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Q. I had been suffering,for a few weeks, with chronic pain in my left buttock/pelvis area. I had seen three different Physiotherapists, one I had seen privately and he thought it was emanating from my sacro illeac joint. The second one I saw in A & E at my local hospital and he said it was nerve pain and could be Piriformis syndrome. The third one wasn’t sure and gave me exercises to do, pending the outcome of my MRI scan. However prior to this scan I had been in such pain, although no pain at all below my left knee, that I paid to see an acupuncturist. She is registered with the BAC. During the session she used a Moxa stick and placed a needle in my lower left leg at the side of my knee. I felt an immediate deep dull ache/pain. I told her this but she left the needle in. She said this was normal. Nearly 4 weeks later I am still experiencing severe pain in my lower left leg. It seems to radiate from the needle insertion point to the front of my leg/shin. It keeps me awake at night and nothing seems to ease this pain. This area was not included in the MRI scan. I am extremely concerned that this young acupuncturist has damaged my leg in some way. She denies any responsibility for this. I am a healthy, usually active lady in her mid sixties, of a normal weight.

A. We are very sorry to hear what has happened to you. We are keenly aware that unusual outcomes after treatment can be very distressing.

The most common cause of what are, we have to say, quite rare events is that the needle has caused some deep bruising which is not visible on the surface of the skin. This can stay in situ for several weeks until it is cleared by the body. In the interim this can impinge some of the nerves in the area, and this in turn can cause pains in the area or lower down the limb. It should, however, clear up within a matter of weeks. Serious damage to local tissue is highly unlikely; the needles are too fine to penetrate most physical structures. The use of pre-sterilised needles in the manner in which all practitioner are trained will also rule out infection.

However, what is happening to you does sound a little serious, and were you to be our patient we would want you to attend your doctor's surgery for further investigation. Serious adverse events from acupuncture treatment are rare, but they can happen. When a symptom persists for more than a few days it is important to rule out anything more serious than a local bruise. In the old days of re-usable needles it might have suggested a piece of broken needle but in modern times where everyone uses single-use disposable needles this is unheard of.

As practitioners we would also be interested to hear of the state of the other problems you have been experiencing. One positive outcome, if we could call it that, would be if the treatment has caused an adjustment of the physical structure such that pains in the lower back/pelvis area had abated but been replaced by pains elsewhere. We do occasionally see a pattern where good adjustments in the torso can precipitate pains lower down the limbs, but in your case the fact that the pains started as the treatment took place suggests otherwise.

Our advice, then, is to arrange further investigation through your doctor. We think it is highly unlikely to be permanent damage or even serious damage, and it may have been a rather maladroit expression of this by the practitioner which has clearly added to your upset. The professional handling of patients is as much a concern to us as the safe practice of acupuncture itself. If you feel that the standard of care at this level was unacceptable or below our published standards we have clear procedures for handling such complaints to which we can direct you.

We hope, however, that you manage to see your GP and receive reassurance through further investigation that this is a transient, albeit longer lasting than usual, reaction.

Q. Is acupuncture suitable for treating polymyalgia rheumatica?

A. As you can imagine, we have been asked about PMR several times, and a stock responses has been:

There are surprisingly few studies into the effects of acupuncture treatment on polymyalgia, and this does limit what we can say from a conventional medical perspective about the treatment of the condition. However, we suspect that this is a great deal to do with the diffuse ways in which the condition presents. In our experience the definition is imprecise, and we have seen patients with identical presentations diagnosed very differently.

From a Chinese medicine perspective, though, this doesn't really matter. For us the description of the patient's symptoms is seen against an entirely different theoretical framework. This involves an understanding of the body as a flow of energy whose rhythms, flow and balance can affect someone's health. When pain arises it is usually a sign of blockage in the system, or excesses and deficiencies which we can correct with the use of needles.

The real skill and art of the practitioner lies in identifying the true source of the problem. Such is the complex web of inter-relationships within the body a symptom will often not be the same as the cause of the problem. Finding out where the root cause is and addressing it is what differentiates a traditional practitioner from someone using simple all-purpose formula points. If the root is not addressed then the problem will come back. This also explains why a dozen people with the same symptom can be treated in a dozen different ways, with treating being individualised to each case.

