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134 questions

A few days ago I had acupuncture for the first time can you please tell me if it is normal to have swelling & bruising in a particular site that has been treated?

A:  We wouldn't go so far as to say 'normal', but occasionally bruising and swelling at a needle site can happen. This is a relatively infrequent occurrence, and indeed in a major survey we conducted a decade ago there were only seven such instances in over 34,000 treatments.
 
However, what matters is that it has happened to you, and it can't be very pleasant. Generally such bruising and swelling subsides within the first 24/48 hours, but if the area continues to be visibly inflamed after 3 or 4 days it is wise to contact the practitioner for advice. If someone came back to us with what you have and it had persisted for more than a few days we would probably be inclined to advise you to consult your GP.
 
Of course, a great deal depends on where the bruising is. Some areas heal more quickly than others, and your practitioner should have a very clear sense of what you might expect, given the areas treated.
 
We have to say, though, that serious adverse events after treatment are very rare indeed, so there should be no reason to be unduly worried.  
 

Q: I was attending a NHS acupuncturist for an abdominal ache. I had a temporary vertigo episode and mentioned it to him. He suggested inserting a needle adjacent to my left ear, between ear and sideburns.  I am having what I would describe as a pressure like an ache around the area of needle insertion which is tending to cause a slight headache. The discomfort is increased when using a phone on the left side. What could this be? Unfortunately the acupuncturist has now left the NHS practice.

A: We are sorry to hear of your experience. The first thing we have to say, however, is that long term adverse effects from acupuncture are extremely rare. If someone does have a bad reaction to treatment it is usually transient, lasting no more than 24 to 48 hours. Two safety studies conducted a decade ago independently of each other showed the same incidence of adverse effects - 7 in over 30,000 treatments - none of which were enduring. Subsequent studies have shown not dissimilar results.

Two possibilitities come to mind. The first is that the practitioner has caused a slight bruise deep in the tissue near the ear, and that this is putting pressure on the nerves which are traversing the area and causing discomfort. The fact that the discomfort increases when you use the phone suggests that either additional pressure from the phone or your 'phone calling position' exacerbate the problem.

The other possibility is that there has been an energetic reaction which has caused a blockage. You say that you had treatment with a NHS acupuncturist, but this is a zero set, as far as we are aware. We have a very small number of members who are contracted to work within the NHS, but the majority of acupuncture provision within the NHS is offered by GPs, physiotherapists and a small number of nurses. We are not entirely happy with the idea that someone has stuck a needle in to treat vertigo. because treatment within the NHS is usually limited to someone's scope of practice, and to conditions for which there is an accepted evidence base. As far as this latter restriction is concerned it is one with which we are all too familiar, since it restricts very considerably what we can say here, and vertigo is not one of the conditions for which that level of evidence base exists. This suggests to us that the treatment is a formula one, and may not be done with a full understanding of the energetics of the body.

If so, you may need to see someone, such as one of our members, who can advise you whether there is some sort of blockage in the area, and whether more treatment would be able to help you. We are bound to recommend that you discuss your problems with a BAcC member local to you anyway, because our belief is that traditional acupuncture treatment can often make sense of disparate symptoms like these, and offer some relief in a way that conventional medicine cannot.

However, we are fairly sure from what you describe that this is a short-term physical problem caused by local damage resulting from the needling. This should mean that the problem will reduce gradually and disappear. As a precautionary measure, however, you would do well to contact your GP and arrange to have the problem logged and inspected, so that in the event that it does persist beyond six weeks you can then move towards a referral to a neurologist that much quicker

Q: I recently had acupuncture therapy , how long after would I know if it pierced my lungs? Is it a common side effect?

A: The most important thing to start with is that a punctured lung, or pneumothorax as it is technically known, is very rare. We were asked about this by someone conducting research last year, and our full answer is reproduced below.

If you had had treatment and were experiencing a pneumothorax, the first symptoms would appear within 48 hours at the very latest, although probably a great deal quicker, and would almost certainly be a general and diffuse chest pain on the said where the lung had collapsed and shortness of breath. If there has been no significant symptom within 48 hours you can be pretty sure that you are OK.

As we said, this is a rare outcome, and we have only come across reports of four or five cases in the 18 year history of the BAcc with over 2 million treatments a year taking place. Our members are all trained in safe needling on the thorax anyway, and take especial care when they are treating the frail, the elderly and those with a history of bronchial trouble.

Our full response last year was:

I'm pleased to say that the reason that there is not a great deal of documentation is that pneumothorax after acupuncture treatment is very rare. There are on average about 3.5 million treatments a year administered by traditional acupuncturists, doctors and physios (BMAS and AACP members) and we hear of a case perhaps once every two or three years. There was a prevailing myth that the commonest cause of pneumothorax was acupuncture treatment, and we commissioned a researcher to call all the A and E units in London, all of whom responded that this was patently untrue. Urban myth, I'm afraid.

The sorts of searches you will have undertaken will have thrown up references to the two main safety studies by MacPherson of the BAcC and White of the BMAS, which reported no serious adverse events, and you will also have come across wider studies by White and Ernst, which also report very little. Ernst has been a very stern critic of the traditional acupuncture profession, and his studies of adverse events can be assumed to be as accurate as it is possible to imagine (anyone who includes a case of cardiac tamponade by a women self-treating with a knitting needles as an adverse event of acupuncture can be safely assumed to be as inclusive as it is possible to be).

The WHO report on adverse events also makes it clear that there are few cases of pneumothorax, and if you use the search mechanism 'ncbi acupuncture pneumothorax' in google you will generate a number of single case studies, these being all that there are.

