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134 questions

Q: For the last 3 yrs or so I have had acupuncture, for carpal tunnel issues, from my physiotherapist. It's been a very effective. She is on maternity leave and has a replacement.  I suspect that the replacement has made an error and left a needle in my arm. I have had pain in my arm for 6 weeks since my last visit. Is there a risk to my health from pieces of needle  Do I need to take measures to have it removed? It maybe that nothing is in there and this is just a side effect of poor treatment.

The first and most important thing to say is that if you believe that a needle or piece of needle is stuck in your arm, you need to have the arm X-rayed as a matter of urgency. We would be very surprised if this was the case, given that the standard of needle manufacture is very high these days and given that it would require a negligently careless practitioner to insert a whole needle into an arm or even for a whole needle to be accidentally embedded and not checked in the count of needles used. However, stranger things have happened, and an X-ray will very rapidly establish whether there is something physically stuck there.

A: The risk from a piece of broken needle in the body is minimal. The materials themselves are not toxic, although a very small number of people are allergic to the needles. The only risk would be if the piece of metal migrated by entering a blood vessel large enough to transport it around the body. This is highly unlikely, especially when you bear in mind the kinds of stories ex-servicemen tell of pieces of shrapnel which have been stuck in the same place for 50 years. If there were to be a piece of needle stuck in you, though, it would require minor surgery, probably under local anaethetic, to remove it.

The more likely outcome is that the treatment has nicked a very small blood vessel and caused a minor haematoma/bruise under the skin surface but adjacent to the nerves travelling in the area. The internal 'scab' that this may form will press on surrounding tissue for as long as it takes to heal, and this can be anything from one to six weeks. Carpal tunnel syndrome already involves considerable pressure on the nerves and blood vessels travelling to the wrist, and anything which adds to the compression in the area is undoubtedly going to exacerbate matters. However, once again, we have to say that if a problem continues to aggravate after this length of time, there has to come a point where you have to see your GP and start to arrange the investigations necessary to determine what is going on.

In all of this, your practitioner should be a resource to you. The good practitioner will be just as concerned as you about the fact that you have experienced six weeks of discomfort, and will almost certainly be as keen as you are to find out exactly what is gping on. We think you would be well advised to contact either the practitioner or your GP within the next week or so to get to the bottom of what is happening here.

Q:  Can I please ask if it is appropriate to tear off a piece of the paper roll I have laid on whilst having an acupuncture session and use it to stop blood flow when an acupuncture needle has been removed  Could I also ask if it is normal to have a lot of blood loss when a needle is removed ? I had an acupuncture session and when I was about to get up I had pain at the top of my neck ( where it joins my skull ) and mentioned that I could feel a lump. When I stood up the HCA said that there was blood flowing . . . it went down my neck and started coming onto my front before it was stopped. I have had ( and still have ) a throbbing sensation where the needle was placed and  in the surrounding area.   It is sensitive to  touch and I have consequently had a headache ever since. This being the case I wanted to ask for guidance on if I should continue with acupuncture treatment, given the outcome of my fourth session.?

A: The answer to your first question is 'no', definitely not. The BAcC's Code says:

If you draw blood, you should apply light pressure with clean cotton wool or a clean swab, avoiding contact with the patient's body fluids, and dispose of the cotton wool or swab immediately in a sharps container or clinical waste bag.

Blood loss after the removal of a needle is not common. There are a number of factors which can influence whether there is a small spot of blood - location of needle, time the needles was left in place - on removal of a needle, but a blood flow of the kind you describe is very rare. It sounds as though the practitioner has accidentally needled a slightly larger blood vessel, and that the lump is almost certainly a bruise which has formed at the site. This will probably be slightly tender for a few days until it resolves itself. We are not entirely clear why the headache has occurred. This may be simply because of the inflammation in the area causing a tightening of the muscles, in turn generating a headache, or it may be related to the energetics of the area. Without knowing what style of acupuncture was being used or with what intention it is difficult to say.

