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Q: I saw an osteopath today for acupuncture treatment of my lower back. I have 2 damaged discs at L4-5. As one needle went in it was fairly painful like a nerve had been touched. She said she was near one of my damaged discs. When she started moving a different needle the pain was unbelievable like a intense burning sensation. She removed the needle straight away and massaged the area until the pain subsided. Everything I have read seems to suggest I shouldn't have felt this pain. I am due to go back for another session next week but I'm really concerned now.

A: We are very sorry to hear of your experience. Acupuncture treatment can occasionally be a little uncomfortable with a dull aching sensation, and on very rare occasions it can produce a very sharp reaction if a nerve is hit. Much rarer, though, are the occasions when it generates extreme sensations.

However, the fact that the pain subsided after a little gentle massage is quite a positive sign. If there had been serious damage or if the practitioner had hit a nerve there is less chance that things would have settled down so quickly. Indeed, where someone has had some very long term conditions there can occasionally be a quite violent release with some very strong after effects, so it could possibly be that this has been a very positive treatment. You will soon find out from changes which occur after the treatment. We tend to advise people that the next 24-48 hours might be a little up and down, but after that if there is going to be improvement it will swiftly become noticeable.

Although we have great respect for colleagues in the other professions who use acupuncture alongside their own modalities, it is no secret that we have been highly critical of the proliferation of very short courses adding acupuncture to another existing modality. The doctors and physios, both of whom have special interest groups protecting the public interest, have published standards for what they do and well-organised training. Many osteopaths and chiropractors, and even some podiatrists, however, are increasingly taking these short courses. We believe that it is not possible to cram both the techniques and theory into such a course at the same time as ensuring that appropriate safety standards and hygienic practice are being passed on.

This is not intended to cast aspersions on your osteopath, who may very well have substantial training and experience, and we have no doubt that what you have experienced is probably a one-off. However, as a general rule we prefer people to see practitioners whose primary focus is acupuncture rather than practitioners offering acupuncture as an adjunct within their existing skill set. Knowing what to do is important, but knowing what to do when things go wrong is as, if not more, important. For this it is essential that someone has had an in-depth training. We would not countenance our members having a go at a few osteopathic manipulations, and we're pretty sure the osteopathic associations wouldn't be that happy either.

By all means go ahead with the treatment next week, and rest assured that the chances are that it will be largely uneventful. If there is any repetition of the extreme pain or sensation, then remember that any healthcare professional can only work with your consent. If you say 'stop' then they have no choice but to so do. But we doubt it will come to that!

Q: Can I get Acupuncture free on the NHS in the Chester area?

A: We're very sorry to say that unless by chance there is a GP or physiotherapist inside the NHS to whom you can get a referral there is very little chance of obtaining acupuncture treatment within the NHS, in the UK as a whole and not just within the Chester area. There used to be a number of projects and facilities within the NHS which provided treatment free at the point of delivery, but as we are sure you are more than clearly aware, the current funding strictures inside the NHS have seen a great many of what have been perceived as 'luxury' services cancelled or closed down.

The only realistic chance of getting treatment within the NHS will be if someone working within it has added it to their repertoire. With over 7000 physios and 2500 doctors having done so there is a small chance, but the acupuncture you receive will be decidedly medical, not traditional. This means that it is likely to be directed at the symptoms from which you suffer, and be based on a western medical diagnosis. We don't knock this; many of the people trained in this style do a great job. They are limited really to those things which have an evidence base, and for many technical reasons the thousands of acupuncture studies are not really accepted as sufficient proof to offer a wider range of treatments.

If it is the cost which is the determining factor you could do worse than talk to some of our members in your area (whose details you can find by entering your postcode in the database search on our home page). Many are prepared to offer reduced fees for cases of financial hardship but we never advise people to advertise this because it sometimes encourages people who can well afford treatment to start bartering. There are also a number of community acupuncture clinics which aim to offer treatment in a multi-bed environment, but we have checked their website (acmac.net) and there are no clinics near you. The nearest is in Manchester, the fares to which might well outweigh the cost savings on treatment.

We suspect you might find this an impossible task, but we send every good wish to succeed and if you do manage to get into the system we would love to hear how you did it!

Q: Does acupuncture have a gradual or immediate effect on the body?

A: We suppose the clearest expression would be that the effect of using the needles is immediate, but the changes experienced by the patient can often take a while to be felt.

We think that a major challenge in helping the public understand the system of Chinese medicine is that the acupuncture points and the channels which connect them often look like an electrical wiring diagram when they are shown in books, and people have a sense that putting a needle in a point immediately activates the whole channel at once. Now this can be the case; we have had many sensitive patients over the years who have been able to describe in detail the whole pathway of a meridian including the deep internal pathways. However for the majority of people, although they will feel where the needle is placed, they are not going to experience changes immediately.

Some of the very ancient and beautiful Daoist paintings show the body as a landscape, with the stomach as a granary and so on, and the channel system is shown as a drainage and irrigation ditch. Needling a point is rather like opening a sluice gate and starting a flow which will have an immediate effect at the gate (which is why a practitioner will take a pulse at the wrist and pronounce themselves satisfied that something is happening) but take a while longer to reach the areas that matter. Otherwise it would be like watering a plant and seeing the leaves suddenly spring into life again.

