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Q:  I am getting acupuncture for fertility reasons but I am a little worried.  My practitioner does not talk at all during the session which is probably normal. He begins with a very rough massage and then places needles in key areas. I am left to lie there for 20 mins until he returns to  the room and says you are finished now and that's it. I keep hearing how relaxing acupuncture is,  so I am now worried because my sessions seem so functional.  In saying that I am there to help me get pregnant so if it works I can live without the relaxation element. Please advise.

A: We are sorry to hear that your experience of treatment is not quite as you expected. Of course you are absolutely right - when you become pregnant the fact that the sessions were not as relaxing as you had hoped will fade into the background. As one of our old teachers once said, 'you're there to make people better, not to make friends'. That said, he was mainly warning about avoiding difficult treatments and hard questions, not about failing to make rapport -this was one of his great legacies, the need to establish a good rapport. While it is not an essential part of the treatment, many people do report going into states of deep relaxation when they are treated, and most practitioners will try to ensure that their patients find the experience enjoyable, whether because they drop into a restful and meditative state or talk about
their experiences and life in general.

Some practitioners, however, do not work in this way. It is not unknown for practitioners to work in the way you describe, and for some practitioners trained overseas this can often be the norm. Many Chinese practitioners, for example, are used to treating people in outpatient departments such as those where they initially trained, and this can involve working at great speed to move from patient to patient, with sometimes as many as 100 patients to see in a day. Working in the way you describe could simply be how they were trained.  This is not confined to Chinese practice; there are also a number of indigenous practitioners who prefer to let the needles do
the talking, and treat and leave. Indeed the majority of Chinese practitioner working in the West enjoy the greater amount of time available to build rapport and allow for relaxation.

Essentially, then, this is not abnormal, but not quite what you had hoped for. We suppose the choices are a little bit stark: carry on as is or drop this practitioner and go to another one. We would not be foolish enough to suggest you talk to the practitioner about changing the way he works. It might, though, he possible to address the fact that the massage is a little intense by asking for a more gentle version of the same; most responsible practitioners will be more than happy to adjust their treatments to suit the patient. This may help to make the treatment more relaxing.

We generally recommend that prospective patients shop around if they are in any doubt about what they are about to take on, and we always take the view that while rapport is not essential it helps to make the experience an enjoyable one. The same applies for length of treatment; if a very friendly practitioner works in 20 minute sessions that might not be as valuable to a prospective patient as treatment from someone with slightly less good rapport but who allows longer in the treatment room. People are perfectly free to change practitioners, and there is no reason for a subsequent practitioner to contact the previous one if the patient says that they should not. If you did choose to move, there would be no problem as long as you cancelled any outstanding treatments in good time.

Above all, though, we hope that the treatment works.

Q:  I have a spine condition due to age whereby the vertebra in my neck are compressing trapping nerve ends and causing numbness and tingling in my fingers. Can acupuncture help relieve this, and if it can who can I contact in my M241GB postcode area?

A: Finding a BAcC practitioner in your area couldn't be easier. If you log on to our website at www.acupuncture.org.uk you will see on the home page a postcode search facility which will identify the geographically closest practitioners. This is more sensitive than searches by town because this sometimes excludes people who are just over a town boundary but relatively close.

As far as your health problem is concerned, we are always a little cautious in the claims which we make for acupuncture treatment for age related problems. In the language of modern sales advertisements, once it's gone it's gone, and deterioration of the cervical spines causing impingement of the nerves is not that straightforward to treat. We had a similar enquiry sometime ago about trapped nerves in the neck, and we answered:

If the problem is structural there may be some value in having some form of manipulation alongside or instead of acupuncture treatment. Osteopaths and chiropractors often treat this problem as one of their 'stock' items for referral. However, a great many problems of this nature are caused either by spasms of the muscles which in turn impinge the nerves or by inflammation of the surrounding tissues. In both cases acupuncture, both in the traditional Chinese form used by BAcC members and in the western medical form used by doctors and physios, is frequently used to good effect, and there is considerable evidence for the successful treatment of inflammation and muscle spasm with acupuncture. Most studies are done on chronic, rather than acute, neck pain, but the results of a very large German study condcted five years ago

http://www.ncbi.nlm.nih.gov/pubmed/16781068

are typical of the kinds of outcomes reported, although Ernst and White were not quite so positive in their review

http://www.ncbi.nlm.nih.gov/pubmed/10342627

However, when there has been significant deterioration many osteopaths and chiropractors will not treat in case they extend the damage, and aiming to reduce the inflammation and pain becomes the main objective. There is no doubt that acupuncture has something of a reputation for this; it has become a standard part of the package in pain management clinics. The question then becomes mainly one of how much relief the treatment offers and how sustainable the effects might be. It shouldn't come down to finances but it often does. If someone can afford weekly or fortnightly treatment over an extended period and the trade-off is that they can carry on working, then there are times when a practitioner will carry on treating. Most, though, are reluctant to continue when there is no 'upward' curve.