The best advice that we can give is that you visit a BAcC member local to you so they can give you a brief face to face assessment of what could be possible. A skilled practitioner should be able to give you a rough idea quite quickly of how much change they think they might achieve and over what period of time. Most of our colleagues are happy to give up a few minutes without charge to enable the patient to make an informed choice, and will also be likely to offer good alternatives if they think these will address your problems better.
If asked by a patient what the evidence for the success of acupuncture for PMR is, though, we would have to be honest and say that not only does it not meet the gold standard of western research, the RCT, but often fails to meet any reasonable standard. We believe that this is partly to do with the difficulties of assembling a meaningful cohort for a trial, the diagnosis not always being precise, but partly to do with the fact that treating it as a purely physical condition may not be dealing with the underlying causes, some of which are often mental and emotional.
We believe that, downbeat as it may be, this is still a good answer. PMR is a condition which can on occasion be intractable, and it would be remiss of us to start making claims for treating all cases with great success. For many people the diagnosis is much broader than PMR itself, and there are often complex emotional problems which arise from having been incapacitated for a long time.

So, this doesn't sound entirely encouraging. However, there are several styles of acupuncture which describe a problem like PMR very accurately but from a Chinese medicine perspective so perhaps it is a little over-cautious to be so downbeat. One of the great strengths of Chinese medicine is that it can make connections between different parts of the body and different organic functions by way of an understanding of the way that energy flows in the body. this can sometimes point to functional disturbances or even straightforward blockages, so without having had sight of your unique presentation we should perhaps be more open to possibilities. We are sure that visiting a local BAcC member for advice about what they can see in your system remains your best option.

Q. Hi, i suffer from a condition called Gilberts syndrom, its basically a faulty gene/missing gene in the liver. A family friend has acupuncture for a different liver problem and she said maybe i should try it, the main symptoms i have are nausea/dizzyness/tiredness. Is this something that acupuncture could help with? Also i suffer with anxiety (mainly from my health problems) would it aid with this as well? thanks

A. This is one of the problems which illustrates rather well the difficulty of talking named conditions in one system of medicine and their treatment in another. As you are better away than we, we are sure, Gilbert syndrome can be relatively asymptomatic, although you have been in the unlucky minority for whom nausea and dizziness are common. There is no research of which we are aware which suggests that acupuncture can successfully treat GS. However, what we are talking about is a functional disturbance of the Liver (understood in the West as a genetic abnormality), which in its capitalised form is a Chinese medicine definition of the Liver which embraces the liver as understood in western medicine. And, from the Chinese medicine perspective, the Liver is indeed often involved in pathologies like nausea and dizziness, which are very often a part of Liver syndromes.

Of course, nothing is that straightforward! The essence of Chinese medicine is to treat the individual, not the disease, and although the distress might be expressed through Liver symptoms the art and skill of the practitioner lies in looking at the overall context and seeing what might be causing this distress. Sometimes this is a primary Liver imbalance, and sometimes it is the Liver reacting to an imbalance elsewhere. This makes a profound difference to the way that a practitioner will treat the person, and create what many in the West find quite anomalous, twenty patients with a named condition being treated in twenty different ways.

We would suspect, though, that given that these problems can often be traced back to disturbances of Liver function there may well be something which acupuncture can assist.

The treatment of anxiety is an area where, in spite of the difficulties of translation between systems, there has been a great deal more research which suggests that acupuncture treatment has a role to play, as our factsheet

shows. It also tends to be one of the more omnipresent conditions accompanying other main complaints with which people present. From a Chinese medicine perspective it is often the sign of a not unreasonable response to a challenging situation being maintained long after it is appropriate to do so. Appropriate is a key word in Chinese medicine. It is fine to be anxious for a short term, but there comes a point where it persists and becomes a problem. Restoring someone's balance should in theory go some way to addressing these kinds of inappropriate ways of dealing with the world, but it can take a long while. Anxiety can unwittingly become a way of life.

What we always advise is that someone visits a local BAcC member to get a sense of what may be possible. Most of our colleagues are happy to give up a few minutes without charge to prospective patients to ensure that they are properly informed about what make work for their own unique case before committing to treatment.

Q. Hi, I have had 3 courses of acupuncture for my tennis elbow. Each time the needles have been inserted around my elbow joint and on insertion and movement (the practitioner twisted the needles once after insertion) there was quite significant pain - I was whinceing. Once in situ there was no pain. Is this normal? Apparently the needles were tapped onto the bone in my elbow to stimulate the healing process. The treatment lasted about 20 minutes.

