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134 questions

Q:  i had an acupuncture treatment yesterday,the second time by the same,experieced practicioner. I have had problems with my sacro-iliac and L5-S1,but all is well now and  the acupuncture was to aid healing. However,this morning,while still asleep I tried to move on my left side to sleep,but even in my dream state felt the world start tilting around. I woke up and tried again ,but the same thing happened. I can sit and stand straight ,but as soon as I lean left or right on my side I start losing the balance and would maybe faint if I kept at it. Is this normal? I have had acupunture before many times, but never with this sort of result. According to the acupuncturist I am very receptive to it and felt absolutely wiped out last night so I thought rest was the best thing.  I did have a slight stomach upset 2 days ago, but had eaten before and after the treatment so didn't think that would be the reason for this extreme tiredness and now this strange dizziness.  Any advice would be appreciated as I am a little worried about this.

This is an unusual reaction, especially in someone who has had acupuncture many times before. The chances that it is a physical problem caused by the treatment itself are very slim; acupuncture has a remarkably good safety record, even in the hands of the poorly trained, and unless someone sticks a needle in a vital organ or vessel, there is very little chance that physical harm will happen. If this is the case it is usually immediately noticeable.

There is always a slim chance that there may be an energetic effect which is causing this. The kind of vertigo/dizziness symptoms which you have can be caused by a number of imbalances within the system, and it would not be impossible that releasing a blockage in the system could unearth a secondary blockage further down the line which generated this symptom. It would be unusual, but not impossible. The person best placed to help you with this is the practitioner himself or herself. He or she will know exactly what they did, and also be familiar with your energetic balance and if there is a chance that it is a treatment-related problem in Chinese medicine terms, they can give you the appropriate advice and perhaps invite you in ahead of your next planned session to address the problem.

The most likely cause, however, is that you have some sort of mild viral condition which happens to have arisen at the same time as the treatment. If so, it may be worth contacting your GP and popping in to see them. Vertigo and dizziness such as you are experiencing can be very disconcerting, and we are not surprised that you are worried. There are a number of medications which can help, as indeed can acupuncture treatment if you want to try to avoid drugs, but it is important when something new and unexplained appears to see your GP as a precaution to eliminate any more worrying conditions.

Our advice, though, would be to call the practitioner first and ask what their view was, and then, if the symptoms persist, to contact the GP for a visit to get their advice. We hope that you manage to regain your normal balance, literally, as soon as possible.

Q:  I have had two sessions of acupuncture for the treatment of whiplash. The first was a short session with just a few needles to test my  responsiveness and led to no problems. The second I had more needles and they were left in for longer. Apart from mild discomfort I had no problems at the time. 3-4 hours later I experienced extreme lightheadness. I did not faint - but felt pretty dreadful. The next day I felt worse and developed aching all over, sore neck and swollen lymph glands in my neck. I am wondering if this is all related to the acupuncture of if it is merely coincidental?!

It is not unknown for people to have the kinds of reactions which you have experienced after their first or second session. While adverse reactions like these are still relatively uncommon, they do tend to happen more often after the first session rather than later sessions, and we surmise that the first session was perhaps overly gentle and not really 'normal' enough to assess the impact of treatment as usually undertaken.

The symptoms themselves are not the usual crop that we might expect. The light-headedness is one of the more frequent side effects, but the other symptoms sound more like the onset of a cold. This can happen if a cold does not fully clear; the Chinese medicine view of colds is that they invade from the outside and when the treatment takes effect the pathogen can be expelled, causing cold like symptoms on the way out. And, of course, it could be coincidental. It is not unknown to be blamed for all sorts of things which happen at around the same time as the treatment, although this expert drew the line at a patient whose car's failure to start was assumed to have been connected!

The key things to look out for are how long this crop of symptoms takes to go away, and whether they recur with the next treatment. The majority of adverse reactions which arise from treatment are described as transient; once the system settles down again the pattern disappears. If the symptoms are still there after three or four days, then it would be wise to contact the practitioner to ask his or her advice. It may be worth considering a doctor's appointment, but unless there is something odd about the presentation, which doesn't sound the case, they are more likely to take a watch and wait approach.

If the same thing happens after your next treatment, then you should definitely discuss with your practitioner the turning down of the volume to ensure that you get the benefits of treatment without any secondary effects. We would assume that 

he or she would already have taken this into account for the next session based on your feedback, but if someone always throws large reactions to treatment it is always worthwhile trying to work out how best to make sure that treatment is gentle and geared to the individual patient. In extreme cases it may even be worth checking whether acupuncture treatment is the best option.

We strongly suspect that the symptoms will have already subsided by the time you read this, and hope that your whiplash is helped by treatment. There are a number of small studies like this one:

which, while not conclusive by any means, make encouraging noises about the benefits of acupuncture treatment.

Q:  I've had one session of acupuncture done for the first time ever. I had the needles pretty much all over the top of my body including the temples.  Two  weeks on and I am now experiencing this pressure on my temples almost like someone is pressing each side with their thumb.  Is this normal, I feel really worried about it as I never had this sensation before.

A:  The first thing to say is: don't panic! Adverse events and injuries after acupuncture treatment are very infrequent, and those which do occur tend to be short-lived and relatively minor. Having said that, to have an off feeling two weeks after treatment is slightly unusual, especially on both sides of the head. 