Having said all this, there are many ways of  understanding symptoms in Chinese medicine which may not have the same assumed causal relationship with a structural problem. We have treated many people with arthritis of the lower spine whose back pain has disappeared without any discernible change in their X-ray pictures, and although the likelihood is that impingement of the nerve is causing your problem, it may be worth examining whether there may be other reasons for the numbness and tingling.

As we nearly always say, the unique nature of the individual and their energetic patterns means that it is very difficult to give definitive advice by e-mail, and we best advice is always to visit a BAcC member local to you for an informal assessment of what may be possible. Most are happy to do this before people commit to treatment, so that if they do they have a very clear idea of what to expect and what the outcomes might be.  

A:  We have been asked this question before, although not as frequently as we might have imagined, and the most recent answer that we gave was:

There have been a number of studies and reviews of the effects of acupuncture on specific aspects of Type 2 Diabetes, two examples of which are:
 
http://www.ncbi.nlm.nih.gov/pubmed/18257350
 
http://www.ncbi.nlm.nih.gov/pubmed/20590731

 

However, as in many cases, there are not enough trials and not a consistent enough standard of methodological rigour to be able to draw any firm conclusions on which we could base positive recommendations.
 
One factor which our members do take into account when treating people with diabetes in any form is that acupuncture treatment may have the effect of kick-starting any residual function in the insulin-producing cells. For Type 2 this is less critical but for a Type 1 diabetic with a carefully balanced regime the addition of unplanned insulin in the system could tip then into an unexpected hypoglycaemic state.
 
Diabetes is not new, and was recognised in most ancient cultures, sometimes being diagnosed, as in ancient Greece, by the sweet taste of the excess sugar in the urine. Traditional Chinese medicine also recognised some of the groups of symptoms as distinct 'wasting-thirsting' syndromes, as our factsheet describes

 

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/type-2-diabetes.html
  
but as the factsheet also says, acupuncture is generally used alongside conventional treatment and is not offered as an alternative to it.
 
Although it is becoming a more common condition, partly because of the increasing age of the population and partly because of the increasing levels of obesity and dietary weakness as well as being a hereditary condition, it remains a serious problem, and can lead, if not properly managed, to some very serious complications in later life. For this reason our members are always very keen to ensure that their treatment is a part of an overall management plan for the condition.
 
Each presentation is different, however, and you would be best advised to have a short conversation with the practitioners who have helped you before about whether they think acupuncture would benefit your particular presentation. Clearly we believe that regular acupuncture treatment is a valuable way of maintaining good health, but we have to take into account that many patients have specific outcomes, and try not to commit people to open-ended treatment if what they need or want may be more limited in scope.

 

We think that this remains sound advice. What we would perhaps add now is a more positive statement about the advantages of using acupuncture to help with the factors which predispose people to Type 2 Diabetes, like diet and exercise. Although we cannot make any specific claims about acupuncture having been shown to assist in weight loss or make someone fitter, there is no doubt that the dietary advice which is a part of the Chinese medicine tradition can be very valuable. It is often surprising how many people are eating the types of food which their system, understood in Chinese medicine terms, are least able to cope with and which make their problems worse. Even something as simple as a slight variation of diet based on an understanding of which foods help or hinder the system can have a surprising effect.

Each person is unique and different, however, and the best advice we can give is for you to visit a BAcC member local to you for advice which

Q: An acupuncturist put a needle in my neck and then suddenly pulled it out and stopped the session. When I asked why he said my body suddenly went really cold, but wouldn't explain any further. Since then I've had increased pain in my neck and I haven't been back to him, but I wonder if you could tell me what might have occurred at that time? I would really appreciate having a clearer understanding of what that could me (my body suddenly going cold) and if this is a common problem in acupuncture or something associated with a doctor who perhaps is less qualified than they should be?

>A:  We are sorry to hear of your experience of acupuncture treatment. While not impossible for this to happen it is relatively rare in our experience. 

