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A:  The answer is probably yes, but depends a great deal on what they are trying to achieve.

We shall assume for the moment that they are not using traditional acupuncture. There is a style of traditional treatment where needles are inserted and removed almost immediately, but this is because the system is based on an understanding and use of subtle energies. It is unlikely that a chiropractor would be doing this.

It is much more likely that they are using one of the western medical systems, either trigger point acupuncture, segmental acupuncture or straightforward neurophysiological techniques. The former is more likely and is based on an idea that knots form in muscular tissue which can impair the body's freedom of movement. Using needles into these trigger points can release the muscle, and this is often done by osteopaths and chiropractors to enable them to encourage changes in structure. 

We are always slightly ambivalent about other healthcare professionals using a small amount of acupuncture. In principle we accept that it will happen, but we have tried for years to ensure that practitioners who take on even small elements of the system are fully aware of all of the health and safety implications and also of proper hygienic practice and clinical waste disposal requirements. These are the same whether someone uses one needle or a million needles every year.

It is always worthwhile asking your practitioner what they are doing. All responsible practitioners are only too happy to explain to people what they are hoping to achieve.

Q: I had acupuncture for the first time on Friday, followed by discomfort, very bad pain in the soft tissues around the knee.  5 days later moving around and then on the eighth night with burning sensation. Five needles 2,5 - 5 mm were placed in the thigh about 5 cm above the knee. The sessions of after pain have made me numb and unable to do much. Can be this from the acupuncture and how long I should expect this to last?

A: We would have to say that the effects are very probably from the acupuncture treatment. It might just be a coincidence, and with over 4 million treatments in the UK every year such coincidences can occur. However, when a symptom turns up exactly where the needles were placed it would be very strange if this were caused by anything else.

The question is, what has happened? The pain sounds like they started pretty much straight away, and seem to have progressed, We could understand it if the pain had levelled out after a couple of days. Occasionally treatment can cause some deep bruising, and this can impinge nerves in the area and cause quite unpleasant side effects for up to a fortnight after the treatment. However, the needle depths would seem to rule this out.

The only other possibility is that there is a slight infection in the area. If the practitioner is following the normal protocols for single use disposable needles, one needle per point,  this won't come from the needles themselves or by transfer from site to site. What can happen, rare as it is, is that bacteria from the surface can be pushed into deeper layers of the dermis and cause what is called autogenic infection, i.e. bacteria which are safe where they are but reactive when they are moved to different or deeper areas of the body.

This is highly speculative, but if you were one of our patients we would send you to your doctor just to be on the safe side. It might be a rare coincidence, and there might be something going on in the area which needs further investigation. If so, then a doctor will be able to offer an explanation and treatment, and in many cases be able to tell you whether the acupuncture treatment may have been involved.

It might, though, simply be an unusually extended post treatment adverse effect which will wear off. The fact that this is causing post pain numbness and limitation of movement, though, suggests something more significant and we would recommend that you consult

Q:  My wife suffers with  varicose veins  in both legs. In one leg the veins  are in very projected stage.  We checked with the doctor. Laser surgery was suggested, the other suggestion was surgery..We went to an acupuncturist for advice but this was not satisfactory.It seemed the main interest was money - paying for 15 sessions.   Would acupuncture help?

A:  We don't think we, or anyone else, could give an assurance that 15 sessions of treatment or 15 days of treatment could resolve a problem like varicose veins, especially if they have reached the point where surgery is an option. In reply to a query some time ago about varicose and thread veins we said

There is no research of which we are aware suggesting that acupuncture has been used as  a front line therapy for treating thread veins, although obviously all of us have had patients over the years who have presented with varicose veins and thread veins. Here again, research into varicose veins is not that plentiful, and the results tend to be equivocal.

That said, within Chinese medicine itself all forms of pooling of blood in the lower limbs as a consequence of venous insufficiency have been interpreted within the diagnostic categories for over 2000 years - this is not a new problem! There are a number of well-recognised syndromes which can account for the problem in the terms in which we understand energy flow, and in each case the varicose/thread veins will be a part of a much wider grouping of symptoms which result from a functional disturbance in the body. Some of these may not even be recognised as symptoms; bruising easily or going to the toilet more frequently may just be written off as 'just something funny about me.' To a Chinese medicine practitioner, though, taken in conjunction with some of the independent information we get from taking the pulse at the wrist and looking at the tongue, they can point to pathologies which may be treatable. Functional disturbances tend to generate groups of symptoms which make perfect sense to us although in conventional medicine each might be treated by a different specialists.

The best advice we can give is that you pop along to a BAcC member near you for a brief informal assessment, hopefully without charge, of what may be possible. If there is good supporting evidence of wider patterns a practitioner may well feel confident about the chances of reducing the veins or stopping them getting worse.

We have to be honest, though, and say that our experience is that by the time people are beginning to consider having injections it is not that easy to reverse the trend, and we would be very very cautious about anyone who makes promises in this area. We would tend to say to a prospective patient that maybe three or four sessions would be enough to see if some small changes occur (easy in the days of digital photography), and then take a view about whether to carry on.

This remains the best advice that we can give. As far as the practitioner's request is concerned, it is not uncommon in China itself for someone to have daily treatment for 10 to 15 days for a number of conditions, although this is usually reserved for acute problems like back pain and sciatica where it is believed that a burst of treatment gathers momentum better than more spaced out sessions. Whether this would be suitable for a long term and chronic condition like varicose veins would be a professional judgement call. Without a face to face assessment of the problem we wouldn't really be able to say.