A. There are two elements to your question, one of which we find slightly puzzling.

It is not unusual for people to experience more sensation when a needle is being inserted than when it is in place. There are a variety of reasons for this. A needle is, after all, a sharp pointed object and fine as acupuncture needles are there are going to be small blood vessels and nerves which it touches on entry and which will cause a sensation, as will the breaking of the skin surface. After a needle has been inserted many practitioners use a quite vigorous action on the needle itself to elicit a sensation called 'deqi' which can vary from a dull ache to something a little more intense. This is particularly the case with Chinese techniques which tend to be a little more forceful than, say, Japanese techniques. Once the sensation has been elicited it tends to subside.

As far as we can tell this is probably what happened to you, and to that extent it is normal. Indeed, for conditions like tennis elbow where there is considerable stagnation of the tissue a more vigorous technique can be advantageous. Even the western versions of acupuncture which recognise what are called 'trigger points' can be a little bit challenging. However, we are a little puzzled by the claim that the needle is actually hitting the bone. This is something we would try to avoid because the tip of the needle might well be damaged by contacting more solid or dense tissue, and we don't really want to be drawing something shaped like a fish hook out of a patient. In the old days when people re-used needles after they had been sterilised this was something which could happen if a bent needle was re-inserted. Thankfully we now all use single use disposable needles, so this particular unpleasantness is a thing of the past.

So, we think there is nothing to worry about. If the practitioner is inserting the needle down to the level of the bone, which is what we suspect they mean rather than deliberately hitting the bone, then this simply means that they are using quite strong techniques which will probably serve you well in getting rid of this annoying problem.


Q. My son has recently been diagnosed with stage 3b/4 chronic kidney disease. He would like to use acupuncture to help him through this challenging life changing period. Our insurance will cover the costs of this type of treatment.

However, he is unable to get a Doctors note to support this type of treatment either from his GP or from his kidney consultant. Therefore he cannot make a claim from our insurance.

How can I arrange a consultation with a doctor to support his acupuncture treatment?

A. We are very sorry to hear of your problem. We have seen this a number of times where the insurer is apparently happy to cover acupuncture as an option but requires the GP or consultant to act as a gatekeeper in providing a referral letter. We are not sure which scheme provides your cover, but we are aware that the scheme providers are wary of writing a blank cheque to scheme members for treatment where there isn't an agreed protocol which offers a realistic chance of success within a fixed number of treatments. Traditional acupuncture, which is as much about maintaining health as it is repairing damage and disease is potentially open ended and contextual, i.e. the same problem occurring in twenty people might arise from twenty different causes, some of which might respond quickly and some of which might not.

Since the schemes are created on an actuarial basis, where the provider has to have a realistic idea of what the commitment is, then the doctors and consultants are often instructed only to refer those patients with conditions for which there is a goof evidence base and standard treatment. This reduces the number of referable conditions dramatically.

It may be possible to locate a doctor who is prepared to refer your son; many private hospitals have GPs who are able to see patients at a price. Whether this would count as a referral is another matter; there's no point in spending £100 for a letter which your insurance company will repudiate anyway. We have seen patients whose companies have larger schemes which they control use this as a bargaining/blackmail chip by threatening to pull all their staff our of the scheme and go elsewhere, but this does have the disadvantage of a fresh start for people with pre-existing conditions whose cover lapses immediately.

We have found that talking directly to the insurance providers is often the best bet, both for throwing yourself on their mercy and also for finding opportunities within the system which you might be able to use to your advantage. Companies are run by human being who are often predisposed to help.

Another option is to use the PALS (Patient Advisory Liaison Service) which, in our experience, is pretty effective at fighting patient's corners. If you son is under hospital supervision, which we are sure he is, then this may well be worth a go. it won't be costing the hospital a bean, and consultants do not generally want the hassle of people nagging them when they might be shown to be unsympathetic. At very least it offers you something concrete about why they are refusing to sign, and that gives you are starting point for further negotiation.

There isn't a great deal of research we can point you to to support your case, and studies such as this

are few and far between. However, if you do get to a point where evidence might help to sway someone's mind then we will do what we can to help you.

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