There is no doubt in our minds that you should speak to the practitioner involved and alert them to what has happened. Since they will know what they have been trying to achieve, and more critically, how deeply they needled, they will be better placed to advise you. We are aware that some people are uneasy about going back into a situation where they have been injured and do not relish the prospect of a confrontration of the 'look what you did' kind. If this is the case and you do have concerns about what has happened to you it is always a good idea to see a GP for reassurance and advice - trying to see what has happened behind your head is a challenge to say the least.

Whether you have more acupuncture is a moot point. BAcC members, as traditional acupuncturists, have a wide range of choices available to them to needle distally, i.e. away from the area where the problem is manifesting. If the treatment has been administered by a healthcare professional like a physio or osteopath, their training uses much more local treatment, and it may be that you would feel uneasy about being needled again in the same area.

Whoever has given you the treatment we can say with confidence that all UK practitioners belonging to professional associations have proper insurance cover and are accountable to their professional bodies for their standards of practice. If you do not feel that your concerns are adequately addressed you will find the professional associations are both helpful and supportive.

Q:  I had my first acupuncture session for neck and shoulder pain at an NHS Hospital 4 days ago. I felt  dizzy as hadn't eaten so he stopped after 10 minutes . However,  that afternoon I had a shooting pain a few times in my hand then a few twinges behind my eye.  This has past but I now have a recurring pain in the joints just before my fingernails.  Shall i continue my treatment next week ?

A:  We are sorry to hear of your experience. We are not sure whether the practitioner is a BAcC member - in an NHS hospital this is highly unlikely - but we assume not because it is always one of our basic pieces of advice to a first-time patient to make sure that they have eaten something before treatment. In our experience, not eating can lead to light-headedeness and a possible faint. Although we wouldn't want someone to have treatment immediately after a three course dinner, a normal pattern of eating should be enough to ward off any short term adverse effects.

As far as what you have experienced after the treatment is concerned, you need to look at it from two different perspectives. If the acupuncture was undertaken by a physiotherapist or other conventional healthcare professional, the chances are that they would have been looking for trigger points, knots in the muscle, which when needled tend to relax and relieve some of the tension which causes the pain. Western medical acupuncture can be a little more vigorous than traditional Chinese acupuncture, with larger gauge needles and sometimes repeated insertions. Had the practitioner needled into a nerve you would have been very immediately aware; the feeling is unmistakable. What may have happened, though, is that there has been a small bruise formed at the needle site which has impinged on the nerves travelling through the area. This might account for the reactions you have experienced and are continuing to experience. The fact that the initial symptoms were more severe and have abated suggests that if there was internal bruising it is starting to heal.

From a traditional chinese acupuncture perspective it is possible that the treatment has caused some of the blocked energy in that area of the body to move. If the treatment was administered by a traditional practitioner this will have diagnostic significance and they will pay particular attention to what you have to report. This may also be the unintentional consequence of someone using one system of medicine having an effect only recognised by another. There is a point, for example, used in the treatment of tennis elbow which if over-vigourously needled can reduce someone's blood pressure quite dramatically, although the practitioner working with Western Medical Acupuncture would be unaware of this consequence.

On balance, though, this does sound like a minor physical injury caused by the needling itself, and whether or not you decide to have treatment, it is important that you keep your appointment and describe what has happened in great deal to the practitioner. If as is likely the symptoms have continued to abate you would probably benefit from continued treatment. However, the choice remains yours and if you are not reassured by the explanation or worried by the continuing symptoms you can simply decline the treatment which cannot be undertaken without your consent.

Q:  When I had acupuncture  a needle was put in the Li 4 on my hand, I felt pain shoot down my left forefinger. She said it was fine and left it there. The pain continued for several days.   I  emailed the acupuncturist and have made an another appointment . I have  no pain on my straight finger just when moving to the left. Does this sound normal?

A:  We wouldn't want to describe this as normal but it is certainly possible. When this does happen it is usually because the needle has caused some bruising quite deep inside the fleshy area surrounding the point and this may be causing an impingement of the nerves which run down from the wrist. The problem should resolve within two weeks to a month at very latest. If it hasn't by this point then it would be wise to contact your GP and see if you can arrange for a neurological assessment.
 
