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A :As you may have seen from this answer about a similar rheumatoid arthritis problem which we posted some time ago:

As you can see from our factsheet for one auto-immune disorder affecting the joints, rheumatoid arthritis

the evidence for the use of acpuncture treatment is equivocal. The gold standard for evidence, the ramdomised double blind
control trial, it has to be said, is not the best method for assessing acupuncture, and there is a great deal of slightly lower grade evidence from China which is encouraging.

However, acupuncture as a system of medicine is premised on an entirely different understanding of the
human physiology as a flow of energy, called 'qi' whose flow and balance is crucial to good health. Qi is also said to make up all of nature, and so interactions between man and his world would and could have a direct bearing on health.

The best course of action with problems such as these, however, is to visit a BAcC member local to you for advice. Most
are more than willing to give up some time without charge to give someone a better assessment face to face of whether acupuncture treatment is a  good bet, and most are always willing to refer on to other forms of
treatment if they think something else would be better for the patient.

we tend to be a little cautious in our responses about RA. In our experience this can sometimes be intractable to treatment, and we do not want to excite expectation which cannot be fulfilled.

However, there is a long history of acupuncture being used for chronic pain, as another factsheet shows:

and when acupuncture first started to become popularised in the West after Nixon's visit to China in the 1970s, it was the mechanisms of pain which became the focus of a great deal of the research. This was largely because the outcome measures were very clear. What we tend to say to people who look for pain relief from acupuncture is that in absence of a reversal of their main condition, the equation is really one of how much relief the treatment gives, and how sustainable the change is, set against the cost of the treatment. If the equation works, i.e. it remains cost effective to have long term treatment because the freedoms conferred allow a better quality of life, all well and good. If the change is short lived, however, then it may not be such a good option unless there are specific circumstances where being pain free even for a short time would be ideal.

Our usual response when working with conditions like RA, and one which is in keeping with the tradition to which we are heirs, is to set aside the western disease labels and to examine what is happening from a Chinese medicine perspective. This can often produce far greater clarity ofintent than working with a disease label which in itself carries associations of chronic degeneration.

Q:  My  mum (aged 72) has spondylosis and suffers greatly with pain in her neck and now has quite a pronounced curvature on her spine. Would acupuncture help with the pain anddiscomfort she is experiencing?

A:We actually gave a very comprehensive response to a question about pain relief and spondylosis some months ago. It said:

There are very few research papers for the treatment of spondylitis with acupuncture, and those which have become available are generally Chinese studies which are both small and often methodologically flawed. A good example is this one:

This does not mean that it has no significance. The problem is that in the West there is more focus on the 'does it work?' question rather than, until recently in China, a focus on 'what works better?'. When you are using a two-thousand year old tradition which is embedded in the culture the use of the western drug testing model, the randomised double blind control trial, is not likely to be
your model of choice. This latter test is not entirely appropriate for testing acupuncture, because reducing the variables to one is inconsistent with how good acupuncture is practised, so unsurprisingly the number of meaningful trials is limited.

That said, pain relief was one of the most heavily tested aspects of acupuncture treatment when it became more popular in the West, which is generally taken to be after Nixon's visit to China in the 1970s. The outcome measures for research purposes, the various neurotransmitters, and the patient reports of pain are easily measured, and many studies were done which showed that acupuncture does have an effect on the experience of pain. Our fact sheet on chronic pain cites a number of the better known ones. The main issue with using acupuncture for pain relief is weighing up the extent and sustainability of te relief against the cost of treatment, to put it bluntly. If, for example, treatment offers 48 hours of pain free life followed by a couple of days of bearable pain, then someone with deep pockets might find
acupuncture treatment a reasonable investment. The vast majority of us, though, are not in this position, and also the greater majority of practitioners tend not to like to continue treatment indefinitely if there is no sign of a permanent reduction in the levels of pain.

The key aim with a condition like spondylitis is not a reversal of the fusing of vertebrae ultimately caused by the condition but a breaking of the cycle of inflammation which tends to sustain itself, i.e. inflamed areas press against surrounding tissue and further aggravate the inflammation. If treatment, whether by medication or acupuncture, can break this cycle there is a chance of
maintaining a level of manageable pain. The disease label covers a wide range of presentations, and you would need to see a
BAcC member local to you for a brief face to face assessment of whether treatment would be worthwhile for you. From a Chinese medicine perspective there are also a number of systemic problems which can underpin what is in effect a local problem, and a practitioner will be able to assess quite rapidly what else may be going on in the system to inform the diagnosis in Chinese
medicine terms and to give a clearer sense of the prognosis. He or she, if you do decide to have treatment, will be very clear about setting clear outcome measures to see whether the treatment is working, and regular review periods to assess whether treatment continues to be of benefit. We think that remains good advice. The fact that your mother is 72 is not in itself an issue. The problem is more to do with the level of deterioration. In the parlance of modern supermarket advertising 'when it's gone it's gone', which means that in most cases a physical deterioration of bony structures limits the extent to which change can be effected. However, the
fact that someone has spondylosis and also has pain does not mean that there is an absolute correlation between the two. We have treated patients with severe deterioration and seen changes which were thought to have been impossible. It may well be that the pain was not a direct response to the physical issue. However, this is the exception, not the rule, and since each person's condition
is going to be unique to them in Chinese medicine terms, the best advice that we can give is to visit a local BAcC member for a brief face to face assessment of what may be possible.

