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Q: I hade acupuncture for the first time at my local hospital and although I was very emotional straight after the short 10 minute session I felt fine. 12 hours later I was itching,  17 hours later I had passed out and hit my head resulting in concussion. Speaking to my acupunturist she said that, although uncommon,  it is not impossible that the fainting was caused by the acupuncture. My GP however is very doubtful. Whilst not blaming anyone at all, I would obviously like to know why I passed out. I never have before. Is this possible, could the acupuncture have caused it? Dr has done ECG and blood tests, ECG was fine, blood tests are still in the system.

A: As your acupuncturist said, fainting is an unusual but not unknown reaction to acupuncture treatment. In the majority of cases this is a combination of nerves or anxiety, often with not eating for quite a while before treatment, and the treatment itself. Even with optimal preparation there can be occasions where the treatment induces a rapid short-term drop in blood pressure, often diagnosed as vasovagal syncope and a reaction by the vagus nerve to the treatment. This can often be triggered by over-vigorous needling, perhaps slightly more strong than the average traditional acupuncturist might regularly employ.

However, when fainting does occur after treatment the effect is usually within the session itself or very shortly afterwards. It is rare to hear of circumstances such as your where there is a precursor symptom of itching followed by a faint 5 hours later. The fact that all of the usual readings - bloods, ECG,etc - are good is a reassuring sign, although I suspect that were we to be in the same position as you we would also want to know what drove the process along.

If you were our patient we would probably recommend that you sought further conventional testing from orthodox medicine. It is just about possible that the symptoms, itchy skin and fainting, may relate to an anxiety reaction to treatment, and you do mention that you felt quite emotional after the treatment was administered, but if we rule this out, then the gap before your faint occurred is just a little too long for us to say with confidence that acupuncture is the causal factor. However, we would certainly want to know what you did in the hours immediately following treatment to rule out the usual suspects: hunger; tiredness; highly stressful situations; and so on.

You do not mention whether you had subsequent treatments which did not affect you so badly. If you have now completed the course of acupuncture treatment, you could always drop into see a BAcC member local to you for advice. The diagnostic systems of Chinese medicine can sometimes offer understanding of unusual symptoms where orthodox medicine does not, and this may prove beneficial in trying to establish what happened to you.

Q:  Some years ago I had accupuncture and was advised to lay for an hour and to avoid caffeine and nicotine also. This was to enable the treatment to work to its best ability.

My 80 old mum is now recieving accupuncture and has not been advised the same. This worries me as she is paying nearly £50 per session and i want her to have full benifit from her sessioNs.   What are your thoughts ?

A:  There is nothing here to be worried about. We produced a standardised aftercare sheet some years ago when the new licensing arrangements were introduced in Scotland, and in it we said:

You need to be aware that:

· drowsiness occurs after treatment in a small number of patients, and, if affected, you are advised not to drive

· minor bleeding or bruising occurs after treatment in about 3% of treatments

· pain during treatment occurs in about 1% of treatments

· existing symptoms can get worse after treatment (less than 3% of patients). You should tell your acupuncturist about this, but it is usually a good sign.

· fainting can occur in certain patients, particularly at the first treatment.

In addition, if there are particular risks that apply in your case, your practitioner will discuss these with you.

Anything more than this is a matter for professional judgement, and with a broad variety of acupuncture styles practised within the BAcC there will clearly be variations in the advice given. Some practitioners take a particularly hard line on stimulants of any kind, and give very explicit instructions to patients about what they should or should not do. Among the other things that we have regularly heard said are not to take vigorous exercise, not to eat very large meals, not to drink alcohol after treatment or the night before a first treatment, not to drive at speed in the hour after a treatment but to relax for a while, and so on. In the vast majority of cases the advice will be geared specifically to the kinds of thing a patient might do or say they are about to do, and this is why advice may differ from person to person.