However, we have a small concern over the fact that the pain is enough to warrant taking ibuprofen. This suggests that it is interfering with your daily life by being triggered by straightforward movements. We would certainly want to examine the area and palpate gently to see what is going on, and we would also want to check that the pain was caused by a physical factor like a bruise and was not a manifestation of an energetic blockage. Unlikely as it sounds this can happen, and a needle or two in the area might well help. Even from a Chinese medicine perspective bruising can be helped considerably by enhancing the flow of energy through an area, although generally speaking most people seem to resort to arnica, either in tablet form or as a gel to run on. This usually seems to help, even though the clinical evidence for its effectivesness remains sketchy.
 
Your best resource, though, is your practitioner. She will be able to offer the best advice based on what she can see and feel, and the problem should resolve relatively quickly.
 
  

Q:  My friend got acupuncture yesterday and in the evening after the session felt extremely overwhelmed and was upset and crying. She is being treated for anxiety and general overwork/stress over the last 4 years at least. She said it was painful when the needles wherein her. This is not her first session. Is this a normal reaction, and if so, is it a good sign?

A:  The first and most important thing to say is that serious and continuing adverse effects from acupuncture treatment are very rare. When things do happen after treatment, be they unusual headaches, a slight feeling of dizziness, extreme tiredness after the first session, and occasionally a significant emotional release, many practitioners will take this as a very positive sign that the balance of the system is being restored. The accepted belief is that when the body is not in balance it retains areas of disturbance or blockages, and once balance begins to be restored the disturbances surface as short term, and sometimes quite unpleasant, effects.

When these are physical, we tend to keep a close eye on what happens. The usual extent of a disturbance like this is 24-48 hours. Anything more than that we would look carefully at other possibilities. One is that the treatment has uncovered another blockage which wasn't noticeable to begin with and this is now generating symptoms. It's only when the rain falls that you find out that your gutters are blocked, and in the same way, when someone is very depleted it is only when the energy flow is much stronger that a pre-existing blockage surfaces as a problem.

The other main issue is that the symptom may not be anything to do with the treatment, and we are very clear with our members that they should not waste time arguing whether acupuncture did or did not cause a symptom but first and foremost ensure that someone gets the treatment they need. There is very often a temptation to succumb to the 'post hoc propter hoc' fallacy, that because something happened after treatment it must have been caused by the treatment. This is often not the case - after all, the practitioners spends one hour of the 168 in a week with a patient, and the patient's life carries on with all its normal complexity around that. However, there are ways and ways of making this point, and if this is not done adeptly, it starts to sound like 'it wasn't my fault' which is often taken as a refusal to admit liability.

In your friend's case it may well be that the treatment has uncovered something which she is now experiencing as an outpouring of a none too pleasant emotion, but if this is the case, then the treatment should be moving her forward, and future treatments will help her to move beyond the feeling of being overwhelmed. It is also possible, however, that there are other factors in life which may also have had an impact. We are certain that her practitioner will explore this with sensitivity when she goes to her next session.

As for the needles being quite painful, there is often a correlation between how people experience the needles and how settled in themselves they feel, and although this is a comment based on experience rather than research, people with anxiety issues are often highly reactive to the physical impact of being needled. However, the fact that she experienced these particular needles as more painful than ones she has had previously, and the effect being much more tangible, there is just a possibility that the treatment may have been too strong for her. We do find a small number of patients for whom too many needles or too vigorous a reaction can wobble them for a few days, and an experienced practitioner will know to reduce the number of needles and strength of needling if the feedback makes them suspect that a person is sensitive in this fashion.

All of these issues are worth discussing with the practitioner, and we are often surprised that people feel any diffidence at all about confronting practitioners with these sorts of questions. Our members are perfectly happy to go through all aspects of treatment with their patients, and believe that good communication is essential to good treatment. 

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