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A:  We are not entirely sure at this point whether the treatment and the effect are related. Generally speaking, when treatment causes what we call adverse events, usually transient adverse events, these are very often local to where the needles have been placed. Infection from needles is so rare as to be easily dismissed as a cause; single use disposable needles used properly are as safe as can be. The only other thing we tend to look for is any deep bruising or damage which may not be apparent on the surface, but which may be causing something to happen by impingeing a nerve. However, as we said, it is usually fairly easy to follow the track from where the needles were to where the problem arises, and it would be very unusual to see a bilateral effect from a one-sided needle insertion unless the needles had been placed centrally in the neck or back.

However, this is to look at things from an entirely conventional perspective. When we treat according to traditional Chinese medicine principles we can often remove blockages in what we term the energy flow of the body, and sometimes reinstate a normal flow to the extremities where this had been compromised for a long time. This can sometimes be quite dramatic. We are also aware of the possibility that heat gets released after treatment. There are several ways of understanding pathologies in the system as 'heat being trapped in the interior', and it is not unknown for this heat to clear the system as a generalised feeling of heat or as a red rash.

We are not sure at this stage, and we would probably have to know a little more about what the treatment was and also the context in which it was given. We treat people, not conditions, and this means that the unique balance of the individual is integral to how we decide what to do. There may be aspects from this which would help us to understand what has happened. Clearly the best person to ask is the practitioner who treated you. His or her knowledge of your case history and what they were trying to achieve might be your best and quickest route to finding out what is happening.

We can understand how this is a concern, though. While we expect the problem will have subsided by the morning, if it continues and the skin starts to develop a redness corresponding to the heat you can feel we would be inclined to advise you to visit your GP as soon as possible to get a conventional view of what is happening. It may well be that the problem is unconnected to the treatment, and rather than spending time wondering whether the treatment caused the problem, it may be better to think 'had this happened anyway without a possible cause, what would I have done?'. If the answer is 'sought help immediately' then that is the best thing to do unless someone can give you a reasonable and compelling reason to see what happens.

We suspect that by the time you get this, the problem will either have subsided or be subsiding, or it will be continuing without change. If the latter applies it is important to get a conventional medical assessment of what is going on.

Q: I had my second session of acupuncture for whiplash & sprained back. Afterwards I had  pain in my knee where no needles were placed and a large painful bruise on my back. Is that something to be expected?

A:  We are sorry to hear of your experience.

There are a number of possibilities for the pain appearing behind your knee. The bruise which you have, which sounds very unpleasant, depending on where it is may be impingeing a nerve in your lower back which is creating the sensation of pain in the knee. This may something like a referred pain, where you feel something as though it were behind the knee but it actually comes from pressure on the nerve higher up.

A second, and perhaps likelier, possibility is that the treatment has caused a re-alignment of the back, putting it back into a better position, and as a consequence muscles which have adjusted into different positions are now being forced back into their natural positions and causing a little strain at the insertions of the tendons. We often warn people having treatment for bad backs and necks that this is a strong possibility, and indeed most osteopaths and chiropractors alert patients with these sorts of presenting problems that the first 48 hours after treatment can be a little rocky.

The third possibility is that this is a reaction in an acupuncture point to the problems which you are experiencing. Some points can become spontaneously tender quite some way from the site of illness or injury by a form of resonance between the points and the areas they cover. In some systems of acupuncture, like Japanese Meridian Therapy, this phenomenon is used diagnostically; where the practitioner can find or the patient reports an area of tenderness on the limbs it can often point to an area of weakness inside the body.

In all cases the reaction should subside quite quickly, probably by the time you have received this response. It is very important, though, that you tell the practitioner exactly what you experience, and also make sure that he or she sees the bruise (we are sure that they will, but just in case....). Bruising is a relatively common side effect of treatment (but still rare), but a large painful bruise is not usual. This is something which would usually start within the session, and pressure applied to the point should minimise the effects. If this comes as a surprise to the practitioner it might be good to monitor other points over the next few sessions to see if you bruise very easily. There are both conventional and Chinese medicine reasons for this.

Q:  I went to an acupuncturist for the first time,  I was being treated for weight loss, infertility and stress. At first, I was very relaxed. Then I started going through emotions of upset, then irritability, and then about 20-25 min into it I literally felt like I was going into a panic attack. Is this normal? He made it sound like it wasn't common, but both my nephew and his wife said the same thing happened to them. What would cause this weird sensation and rapid heartbeat panic attack stuff? Just part of the treatment?

A:  We are sorry to hear that your treatment was something of an experience.

Many people find that the first session is a deeply relaxing one, but a small minority find that it can stir up a lot of things. Sometimes this can be at a physical level, where there can be changes to heart rate and breathing, and what feels like the beginning of a panic attack. As often as this are emotional effects, where people find that they experience some moods which appear to come from nowhere, like irritability or anxiety.

