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Q: Are 12 needles for 40 mins for my second visit too much? I was lying on my stomach for the full 40mins for lower back pain.A: The short answer is not at all. It is not uncommon when treating lower back pain to use a significant number of needles locally, and this can often easily run to a total of 10 or 12 needles. It is also quite common to have the patient relaxed in a face down position. If you felt that it was too much, however, or that the position was uncomfortable for 40 minutes, then it is a simple matter to raise this with your practitioner who will be delighted, we are sure, to adjust the treatment for you. A very small number of patients are very sensitive to acupuncture treatment, and this can often limit the number of needles which a practitioner can use. In most cases, though, this is very clear because the patient feels a little spaced out or woozy after treatment, and not in a particularly pleasant way. Practitioners will always ask how the treatment affected someone and in cases like this would automatically scale the treatment down for the next session.
Q: Is the British Acupuncture Council on the approved list for blood donors, and what is the time scale for giving blood after a treatment?
A: The most recent press release which we published on this subject was in June 2013. It said:
Date: Friday, 21 June 2013 12:42
The BAcC continues to receive calls and emails about the NHBTS policy that any patient who has had acupuncture treatment delivered by a practitioner who is not statutorily regulated has to wait four months before they can donate blood. This change to the NHSBT's donor criteria came into effect in late 2009,and with the statutory regulation of acupuncturists now unlikely in the foreseeable future, this could mean that someone having regular treatment with a BAcC member would never qualify to donate blood.
The BAcC has exemplary safety standards and campaigned vigorously to challenge this decision. We have since done our best to make sure that all of our members let their patients know that they must wait four months to donate blood or bone marrow products.
The official notification and rationale for the decision is available onhttp://www.transfusionguidelines.org/docs/pdfs/dl_change_note_2009_32.pdf andhttp://www.transfusionguidelines.org/docs/pdfs/dl_change_note_2009_33.pdf but some enquirers have found this difficult to locate on official sites.
The BAcC is fully committed to reversing this decision for the benefit of the patients of its members. The recent accreditation of the BAcC under the Professional Standards Authority Assured Voluntary Register scheme has given us hope that this new flagship scheme will provide the recognition of exemplary standards the BAcC needs for its members to be granted exemption from the deferral period for donation.
Since then, we have met senior officials in the NHBTS, and discussed with them how we might help to re-instate the donation of blood by non-statutorily regulated healthcare profesisonals, there having been no reported instances of blood borne virus transmission by acupuncture practitioners in the last decade. In order to change policy, however, there has to be evidence, and the NHBTS is proposing to conduct an analysis of previous screened donors to establish the level of risk. This study will take place later this year or early this year. The wheels of bureaucracy turn slowly, and until that time anyone who has had acupuncture treatment from a BAcC member will have to wait four months until they are allowed to give blood. We are sorry that many thousands of donors have been 'disenfranchised' by this change of policy and are working our hardest to bring them back within the list of eligible donors.
Q: Does acupuncture involve having needles in the head and being put to sleep for bad shoulder pain? How long is a session?
A: To answer your second question first, the majority of BAcC members would normally allocate between half an hour and an hour for a session of acupuncture. Some work slightly more quickly, with twenty minute sessions, and occasionally some members with adequate treatment space will let a patient relax after treatment for as much as another half an hour. As far as the location of points is concerned, Chinese medicine is premised on an understanding of the flow of energy, called 'qi', in the body and its rhythm, balance and flow. The pattern of flow is reflected in a number of channels which traverse the body, and blockages or changes in the flow can have effects elsewhere in the body because of the complex interconnections. So, it would not be unusual for needles to be placed in the feet, for example, to deal with headaches if a blockage had to be dealt with there. One of our colleagues used to use the analogy of a central heating system to explain this to patients. Because it is a closed system a problem with a thermostat or valve can affect the pipes at the other end of the house. His practice used to have a number of patients happily telling their friends that they had problems with their thermostats! Chinese medicine also recognises that when problems arise in specific areas this may not always be because of a local injury. If the whole system is weakened, then where a symptom appears may simply be one of a number of weak points. The skill of the practitioner often lies in determining whether a shoulder pain or knee pain is a local problem or a local problem which has arisen because of a more generalised weakness. In both cases there are likely to be needles in or near the affected area, but in the latter case the needles may go where the system needs to be boosted. Sleeping or becoming very relaxed when being needled is not uncommon. Many patients drop off when they are being treated, and many practitioners are happy to let them drift. Most people in modern life are busy and stressed, and there is a common belief that letting someone drift slightly removes some of the barriers to effective treatment which can be created by a patient arriving tense and being in a hurry to get back to work. Your practitioner is your best source of information, though. Our members are more than happy to explain what they are doing, and give you an insight into the way that Chinese medicine works.