In the vast majority of cases doing any of these things would not undermine the effects of the treatment, but might bring about short term adverse effects because the system is still in a state of flux after the session and takes a while to settle. If someone forgets advice on alcohol and inadvertently has a lager with a curry later in the day, there is a very small chance that they might develop a minor headache or be slightly more affected by the alcohol, but the treatment would not be compromised. Obviously if a patient does something extreme, like going on a two day binge, then that may be different, but most people want the treatment to have the best possible effect and manage their own lifestyles accordingly.

Acupuncture treatment can be very powerful in its effects, and these are not going to be derailed or diverted by the things that most ordinary people do in life. We hope that your mother enjoys a successful course of treatment.

I had my first acupuncture session. Since then I have felt flu-like symptoms;  feeling low on energy and achey all over. I had the treatment for more emotional issues but have also had some mild problems with my lower back,  which I neglected to tell my acupuncturist. Since the treatment my lower back in particular has been very achey! Are these symptoms to be expected, are they likely to be connected to acupuncture?

It is not uncommon for the first acupuncture session to cause a number of 'ripples' over the two to four days after treatment. Some of the complementary therapies have a mantra which says that 'things have to get worse before they get better' but we tend to be a little careful in saying such things because very frequently things simply get better. We are also concerned that on occasion things are worse because they are really getting worse, and we've heard our fair share of stories over the years of Comp Med therapists who have seen someone's deterioration as a kind of proof that things are on the mend. Our members are very careful in their assessment of what we call adverse events.If you think of the system as understood in Chinese medicine as an integrated whole in which disturbances arise, often described as travelling inwards, then it would not be a surprise to find that the process of clearing patterns of disharmony caused a number of short term adverse effects as the disturbance clears. Sometimes these can be quite severe; it is not unknown for migraine sufferers to have a very sharp episode after treatment. The key thing, however, is that these are short-term and transient. Most will rectify themselves after two to four days. From then on progress tends to be more steady and upward. This is especially true of many musculo-skeletal problems. Back and neck pain sufferers often report short term aggravations, and most of us forewarn patients that this is a possibility, as do osteopaths and chiropractors whose work often triggers the same outcomes.The same applies to emotional as well as physical problems. This can be a little more difficult to manage, because the level of support someone needs may be a little greater, and our members usually make sure that they are available if a patient needs to talk about the issues which come up, or more often, make sure that the patient has the appropriate personal or professional support in place. We are acupuncture practitioners, not counsellors, and although our listening skills are integral to our work,. there are occasions where the issues with which someone is dealing require more than good listening.However, as you ask in your question to us, are these likely to be connected to your acupuncture treatment? We have assumed that they are, because they sound as though they could be, but it is only fair to say that our members occasionally get blamed for problems which happened after a treatment on the assumption that 'happening after' means 'happening because of'. We always say to patients that if an adverse effect lasts for a couple of days it might well be related the the treatment. Any longer than that, and if there has been no obvious physical damage like a needle causing a bruise or hitting a small nerve, then we say that this is something the practitioner and patient should work together to find out what is going on. This is more productive than becoming defensive or adversarial, which simply wastes time

Our holiday arrangements have meant a slight delay in replying, so we rather hope that by now your aggravations have lessened and that you are now experiencing the positive benefits of treatment.

 

Q:  I have just had my first session for fibromyalgia. The practitioner used one needle in my wrist. It was painful at the time and is still hurting now,the next day. Is that normal?

A:  Our response cycle lengthens a little at weekends, and we are rather hoping that by the time you read this your discomfort will have gone. The vast majority of adverse events from acupuncture treatment, themselves not that common, are transient and clear within 48 hours.
 
There are, however, a few points in very 'busy' areas like the wrist, with many blood vessels and nerves crossing a tight gap, where even a minor bruise within the tissue, not necessarily visible on the surface, can produce a disproportionate amount of discomfort because of the continual movement in the area. In this case it may take a little longer to clear up, but should certainly last no more than a week.
 