There was a report two years ago about acupuncture being performed within the National Health Service which painted a somewhat darker picture, with a great many more serious adverse events than those reported amongst professional acupuncturist (,Wheway J, Agbabiaka TB, Ernst E. Patient safety incidents from acupuncture treatments: A review of reports to the National Patient Safety Agency. The International Journal of Risk and Safety in Medicine. Published online September 4 2012.

This, however, just bears out our conviction that a properly trained and qualified acupuncturist is remarkably safe, and that it is only in the hands of the poorly trained or incompetent that problems arise. This is why, in spite of the fact that acupuncture is very safe and modern statutory regulation is all about reducing risk and safeguarding the public, we continue to campaign for the statutory regulation of acupuncture to stop people 'having a go' without the proper training.

The main cautions for treatment the elderly, the frail or those with a history of repeated respiratory problems, is to needle to a very shallow depth at an oblique angle, and even in the fit and healthy the same rules apply for all points on the thorax, and especially on the shoulder between the clavicle and the scapula where the dome of the lung rises much higher than many people think.

 

Q:  ] I had my first ever acupuncture yesterday to help relieve headaches, the physiotherapist has found some tenderness around my C2 and gave me  acupuncture behind my ear.  I felt several sharp pricks and I think a nerve may have been hit as there was a very sharp pain.  I have since developed swelling on the side of my face that had the treatment and it feels like I have been to the dentist is this normal.
>

A:  We'd be reluctant to use the word 'normal' because that would suggest that what has happened to you is a frequent occurrence, but adverse events of this kind can occasionally happen. Even the best trained and most experienced acupuncturist will occasionally hit a nerve, and the effect is usually short-lived. In rare cass it is also possible to cause slight bruising slightly deeper under the skin which can then press on the nerve and cause irritation for slightly longer. Most adverse effects subside within 24 to 48 hours and are described as transient, but those involving the impingement of a nerve can last a week or more.
 
We routinely advise patients who call us with similar stories to visit their GP if an adverse effect lasts more than a couple of days. In the case of reactions from nerves being hit the GP can make the call about whether to refer on to a neurologist. In our experience this only happens when the problem persists for a number of weeks, but it can be as well to put down a marker at about the time the problem occurs to make sure that it is taken seriously if after a longer gap a symptom persists.
 
We would not want to sound alarmist but we are a little concerned that you have experienced swelling in the face as a consequence of being needled behind the ear, and this does suggest that the physio may have caught one one of the more substantial nerves which traverse that area. If this is still the case today, it would be as well to contact the physio to explain what has happened and seek their view, and then perhaps make an appointment with your GP early next week if any effect lasts over the weekend. In our experience, though, most of these kinds of adverse events are transient.
 
This is, in fact, a point we should emphasise. In two surveys conducted a decade ago there were only 14 minor adverse events from over 66,000 treatments, and a subsequent survey of patients rather than practitioners was only slightly higher, with only one more serious adverse event reported. This compares extraordinarily well with conventional medicine, and makes acupuncture one of the safest treatments around in the hands of a properly trained and qualified practitioner. We are assuming that your practitioner is a member of the AACP, the special interest acupuncture body within the physiotherapy profession, in which case you can be assured of their standard of training.  

Q:  I am researching UK journal papers and information on the risk associated with pneumothorax and acupuncture. This does not seem to be well documented in the UK.   I would very much appreciate it if you could suggest some UK studies or documentation which would be useful.

I'm pleased to say that the reason that there is not a great deal of documentation is that pneumothorax after acupuncture treatment is very rare. There are on average about 3.5 million treatments a year administered by traditional acupuncturists, doctors and physios (BMAS and AACP members) and we hear of a case perhaps once every two or three years. There was a prevailing myth that the commonest cause of pneumothorax was acupuncture treatment, and we commissioned a researcher to call all the A and E units in London, all of whom responded that this was patently untrue. Urban myth, I'm afraid.

The sorts of searches you will have undertaken will have thrown up references to the two main safety studies by MacPherson of the BAcC and White of the BMAS, which reported no serious adverse events, and you will also have come across wider studies by White and Ernst, which also report very little. Ernst has been a very stern critic of the traditional acupuncture profession, and his studies of adverse events can be assumed to be as accurate as it is possible to imagine (anyone who includes a case of cardiac tamponade by a women self-treating with a knitting needles as an adverse event of acupuncture can be safely assumed to be as inclusive as it is possible to be).

The WHO report on adverse events also makes it clear that there are few cases of pneumothorax, and if you use the search mechanism 'ncbi acupuncture pneumothorax' in google you will generate a number of single case studies, these being all that there are.

There was a report two years ago about acupuncture being performed within the National Health Service which painted a somewhat darker picture, with a great many more serious adverse events than those reported amongst professional acupuncturist (,Wheway J, Agbabiaka TB, Ernst E. Patient safety incidents from acupuncture treatments: A review of reports to the National Patient Safety Agency. The International Journal of Risk and Safety in Medicine. Published online September 4 2012. This, however, just bears out our conviction that a properly trained and qualified acupuncturist is remarkably safe, and that it is only in the hands of the poorly trained or incompetent that problems arise. This is why, in spite of the fact that acupuncture is very safe and modern statutory regulation is all about reducing risk and safeguarding the public, we continue to campaign for the statutory regulation of acupuncture to stop people 'having a go' without the proper training.

The main cautions for treatment the elderly, the frail or those with a history of repeated respiratory problems, is to needle to a very shallow depth at an oblique angle, and even in the fit and healthy the same rules apply for all points on the thorax, and especially on the shoulder between the clavicle and the scapula where the dome of the lung rises much higher than many people think.

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