Bronchial asthma is one of a small number of conditions where we have prepared review papers which are more comprehensive than our customary factsheets, and the one for asthma can be found at: http://www.acupuncture.org.uk/arrc/public-review-papers/bronchial-asthma-and-acupuncture-the-evidence-for-effectiveness.html As you can see from this, the jury is still out in terms of claims for clinical efficacy. The evidence is not conclusive, and although we could make a great deal of the inappropriateness of the accepted research criteria for acupuncture (the randomised double blind control trial which only truly works for drug trials), the fact is that even a badly designed trial should show a trend towards treatment having an impact, and some trials have failed to do this. That said, asthma has existed since the birth of Chinese medicine well over 2000 yeras ago, and there are a number of very well-established protocols for understanding the various ways in which asthma can be classified and for making sense of these within the system of Chinese medicine. In practice few of us do not believe that we can make a difference, but we all run up against a major limiting factor, and this is the accepted western treatment with steroids and bronchodilators. We are always very clear that there are a significant number of medications which are vital to life and good functioning, and our members are trained neither to suggest stopping them nor to encourage patients to stop them, even passively by not speaking up against someone's stated intention. There are a number of western medications, however, where there is a rather problematic position in which patients sometimes find themselves. In the case of asthma, and sometimes epilepsy, a patient may be taking medications for years without suffering an attack, and not unreasonably ask whether they could stop taking the medications because the underlying problem has resolved and the drugs are no longer necessary. There is evidence, however, that the body achieves over time an effective balance with the medications, and their withdrawal can cause an attack. In the case of asthma there is documented evidence that rebound attacks after steroids have been withrawn can be very serious, and for this reason our members are advised to refer patients who want to question their medication back to their doctors for further discussion. Few doctors, in our experience, will let someone come off anti-asthma medication because of the theoretical risk of a fatal or serious attack. However, you did talk about 'having an impact', and there is no doubt that anecdotally we hear of many cases where a patient's use of and reliance on bronchodilators reduces over time. Most asthmatics manage, rather than banish, their condition with the aid of medications, and we are sure that over time the use of bronchodilators in particular will be shown by research to fall after acupuncture treatment. We are also treating people, not simply their conditions, and we find that treatment often helps people to cope better with long-term health problems over and above any relief it brings to the problem itself. Each prospective patient is unique and different, though, and the best advice we can give is that you contact a BAcC local to you and seek a brief face to face assessment with them of whether acupuncture treatment might be suitable for your own case.
China is a very large country, and it would be difficult to offer a definitive view. However, as we understand it, the majority of acupuncture practice in China is offered through the state hospital system, and there are a variety of degree qualifications which mean that most practitioners are also trained in western medicine to a far greater extent than would be the case in the UK. This reflects the fact that acupuncture is in many areas of clinical specialty offered within the state system, and the training which people undertake can be as much as five to seven years long. There are shorter degree courses in China, but these tend to harness acupuncture to a western clinical skill. With the difficulty of making sense of the apparently infinite varieties of course available this means that we often have problems with determining the full extent of someone's competence when they apply through our external applicant route. What we can say with some confidence, though, is that it would be highly unlikely to find a course in China which replicated the form of UK courses, with the acupuncture skill being primary and sufficient western medicine included (about one third of course time) to ensure that practitioners can integrate their work with conventional medicine and be aware of red flag conditions requiring immediate referral. That said, there is no doubt that there are more rural areas where acupuncture is still an apprentice-style system, often within families, which is roughly how it was pre-1945, and in these areas one assumes that if a practitioner was good enough they would be able to eke out a living. How the authorities might react to this is another matter, and we have not heard of any western Europeans who have taken their skills back to China in this way. However, a number of the UK courses have close affiliations with Chinese hospitals and universities, and their students undertake six week or three month study programmes in China, and often undertake postgraduate training in China. Working within a specialist hospital department may give a practitioner a chance to see hundreds, if not thousands, of similar cases in a very short period of time, and this can provide invaluable clinical understanding. There are also a number of short courses in cities like Nanjing and Beijing which offer three or six month training from scratch to westerners, and many of the senior figures in the profession undertook this training when UK training was in its infancy. We have a number of members who in the last decade have begun their training in this way and gone on to work successfully in Chinese hospital departments, but it has to be said that in each case they have had to meet our requirements in the UK and had to undertake a fair bit of additional training in clinical management and western medicine before we could admit them to membership. The short answer, though, is that it would probably be unusual for a UK trained practitioner to be able to drop straight into mainstream acupuncture practice in China because of the way that this is offered as part of an integrated package of medicine through the state system.
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