There are two distinct possibilities. The first is that the practitioner has inserted needles quite deeply in this area and there has been bruising a little way under the skin which has not yet, or may never, appear on the surface of the skin. There are a many blood vessels and nerves travelling in this rather confined area, and slight pressure on any of them can feel very painful, sometimes out of proportion to the amount of tissue damage. The fact that it has appeared on both sides is unusual - bruising is not that common - but if someone is using a fairly heavy needle technique or inserting the needle quite deeply ot is not impossible to generate identical bruises on both sides at once.

The other possibility, and one which we might perhaps consider more likely, is that the treatment has caused a blockage in the flow of energy. From a Chinese medicine perspective pain arises when the flow of energy in the channels is either in excess, deficient or blocked. Needles help to correct these problems, but cam sometimes also cause them unwittingly. If the overall flow is quite weak and is suddenly stimulated it can occasionally reveal where things are blocked 'downstream', as it were. A good analogy is a blocked gutter on a house. When the rain is light, it can just about cope; when the rain is heavy, it overflows.

The best resource that you have in this case is the practitioner him- or her-self. Knowing exactly which points were used, and what the overall balance was, as well as the symptoms which made you seek treatment, will all help to pinpoint exactly what is going on. We are a little surprised that it is a fortnight since the treatment was done, and aren't sure whether you mentioned this when you went back after a week, often the normal interval at the beginning of a course of treatment, or whether you weren't sufficiently reassured by what the practitioner said and still have the pain. In any event, you need to call them to ask their advice. They will almost certainly be as concerned as you that a troublesome symptom like this persists, and will want to ensure that it is dealt with.

It is also worth adding, by the way, that it is not always the case that a symptom has been caused by treatment even when it appears roughly where the needles were inserted. We are always careful to help patients and practitioners getting locked into a 'it's you fault, no it isn't' exchange while a symptom persists. It is far better to seek medical advice by visiting your GP than to argue the toss about whether the acupuncture caused the problem or not. The main aim is to understand what is happening and deal with it first; discussions about causes can come later when it is sorted. If the symptom carries on much longer a short trip to your GP may be the best idea.

Q: As a result of aucpuncture treatment, I have been left with a large sore or infection on my right leg. Is this temporary and how should it be treated?

A:  There are a number of transient adverse effects from treatment which one could classify as 'normal', such as mild headaches or feeling drowsy, but sores and infections are definitely not. You should see your GP as soon as is practicable to assess what kind of sore/infection you have and to get medical treatment for it.

At this distance we have no way of knowing whether or not the acupuncture was the direct cause. Generally speaking the advent of single use disposable sterile needles in 1999  put an end to any remote possibility of cross-infection from patient to patient, and the only way in which a needle could cause infection would be improper use by the practitioner, as for example in touching the shaft of the needle before insertion (again since the advent of sterile guide tubes virtually unheard of) or more likely from the needle pushing bacteria from the skin surface into deeper layers of tissue. The problem may not always manifest where the needles were inserted. although if this does happen, again a rare event, then the primary infection is usually at the needles site.

However, at this stage the priority is getting the problem properly diagnosed and treated. The options after that are numerous. We usually recommend that patients contact their practitioner for advice and support, but we have to be realistic and know that many practitioners will become quite defensive, which is not the outcome we would like to see. Unless the practitioner's technique is potentially at fault, in which case they may have good reason to be defensive, then accidents and adverse outcomes occasionally happen even in a practice as safe as traditional acupuncture. That is why responsible practitioners belong to sound professional associations which often, like the BAcC, provide a very high standard of insurance cover to ensure that patients who suffer detriment are properly covered. Your practitioner can almost certainly direct you to their insurers, as well as to their professional body if you feel that the standards of hygiene and practice fell below what you would expect.

In the first instance, though, you need to see your GP for conventional treatment.

Q: I'm now 5 weeks into my course for migraines and all been going well. However I still have pain  from my treatment 8 days ago. It's just above my
temple and makes me wince when washing or brushing hair etc. what is this and what should I do ? 

A:  The most frequent cause of the pain which you describe is that a needle has caused a small bruise beneath the surface of the skin which has not, and may never, be visible at the skin surface. You would certainly experience discomfort if this proved to be the case, and it might last for up to a couple of weeks. The bruising may cause a slight impingement of a nerve when pressure is applied.

The other slightly more remote possibility is that the needle used has just caught a small nerve caused minor damage. This would be more likely to cause more random occurrences of discomfort rather than simply as a reaction to pressure.

In any event, if the problem continues beyond a second week then it is worth investigating further, and you may well want to arrange a visit to your GP. At this stage they would probably do no more than keep an eye on what is happening, but it would at least place you within the system for potential referral on.

The other thing to do, of course, is to discuss this with your practitioner. They will know exactly what they did, where they placed needles and to what depth, and can see if the problem is related to treatment. It very likely is, but we have seen occasions where a problem has randomly arisen near where acupuncture was administered and arguments have kicked off about whether it was caused by treatment while the problem itself was not being properly addressed. Our view is that it is best to establish and deal with what is happening first before starting to apportion responsibility.

Judging by what you say, though, it is most likely to be a short term transient adverse effect of the treatment and will clear of its own accord within a few more days. Hopefully the treatment of your migraines will continue to show improvements, too; we certainly hope so.

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