If it persists for a week or more it may be worthwhile seeing your GP and arranging for a potential referral for neurological assessment. If there has been damage, which is still unlikely, the earlier it is identified, the better. In a case like this, of which we hear about two or three a year from somewhere over 2 million treatments, it is best to find out early what has happened. Should this be the case, it is worth reminding you that all of our practitioners are covered by a 'gold standard' insurance policy which makes sure that anyone who suffers detriment is properly compensated for their difficulties.
 
As we said at the top, however, in all likelihood this will no longer be a problem by the time you read this.

Q: Is cosmetic facial acupuncture safe? How can you check if someone is a member of the British Acupuncture Council?

A:  To take the second question first, all that you need to do to check whether someone is registered with us is to use the 'practitioner search' function on our home page and go to the 'advanced search' function. Entering their name or surname will quickly establish their current membership status.
 
As far as adverse events are concerned, we are unaware of any reported adverse events through our professional insurers or through our own internal mechanism for collecting data on safety. However, we are not the only game in town; there are a number of trainers in this field who are not BAcC members and do not restrict themselves to training people who are already qualified in acupuncture. This means, without meaning disrespect to beauty therapists, there are people using cosmetic acupuncture in the UK who have not undergone anywhere near the three year degree level training which our members have, and as a consequence may not be as well steeped in the safe practice aspects of our work as well as they might be.
 
We believe that the techniques only make sense if performed within the context of a much more systemic use of traditional acupuncture. An article which you can find on the web and published in our 'house' journal makes this point very clearly:
 
http://www.ejom.co.uk/vol-5-no-5/featured-articles/an-introduction-to-facial-revitalisation-acupuncture.htmlh
 
An extract from the article spells out the sorts of conditions for which cosmetic acupuncture might not be a good idea:
 
FRA: contraindications
Facial revitalisation acupuncture is contraindicated for some pituitary disorders such as a pituitary tumour, heart disorders, individuals who have a problem with bleeding, such as haemophiliacs, or those who are extraordinarily prone to bruising. Administering FRA to anyone with high blood pressure or diabetes is forbidden even if these conditions are said to be ‘controlled’ through medications. For those who would be described in TCM as being of a livery nature, caution and extra efforts should be applied to prevent headaches and dizziness. Administering FRA to people who suffer with migraines should be avoided. For those patients who are diagnosed as being HIV positive or having developed AIDS, this type of acupuncture should be avoided. Caution should be exercised if the patient has had hepatitis previously. Judiciousness should be exercised if facial lymphoedema is present as these patients are far more prone to infection. If the patient is prone to wheezing as in the case of asthmatics, or in the presence of a serious cough, one must consult the patient as to the frequency and severity of the condition and judge if the patient can comfortably and safely receive a long and perhaps intense treatment. Facial revitalisation acupuncture should not be administered to a pregnant woman as there are points used that are forbidden in pregnancy besides the obvious difference in treatment strategy of bringing so muchqi to the surface. Similarly, FRA would not be advisable during any acute illness or any chronic illness that is serious in nature, when a headache or nausea is present, during a bout of cold or ‘flu, or during an acute allergic reaction or in the presence of an acute herpes outbreak, hangover or intoxication of any sort. Regular forms of acupuncture are generally recommended and found to be beneficial for the above contraindications to FRA. Great caution should be exercised with those patients who are undergoing or have had plastic surgery, botulinum toxin injections and similar allopathic cosmetic procedures
 
be a good idea, but does not list any adverse events which have been reported.
 
This does not mean that they cannot happen, although our major concern is not with the safety of an adverse event as much as the potential for causing bruising or marking in the short term. This may have an impact on someone's career.
 
However, in short we say what we always say, if you are going to have acupuncture make sure that you go to someone who is properly trained and insured, and who belongs to a recognised professional organisation with clear codes of safe practice and professional conduct. We are proud of the fact that the BAcC can make this claim about all of its members, a fact recognised in our recent accreditation by the Professional Standards Authority as one of the first two bodies recognised under this new flagship scheme. .

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