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Ask an expert - general

154 questions

A:  We drew up a review paper some years ago

http://www.acupuncture.org.uk/arrc/public-review-papers/substance-abuse-and-acupuncture-the-evidence-for-effectiveness.html

which summarises the use of acupuncture treatment for a number of substance abuse problems, and as you can see in the paper, the evidence for the use of acupuncture is relatively positive, although the trials undertaken are often methodologically flawed and rather small to be used as a basis for definitive statements. The most recent systematic review in 2009 reached this conclusion, and nothing significant has been published more recently to change this view.

However, although mainstream acupuncture treatment is used to deal with the problems of alcoholism, there are a great many projects which use a more limited form of acupuncture, ear acupuncture or auricular acupuncture as it is often known. There are two very large national groups, NADA-UK (www.nadauk.com) and SMART-UK (www.smart-uk.com) whose members offer the five-point protocol and other formula treatments for helping people to deal with the problems of alcohol, and details of where practitioners can be found are on both websites. A great deal of their work is done in drop-in facilities, and some provide additional support and counselling as a part of the service.

There are also a substantial number of practitioners who belong to the Microsystems Acupuncture Regulatory Working Group which is registered with the PSA-accredited Complementary and Natural Healthcare Council. This group includes a number of organisations whose members offer more sophisticated auricular treatment than simple protocols, and their details can be found here (http://www.macrwg.org/).

This does not mean that the ordinary BAcC member does not treat people with alcohol problems, and many do to great effect. Our experience, however, is that the group setting of the detox projects often adds considerable value to the treatment through the peer pressure and encouragement which abounds. It may still be worthwhile seeking the advice of a local BAcC member, however. There are huge variations in the experience of alcoholism, from falling down drunk to a simple realisation that the end of work day drink is becoming a necessity rather than a treat, and our members may well be able to provide exactly what someone needs.

We think this remains basically sound advice. There are a number of issues with which one has to be careful. There is certainly an argument which we have heard advanced by many colleagues that using five-point protocols is all very well, but going to a professionla acupuncturist who treats the person and not just the condition can offer some help in treating the causes of addiction as well as the addiction itself, and we have some sympathy for this view. In fact, we have had our own patients for whom the driver for their addiction problems was an imbalance which we were able to help resolve.

However, many of the problems which lead to someone becoming addicted to alcohol or any other substance are very complex, and being able to negotiate the difficulties is something for the expert, not the gifted amateur. We have seen colleagues get themselves into very uncomfortable situations by gettig out of their depth, and we always advise them that being part of a multi-disciplinary team is pretty much always the best way to help people come to terms with and control their addictions.

A:  In the case of treatment for tinnitus, we have expressed some reservations about how responsive to acupuncture the condition can be, and we have reproduced below our last answer which addressed this problem:

Can acupuncture help with severe tinnitus?

As you can imagine, we have been asked this question on several occasions, and our replies have not been that encouraging. The fact sheet which we have on the website
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html
 
is quite upbeat about a number of small studies, but our clinical experience is not as good, with tinnitus among the more intractable conditions with which patients present. In a recent answer, to which we can probably not add a great deal more, we said:


 A. Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet, found at lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. It is also fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. It is quite easy to spend considerable time and money and be no better off than when you started, and the individual case reports in the tinnitus sufferers' magazines often have the same shape.

However, what many practitioners do find when treating people with tinnitus is that while the noise remains largely unchanged their ability to cope with it seems to improve. Evidence for this is largely anecdotal, though, and it would be wise to discuss carefully with any future practitioner whether they think that they might be able to help. In all events we would recommend that frequent and regular reviews of outcomes and progress are essential.

We don't think you can say more than this. There are two or three clearly identifiable patterns in Chinese medicine, described as syndromes, where tinnitus is a specific named symptom which frequently appears, and it is possible, if your tinnitus has arisen as a part of the syndrome, that there may be some help which acupuncture treatment may offer. An experienced practitioner should be able to make a very straightforward determination on whether this is the case. Overall, however, there is not a great deal of cause for optimism about getting rid of the unwanted

A: We are happy to say that the majority of health insurers are now happy to fund acupuncture treatment. The fact that NICE (the National Institute for Clinical Excellence) has now included acupuncture as a treatment of choice for chronic low back pain has also meant that some policies which were more restricted in cover have now accepted acupuncture treatment as an option.

We are still mid-negotiation with BUPA and AXA/PPP, the two major insurers who have until now not accepted BAcC members as traditional acupuncture providers, but restricted their cover to acupuncture provided by members of the British Medical Acupuncture Society or statutorily regulated healthcare professionals. Their criteria for acceptance even of these are quite strict, and many doctors do not meet them. However, BUPA are on the verge of accepting BAcC members as eligible providers, and we are hoping that where they lead, AXA/PPP will follow.