Q:  I'm not sure if you can advise but I am wondering if the Chinese practitioner I have started seeing is safe. I have never had any Chinese medicine before but was very positive about trying it for fatigue and PMS issues. I didn't do any research but went into an office on the high street here in Oxford. The doctor is Chinese and doesn't speak so much English. The assessment consisted merely of taking my pulse and looking at my notes where I had written what my problems are. Then immediately treatment began - acupuncture and massage followed by selling me herbs. I have been back once and he just asked me how I've been and then we went straight into acupuncture. I want to trust him. I'm guessing this might be how treatment is in China and he knows what he is doing. He did tell
me to stop taking any other medicine I might be taking but didn't ask what I am taking. Could you advise as to your opinion? very much,

A: What you describe is not unusual practice in many of the High Street shops which provide acupuncture and herbal medicine. We have to say that many of the practitioners who work in these settings are often highly qualified and experienced, but it is equally true to say that in many cases their levels of English language, both spoken and listening, are not up to par,and they do often convey a sense of not really taking important issues into account. The exhortation to stop taking medications, for example, could have
very serious consequences if taken literally by someone taking a medication whose withdrawal could have serious consequences, like Type 2 diabetes medication, or where sudden withdrawal of, for example, an anti-depressant could lead to a serious rebound effect on controlled mental health problems.

We have over the years received a great many complaints about which we can do nothing to do with the pressure selling in these
establishments which sees patients being sold herbs, teas and potions and often paying for several sessions up front with no hope of getting a refund if they choose to draw a line after two or three. All that we can say is that you tread with caution. It is highly unlikely, however, that what you are receiving is unsafe; even in the hands of the poorly trained acupuncture has an amazingly
good safety record, and these practitioners are usually highly trained.However, if you do not feel comfortable with how the treatment is delivered, then simply exercise your right as a consumer to walk away and find a practitioner who meets your needs better.

This is not a plug, but we have over 50 members working in the Oxford area, and we are confident that you should be able to find someone with whom you have a good rapport as well as receiving good treatment. Our concern, such as it is, is that we spend a great deal of time seeking all sorts of useful information from a patient, both from case history and from examinations of various kinds, and we would probably question whether someone who takes pulse and tongue and little else is going to be able to do what we believe is the best feature of Chinese medicine, deliver treatment precisely focused on the unique individual who is receiving it.

Q:  HiI have recently become very interested in acupuncture in terms of becoming one.I have looked into it quite a lot but haven't got all my questions answered. I am 16 , doing my last year of gcses and would like to know where to start after I have completed my gcses. What are the entry requirements of becoming an acupuncturist? What are the costs of courses?

A:We are very pleased to hear that you are considering a career in acupuncture. We have never regretted it as a choice for one moment.

By far the most informative site is that of our sister body, the British Acupuncture Accreditation Board (BAAB). This is the body which
accredits courses whose graduates are automatically eligible to join the BAcC, and the website has
some very clear sections about what it takes to become a practitioner. The training is set at degree level, and as such the entry requirements are broadly similar.

As far as the cost of training is concerned there has been something of a turnaround in the last few years with the large increases in
university fees. Before then, the costs of training for courses within universities looked like a steal compared with the £4000-£5000 a year fees in independent teaching institutions, especially when the Licenciate in Acupuncture was often accompanied by a BSc degree. However, many universities put courses right at the top of the fee scale, so £9000 a year became the norm. The fact that this is largely deferred until you earn enough to start paying back is not necessarily a pleasant thought; no-one wants £30K of debt waiting around the corner. There has been a resurgence of interest in the independents, and generally speaking training is on the up again, with some courses looking to use modern methods of distance learning, like webinars, to keep the costs down.

All of the courses hold open days, though, and the BAAB site clearly signposts all the courses to contact, so your best bet is to see if
there is a course relatively near to you which you can visit and see for yourself how this might work. You might want to ring a local practitioner and ask a little more, but we can't guarantee what reception you might get - some will be happy to do so, others may not.

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The issue of group treatment is a very live one for the
BAcC. We have seen the growth of multibed clinics in the last few years
(several beds in one room) which have been set up to provide members of the
public with a chance to receive treatment in a setting which keeps the
overheads and fees low. We have also been aware for years of group clinics for
detox work in which many of our members work, although of course the ear
acupuncture which they use is very much a modern development and not a part of
the scope of practice of traditional practice.

In general we support the use of acupuncture in these
settings as long as the safety, privacy, dignity and confidentiality of the
patients can be preserved. Safety is a key issue. Maintaining safe practice
procedures while moving from patient to patient is a very difficult proposition
which could mean someone having to wash their hands about two or three hundred
times a day to meet safe practice requirements. The temptation to wander from
patient to patient is great, and although there have been no recorded cases of
cross-infection in these settings, the theoretical possibility exists if
someone is touching needles on patient after patient. The other main issue is
the counting in and out of needles. Having a group of people being needled at
the same creates the possibility of needles being lost or dislodged, and in
group settings, unless there is very clearly a named person in charge of each
patient, it is all too easy for a lost needle to go unremarked and unreported.

We also have our concerns about people's right to privacy
and confidentiality. In China it is not unusual to have twenty people in a room
with relatives crowded in and everyone talking to everyone else. This country
is not the same! Our fear is that important information will go unreported and
people's boundaries about comfort with undress will be breached because they
are too British to say 'no'.

We published an internal consultation document two years ago
highlighting all of the concerns we have about group practice settings, and we
received useful feedback from members involved in multibed provision. We are in
the process of re-drafting all of our Codes, and will now be ensuring that the
rules on all of these issues are updated to reflect the higher levels of
vigilance and respect which these forms of practice necessitate.

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