From a Chinese medicine perspective all of this is perfectly possible. The practitioner's main aim is to restore balance in the system, and this can mean unblocking energetic blockages which in turn can mean the start of the clearing of pathogenic factors. This can range from straightforward physical stuff, like internal heat being cleared, to emotions  which have been 'stored' and repressed. We have to say, however, that this is not a frequent occurrence, certainly not frequent enough where we would feel that we had to alert someone to it happening before a first session.

There may, of course, be factors in the treatment itself which make a difference. Some people are just very sensitive to needles, and this sensitivity can run in families. In such cases, there is a risk that using too many needles or using to much manipulation of the needles after insertion can make the system go a little haywire. A practitioner will always take note of this reaction and tune down the treatment for the second session to see if that makes a difference. Usually it does because the excessive reaction is a perfect storm of anxiety at a first session, energy unblocking and sensitive system where all three combine to have an effect. Rarely there are cases where someone is always highly sensitive but we have managed to treat people successfully by using a very small number of needles per session. Such patients tend to be very effective responders if one can get the balance of treatment right.

The best thing to do, though, is to talk to the practitioner about your experience. He should be able to make sense of what has happened because he will not only know what he did but also have a good case history in front of him which will allow him to make sense of what has happened.

We hope your subsequent sessions are more relaxing and help you to address your health problems.

Q:  I have had three sessions now for neck and nerve pain.  My practitioner  says I am a strong responder. I had a strong flare after the first session, second one was five ,not as many needles, third session( today) very strong reaction ,feeling faint, I am now worried that this will result in a flare from the nerve pain.  What should I do if this happens(.this was my last visit to the therapist).

A:  We are not quite sure what to make of the phrase 'last visit to the therapist'. If we read this correctly it is that someone has done a short course of treatment rather than that you have had enough!

Treating neck and nerve pain can often cause some very strong reactions. There are dozens of nerves travelling up through the neck and into roots within the cervical spine, so treatment aimed at correcting the structure of the upper spine which can often be the source of the pain will have some profound effects. All of the reactions which you have described fit with this, and for neck and lower back pains we often tell new patients that for the first two or three sessions they might often feel a little worse for a day or two after treatment before the pattern of recovery is established.

If you are indeed a strong responder then this may be doubly the case. We do find from time to time that we take on patients who react incredibly strongly to the needles, and the only sensible thing to do is to reduce the number of needles used and to apply less manipulation to the needles. Treatment can be very very gentle if need be, and with strong responders that is often all that you need to achieve a result.

Where people do experience strong reactions, as you have done, these almost invariably wear off within 24 hours, usually after someone has rested or slept. It would be very unusual to find that a pain had been brought on by the acupuncture, and unless there had been physical damage from the needle insertion, itself quite rare, most of these reactions are simply to do with the readjustments which the treatment is trying to achieve. Osteopaths and chiropractors offer similar advice to their patients when they treat backs and necks; as the body is out back into proper shape there will be some pains caused by muscles re-arranging themselves. We deal with energies, and for us this kind of treatment can often cause slight light-headedness and feeling faint if the treatment has been strong.

If this was a fixed course of treatment and you can't go back to the practitioner (possibly an orthodox medical professional working to a fixed plan?) then you could certainly visit a local BAcC member for advice if the symptoms continue. However, we are pretty confident that they will subside, and the fact that acupuncture rarely causes serious adverse events makes us equally confident that there is no reason for your nerve pain to return. If it does, then it may well be worth dropping in to see your GP if the problem persists for a week or more. 

A: We're sorry to hear of your experience - we know very well how unusual events after treatment can be very disturbing.

While we wouldn't want to go as far as to say normal, it is not unknown for someone to experience strange sensations after a treatment. Very few of these are to do with physical damage caused by the needles, and where they are it is pretty obvious, like a bruise or a dull ache. Balancing up the energy of the body, which is what we do with traditional acupuncture, can sometimes cause some strange reactions, although the ones which you are experiencing are a little stranger than most.

We would probably need a little more information about where the needles have been placed and what the treatment strategy was to offer a more detailed view. We can think of a number of syndromes where the treatment might cause this of sensation, but without more information we are in the dark. A great deal depends on whether the face and body feel swollen or actually are swollen. The former is very much like the kind of odd sensations which people can experience, the latter a little more unusual.

What we always say, though, is that effects like these rarely last more than 48 hours at the outside, and most are gone within the day. If they carry on beyond that or recur over the next few days, the best thing to do is first have a chat with the practitioner and if need be drop into their clinic so that they can see what is happening and advise you on what to do. If things really do carry on for a lot longer it is always worth checking with the GP. Sometimes odd things happen which have nothing to do with the treatment, and it always pays to have things checked sooner rather than later. We have come across one or two cases where the argument about what caused a problem has kicked off without the problem getting treated, which is not a great idea. Getting treatment usually establishes what caused what.

We are confident, though, that the symptoms will quickly go away, and hopefully show that your system is responsive to treatment and will start to make positive changes very soon.

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