The majority of insurance providers, as we said, are more than happy to cover acupuncture treatment to a certain limit. Where there has been any reluctance we have known patients to win ad hominem concessions with the threat of taking their business elsewhere, but we always counsel caution to our patients considering this as an option, because if the company calls their bluff and they have to find a new insurer, many policy providers will not take on pre-existing conditions. If someone has a long history of claims for a chronic problem, the last thing they want to do is undermine their cover by going elsewhere. 

There are no age restrictions on acupuncture treatment. The only limiting factors are the informed consent necessary for treatment and relatively small number of clinical circumstances where treatment is contra-indicated or inadvisable.

At the 'lower' end of the scale, children under the age of 16 have to be accompanied by a parent or guardian, and consent lies with the parent. A child of 14 or 15 is now deemed by case law (this used to be called 'Gillick competent') to be able to refuse to have treatment, but we have not yet encountered any cases where a 14 or 15 year old has sought treatment when accompanied by a responsible adult who is not their parent or guardian. We would take legal advice should this question be asked of us; it is a highly technical argument.

At the other end of the scale the question of competence is just as important. From a Chinese medicine perspective based on the balance of energy and the enhancement of the quality of life there is never a stage where treatment would not be deemed beneficial. However, if someone is starting to exhibit clear signs of dementia or other forms of mental incapacity, a practitioner may need to proceed with caution. The issue of who has authority to give consent is a tricky one, and questions of a highly technical nature abut power of attorney start to present themselves. It is not, as is widely believed, simply a matter for the next of kin to decide.

The other factor in the treatment of children, especially the very young, is that although we do not require members to have undertaken specialist training, we have now published recommendations for what we would regard as minimum levels of postgraduate training and experience for treating children. While it is perfectly safe to treat children of any age with generalist skills, we do recognise that optimal treatment sometimes requires additional training; children are not simply small adults, and there are variations in children's energies which is it valuable to understand.

A:  Pins and needles, often called paresthesia in conventional medicine, is usually associated with poor circulation or some kind of interference with the nerve pathways. Generally speaking, it is self-correcting, so when it occurs all the time it needs to be investigated thoroughly. We don't want to sound like harbingers of doom, but there are several quite serious conditions for which constant pins and needles are a symptom or general warning sign. It is really important to discuss this with a GP and possibly arrange for a consultation with a neurologist just to be sure that this is not the tip of a much larger iceberg. The chances of it being more than it appears are remote, but we have a duty of care to our patients to ensure that there is nothing for which conventional treatment is required.
 
There is, as you might imagine, very little research in this area under the general heading of paresthesia. What you will find is a certain amount of research on peripheral neuropathy, which is one condition where pins and needles sensations are among the range of possibilities. We answered a question on this a short while ago, and you can see our answer here:
 
http://www.acupuncture.org.uk/public-content/public-ask-an-expert/ask-an-expert-general/ask-an-expert-general-general-uncategorised/can-acupuncture-help-with-peripheral-neuropathy.html
 
However, symptoms like this have existed since we started walking upright, and Chinese medicine, which has a 2500 year history, has been addressing such problems within its own conceptual framework. As you may already know by looking at our website, Chinese medicine is based on a theort of energy, called 'qi', which flows around the body in specific patterns whose flow, rhythm and balance are a precondition of good health. When the flow is disturbed or blocked, then ill health in the form of symptoms will start to emerge. The flow is maintained by the Organs of the body (always capitalised in Chinese medicine because these are groups of functions overlapping with the physical organ as it is understood in conventional medicine), and when symptoms like pins and needles appear, it usually points to a number of specific possibilities for Organic malfunction.
 
Nothing is as straightforward as that, however! The interconnections of all parts of the system mean that there is a considerable art and skill in the practitioner's interpretation of what is happening. That a part of the system is causing a problem is not difficult to determine. Whether that is the source of the problem or whether that part of the system is reacting to imbalance elsewhere is critical. Treating in the 'point and shoot' manner of cookbook formulae may help for a while, but if the underlying problem is not addressed the symptoms will come back or worse still, be suppressed while the problem continues to develop. This is why the BAcC sets so much store by the degree-level training our members have; it takes that long to be able, in our view, to begin to master these skills.
 
The best advice we can give in situations like these, where the range of possibilities tends to be quite wide, is to arrange a visit to a BAcC member local to you for a brief face to face assessment and discussion of whether acupuncture treatment is appropriate for this problem. Most members are very happy to do this, usually without charge, to ensure a good 'fit' in terms of type fo therapy and patient. If they feel that there may be other better options, be they conventional or complementary, they will probably say so. 
 
 

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