We would probably classify this kind of reaction as 'needle shock.' This is not caused by any specific interference with or damage to a part of the body but happens in people who are quite sensitive to being needled. We would describe this as  an energetic reaction, whereas conventional medical professionals would tend to describe this as a neurological one, but essentially a rapid temperature change/loss is sometimes a precursor to someone fainting, and a responsible practitioner will simply stop the treatment at that point. They may put the patient in the recovery position, but in any event will often make them lie down for a moment until they feel better. In your case, you had not felt any reaction, and it was the practitioner's experience of cold which meant that they drew the acupuncture session to a close, so restorative action may not have been required.

We don't think that the level of training that your doctor has is a factor. One significant difference between medical acupuncture and traditional acupuncture, though, is that western acupuncture has no concept of energy, and is often based on an understanding of trigger points, blockages in the body of muscle, or on a neurological mechanism which causes a healing response. This does mean that the technique can often be applied a little more vigorously than we would expect our members to do, and this can sometimes trigger a reaction such as you have had. If this was a traditional acupuncturist, they would simply reduce the number of needles they used, insert them less deeply and use less manipulation of the needle. However, since these are not usually factors within medical acupuncture, the practitioner has taken the wise precaution of stopping.

The increased pain in the neck may be connected with the acupuncture session, but without knowing the timescales involved, i.e. how long it is since the treatment and how soon after the treatment the pain increased, we cannot say. It is highly unlikely to be a sign of physical damage, although there may be some internal bruising which can happen after treatment. We are assuming that you were having treatment for neck pain, and it is not uncommon for this to be affected by all manner of movements, thus making it very difficult to work out exactly what causes it to become worse.

The bottom line for us, though, is that if a patient has a problem after a session, then the first and most necessary port of call is the practitioner who undertook the treatment. They know exactly what they did, where the needles were inserted, and so on, and are best placed to comment of what has happened. If the practitioner does not give a satisfactory answer, the next step is to contact any professional body to which they belong, or in the case of a doctor the practice manager of the practice where they work to find out where to make a complaint. Hopefully, however, it will not come to this, and the practitioner will be able to reassure you about what has happened.   

Q:  We  are very attracted by the Channel Islands, and would like to move there. My husband has been practicing acupuncture in the USA for 30 years. In USA and in China, he learned TCM. He is an American citizen and I am German citizen. How would it be possible for him  to practise his profession  and help the people on the Channel Islands?

As far as we are aware,  the level of qualification which your husband has achieved in order to be able to practise in the USA should be more than adequate to meet the eligibility requirements for practice. We are familiar with the requirements in Jersey, having had extensive correspondence with the government of Jersey when the new Code of Practice

http://www.gov.je/SiteCollectionDocuments/Health%20and%20wellbeing/LD%20Piercing%20and%20tattoing%20law%20approved%20code%20of%20practice%2020140926%20JE.pdf

was introduced, and we are sure that the current US standard more than meets the criterion set down in page 22 of the document.

Guernsey and Alderney have a very similar statement in their byelaws

http://www.gov.gg/CHttpHandler.ashx?id=92734&p=0

We believe that Sark submits to, or complies with, the laws of Guernsey in most matters, but with a population of 600 we think it is highly unlikely that you will be choosing this as your primary practice site.

In all matters to do with registration for acupuncture practice we always advise people to initiate a dialogue with the authorities under whose jurisdiction they fall. In the end they will always have the final word on who and what is acceptable, and practitioners will always become visible sooner or later, so hoping to go unnoticed or uninspected is not a good option.

There are a number of aspects of the legislation in Jersey to which we took exception, mainly around requirements for second sinks in treatment rooms for washing equipment to be re-used. The laws apply to all skin piercing activities, and although none of the equipment we use is re-useable, our members were required to comply. This illustrates what we have always told our members, that whatever standards we set, the local authority rules, if higher, are the ones they have to follow. 

The only factor on which we cannot comment is the more general one about residency on the islands. Jersey, for example,. has fairly stringent rules for who can and cannot live and work on the island, and you would need to take advice from the relevant authorities on eligibility to work there.  The summary here

 http://www.cab.org.je/index.php?option=com_content&view=article&id=91:jersey-information-for-those-wishing-to-live-and-work-in-the-island-312&catid=20&Itemid=48

is quite useful and the formal portal

http://www.gov.je/LIFEEVENTS/CITIZENSHIPSETTLINGINJERSEY/SETTLEMENTINJERSEY/Pages/SettlementInJersey.aspx

gives further detail and paperwork.

We wish you every success in your endeavour.

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