The bottom line in all cases like this is that if you are not completely satisfied with the first opinion you receive, seek another. It would be hard to believe that there is only one acupuncture provider in your area, and we would always suggest that unless someone felt perfectly

Q. I see a sports therapist for help with aches and pains after regular gym exercise. He has also recently been carrying out accupuncture. My concern is I feel quite emotional a few hours after the session almost like a release of tension or something. Is this normal or should I mention it next time. I always sleep so much better and it helps alot with the back pain.

A. It sounds to us like the treatment is having a very beneficial effect, and yes, we do find that on occasion treatment for a specific problem can actually have a systemic effect. So, for example, treating someone for a bad back can release all sorts of blockages, some of which might be expressed in a release of 'contained' emotion. It is certainly something which any practitioner would value as feedback.

This is something of a live issue for us because of the greater use of acupuncture within a western medical context as a focused treatment for physical problems. We have made the case for many years that while we value the fact that people are getting the undoubted benefit, from our perspective any needle inserted into the body can affect body, mind and spirit. Our concern is that you can't know what you don't know so if someone treats on a musculo-skeletal basis they are not going to be aware of the possible emotional reactions this might stir up.

For us this would be valuable feedback, and our systems can interpret and work with reactions of any kind. A great deal of Chinese medicine thought uses rather general concepts like 'appropriateness' so when an emotion appears inappropriately or in inappropriate quantity it becomes diagnostically significant and helps us to restore balance in the whole system. We are all mainly trained in working with people to delve a little more deeply into what is going on, guided as we are by the belief that repressed emotions can manifest as muscular problems. If they are not properly addressed the body will simply manifest another similar problem until they are.

We always tread carefully, though, because we would not want to be seem to be staking out the territory and trying to stop people from using acupuncture in a more physical way. Many people derive huge benefit from such measures. What we would like to see is people referring patients on to us if they start eliciting reactions which they cannot explain, or at very least talk to the patient about the sorts of things that are coming up and directing them to someone who can help them.

That said, we have had many patients who experience these kinds of almost cathartic reactions to treatment without any background of problems not dealt with, and as long as the effect is short-lived and the overall problems seem to improve we don't make a big deal of it. Everyone is unique and special!

Q. Hi,

I wondered if there are any points that we should avoid using for a patient with rheumatoid arthritis for example points where there is a risk of entering the joint such as the eyes of the knee or shoulder?

Has acupuncture ever been known to trigger a reactive arthritis?

Also, should we be using anti-bacterial wipes prior to inserting the needle for someone with rheumatoid arthritis?

A. There are no contra-indications of which we are aware for the use of acupuncture in treating rheumatoid arthritis. Some traditions of acupuncture, strangely enough the modern medical versions, tend to use deeper insertion of the needle than many traditional acupuncturists would countenance, and we have found nothing on their safety forums to indicate that special care needs to be taken. The BAcC was involved with a group of several associations, including medical acupuncture bodies, to draw up safety guidelines some years ago, and this was never raised as an issue by anyone.

By the same token we have not been able to find any evidence to suggest that a reactive attack has happened as a consequence of treatment. This is a little more tricky, because as is often the case in these situations people are generally doing a great deal more just having acupuncture, so it may not have been picked up as valid causation. As we have said to colleagues many time absence of evidence is not evidence of absence. However, there have been recorded cases of which we are aware, and we do monitor adverse events carefully.

The issue of swabbing or cleaning points is a little more contentious. In the NHS there is a roughly 50/50 split between those who insist and those who don't. Our own advice to members, which we are happy to share is:

Where necessary, you should swab the skin with 70 per cent isopropyl alcohol with or without 0.5-2.0 per cent chlorhexidine. If the area of the skin to be needled is clean and free from dirt or organic matter (such as soil) then there is no requirement to swab the skin.

If areas of the body to be needled are dirty then they should be washed first with soap and water.
Swabbing is only indicated for patients who have a suppressed immune system through illness or medication and is not required in the fit and healthy.

The recommended agent to “sterilise” the needle area is 70% isopropyl alcohol usually in the form of a medi swab. Cotton wool balls soaked in alcohol solution are strongly discouraged as these can become heavily contaminated with hand and environmental bacteria. The use of 90 per cent isopropyl alcohol is unacceptable as it may preserve organisms and also because it evaporates too quickly to have an antiseptic effect. Other cleaning agents, if used, should also have adequate antiseptic properties and be safe on the skin. These preparations should contain 0.5-2.0 per cent chlorhexidine and should ideally be in an alcohol solution, as chlorhexidine is not completely effective against Pseudomonas, the main organism causing infection in the earlobe.

The misuse of swabs is very common and it is recommended that a fresh swab is used for each point. The swab should be in contact with the area to be needled for 30 seconds and allowed to dry for a further 30 seconds. It is recommended that you swab points in a way that touches the area only once so as not to re-contaminate the area and it is best to swab from one end of the area to another.

After an acupuncture point has been cleaned in this way, it must not be palpated unless it is cleaned again afterwards.

The arguments tend to focus on whether cleaning a needle site removes protective bacteria as well as killing potentially dangerous ones, so we have taken a fairly commonsense line and asked members to use professional judgement in dealing with patients who might be perceived to be slightly higher risk. Since most high risk conditions have a vast range of presentations we wanted to avoid over-reaction.

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