are doing, most of which in the head and neck area are good, simple common sense. You should have no concerns on this front. However, if you do have concerns your practitioner himself will be delighted, we are sure, to provide sufficient background to be able to reassure you of the value of his treatment and its safety.

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