Clearly there are some conditions where a change can be pretty fast, especially where the problem has been caused by blockage. Some acute short term problems can be reversed incredibly quickly if a patient is lucky, and we have seen headaches and backaches almost magically disappear. For the majority of patients, though, change is more evenly paced, and for many reasons this is a more natural way to recover good health. It can take a while to adjust to the stages of recovery, and having more time means that the system does not get 'jolted' back to good health.

The skill and art of the practitioner lies in using their experience to judge which people are likely to experience change quickly and which may have to wait a while for changes to happen. The longer the problem has existed and the deeper it has gone into the system, the longer it will usually take to address, however well the person may look on the outside. The Chinese tend to use the 'shen' or spirit seen in the eyes as a determinant of who will be most likely to recover well.

Q: I am a medical acupuncturist in Australia. Just wondering if you have any evidence for the use of acupuncture in Polymyalgia Rheumatica?

A: As you can imagine we have been asked about this condition by prospective patients on a number of occasions, and the most recent answer we gave was:

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.

This explains the situation very clearly from a Chinese medicine perspective, but for someone using acupuncture within a conventional medical framework this probably wouldn't help. We have shared a very helpful and informative relationship with our medical acupuncture colleagues in the UK, and they have often found that trigger point acupuncture has been helpful, as has segmental acupuncture to a degree. The theories behind these approaches can overlap usefully with the main presenting symptoms of PMR, but naturally the overall diagnosis overlaps with dozens of other local conditions, so rather than being points for PMR these would be better seen as 'area acupuncture.'

The one thing which medical acupuncture lacks, and we mean no disrespect by saying so, is a systemic approach to ill health in the body. Many of the patients who present to us as traditional acupuncturists have problems which clearly point to weaknesses in the overall functions of some of the body's systems, and we often find that unless these are addressed as well then treatment may only have a short term effect.

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 are sure that your non-medical colleagues in Australia would be happy to discuss this whole area of treatment with you.

Q: Is there much evidence for treating CRPS with acupuncture? My 15 year old daughter has it in her ankle/foot.

A:

We were asked a similar question a year ago and our response then was:

Diagnosing the pain as CRPS (we normally call this Complex Regional Pain Syndrome rather than Chronic, but it's only a name) doesn't really refine the diagnosis a great deal. If you look at the wikipedia entry on CRPS, as we are sure that you have, there is no clear-cut cause, the term mainly being used to describe a complex array of neuropathic and sensory pains of great severity. From an acupuncture treatment point of view, both in traditional Chinese and western medical versions, chronic pain was one of the main focuses of research in the 1970s and onwards following Nixon's visit to China and the film footage of people having operations without anaesthetic. There has been a great deal of research, as our factsheets on chronic pain and neuropathic pain show http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html & http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/neuropathic-pain.html When we are asked about the value of treatment all we can say is that it is worth trying, and that the major issue will not be whether it works but the extent to which it works and how sustainable the improvements are. Generally speaking we do not like to continue treating someone where there is no overall improvement but simply respite from pain which always lasts only for a short while. However, patients over the years have told us emphatically that if the trade off for a little regular cost is the ability to maintain a valuable and valued lifestyle then it's their call, not ours. However, from a Chinese medicine perspective there is often a great deal more hope than simply symptom suppression. The system of medicine is predicated on the balanced and effective flow of energies in the body, and if for any reason this flow becomes imbalanced - overflowing, weak or blocked - then pain will result. The re-establishment of proper flow will restore balance and in theory the pain should go. The major task the practitioner faces is determining how much the problem is simply local and how much it depends on underlying systemic weaknesses for its enduring nature. In your daughter's case her youth probably means that she's in good health, and twelve year olds tend to respond well to treatment, as do most children. Undoubtedly, though, the pain and trauma will have taken some toll. It would be well worth while contacting a BAcC member local to you for advice based on a brief face to face assessment of what is happening in your daughter's case. Although we have not yet finalised our discussions on expert practice in relation to paediatrics, it is likely that in the next few years we shall recognise the postgraduate training that many members undertake in treating children. They are not simply small adults, and it may well be worthwhile using google searches for 'acupuncture' and 'children' to see if there are, as is likely, BAcC members who have followed this path. We are not quite yet in a position to identify them directly. That said, any practitioner worth their salt will be more than adequately able to help and offer their advice.

We don't think there's a great deal we can add to this answer. We have conducted a search of the databases and found case reports like this one https://www.ncbi.nlm.nih.gov/pubmed/23113454, although you are not going to find it easy to locate a Chinese scalp acupuncturist in your area, this being a modern development for which there are as yet no agreed standards. There are also studies like this one https://www.ncbi.nlm.nih.gov/pubmed/21208130.

But single case studies are far too unreliable for drawing useful conclusions. They may prompt further research, but there are too many confounding factors in play to be sure what has effected the change. Many people who become the subject of a study improve by virtue of the extra attention they are getting.

We always find that going back to basic principles is the best answer. From a Chinese medicine perspective pain arises where there is a blockage in energy flow, an excess of a deficiency in the system as a whole, and usually a combination of local and systemic issues. Since each patient is unique and different it is really only possible to say whether a treatment for one of the less common presenting problems will work through actually seeing what is happening.

The advice we gave in the previous answer is your best bet. If a local practitioner can spare a few minutes to see your daughter to assess the situation you will get an honest appraisal of what acupuncture may do and also recommendations for other forms of treatment if the practitioner thinks these might be better.

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