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 A:  The BAcC decided many years ago that 16 years old was the age of consent for treatment in line with most conventional medical procedures. This means that the young person would neither have to seek parental consent for treatment nor have to have a parent or guardian in the room while treatment took place.

However, a certain amount of common sense has to be applied. The laws on consent and the presence of a parent or guardian are there to protect the vulnerable, and although most 16 year olds are quite clearly capable of giving consent there are a number whom it would be not unreasonable to describe as vulnerable. In such cases we always advise practitioners to tread with caution, and if they have any reservations to discuss with the prospective 16 year old patient whether it might be a good idea to have someone else present while the treatment takes place.

Our role is to protect patient and practitioner alike, and we seek to avoid situations where a practitioner's normal working practices, like palpating areas of the body or limbs, might not be fully understood and potentially misinterpreted in a less than positive way. 

 

 Q:  My mum (74 and very active) has a leg ulcer on her right outer ankle and is in a lot of pain, taking constant paracetamol and ibuprofen. Is there any evidence acupuncture can help? 

A: We were asked a similar question last year and the advice we gave then was:

It depends a great deal on whether you are asking about treatment for the pain from the ulcer or for the ulcer itself.  As far as the treatment of ulcers themselves is concerned, there are a number of techniques within Chinese medicine for dealing directly with ulcers but these are often quite rough and ready, using a great deal of local needling and the technique of moxibustion. While this is a common approach in China, in the west it is highly likely that someone with a chronic ulcer is being treated according to protocols which involve frequent dressing changes and removal of the fluids gathering in the ulcer, and we would be reluctant to advise anyone to mix and match the two forms of treatment. However, in Chinese medicine theory ulcers are understood in a number of ways which might make treatment at a distance from the ulcer site possible, and in more general terms still, Chinese medicine was and is primarily concerned with re-establishing balance in the whole system in the belief that a system in balance is better equipped to right itself. On this basis it may well be possible to speed up the pace of recovery.
 
As far as pain relief is concerned, there is a long history of research into the use of acupuncture for pain relief, and the question here is not whether it works, but how much it works and how sustainable the relief is. If someone needs treatment twice a day for several weeks to reduce the pain, this raises issues about cost and attendance at a clinic. However, if one or two sessions a week can bring the pain down to tolerable levels it may be worth considering having treatment. The problem we foresee here is the site of the ulceration. The outer ankle is not really an area which one can easily immobilised, and it may well be difficult to counter the effects of continued minor irritation from movement.
 
However, sight unseen we cannot give a conclusive answer. We have a number of members in her area, and we are sure that any of them will be able to give you and your mother an objective assessment of what might be possible if you can arrange a short visit, hopefully without charge, to discuss the problem with them.

We think this probably still represents the best advice we can give. In our experience leg ulcers can be a very difficult problem to treat, especially where there are a number, and it is highly likely that treatment may be inconsistent with the conventional care being offered. However, long experience has taught us never to say never because occasionally acupuncture treatment can produce unexpected but substantial results. What we would say, though, is that our expectation would be low, and if you do find someone who thinks the condition is treatable, we would advise frequent and regular reviews to assess whether there is any change. It is not difficult to run up to a very large number of sessions without tangible result, and we advise members to ensure that a patient has the best possible information to inform the decision to continue with treatment when results to date have not been great.

Q:  I am looking for a good local person who knows a lot about fibromyalgia to help me with constant pain.  How do I know if they know about it?

A:This is an interesting question because it highlights the difference between conventional and Chinese medicine. From a conventional perspective there are a few clearly recognised symptoms which confirm the diagnosis. From a Chinese medicine point of view, the body is a system of energy whose flow and balance determine someone's health. Where there are blockages, or excesses and deficiencies, pain will result, and the skill of the practitioners lies in determining where the problems are, and what the root cause may be. The root cause may not be the same as the symptoms; there are often systemic problems which can manifest in specific symptoms a long way from where the root cause lies.

However, the experience of practitioners working over the years means that there are often a number of well-defined patterns as understood in Chinese medicine which produce the symptoms of fibromyalgia, and every BAcC member will be competent to address the health issues you have, and also will probably have treated many people with the same symptoms over the years. 

We have produced a factsheet on fibromyalgia

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/fibromyalgia.html

but this does not offer conclusive evidence of efficacy, and mainly says that there are few trials and the evidence is not clear-cut. Certainly this expert's view of fibromyalgia is that is can be a difficult problem to clear, but while it is not always possible to remove the problem in its entirety, the level of discomfort can be reduced significantly. It is also commonly reported by patients in treatment for fibromyalgia that they are better able to cope with the problem through acupuncture treatment.

Each presentation is unique and different, however, and there is no substitute for seeing whether a BAcC member local to you is prepared to give up a short time to give you a face to face assessment of whether in their view treatment may be of benefit.

A: We are aware from articles such as the one here

http://link.springer.com/article/10.1007%2Fs10151-013-0985-z#page-1

that acupuncture has been used to good effect in the treatment of the kinds of problems which require or benefit from sacral nerve stimulation, as is a similar technique called percutaneous tibial nerve stimulation, described in this article

www.csp.org.uk/sites/files/csp/secure/sheppard.pdf

Generally speaking, when we are asked about acupuncture in this context we spend some time describing how an ancient tradition with a 2000-year history has addressed problems such as these based on an entirely different understanding of the way that the body functions as a flow of energy. However, when someone asks a direct question about obtaining a specific technique which belongs to conventional medicine, and by extension to practitioners of western medical acupuncture, it would seem churlish not to provide them with what they need!

A simple google search on 'sacral nerve stimulation acupuncture UK' generated this result for a practitioner

https://www.uclh.nhs.uk/OurServices/Consultants/Pages/MrJeremyOckrim.aspx

which may be helpful if you are London based, and I have absolutely no doubt that persistent scrolling down the pages will probably generate someone local to you. It is also possible that someone trained in western medical acupuncture might well offer this kind of specific named treatment, and you can find a directory of practitioners who belong to the special interest group for doctors, the British Medical Acupuncture Society, at this address

www.medical-acupuncture.co.uk

We do not have specialists in this field as such. Traditional Chinese acupuncture is by its very nature generalist, treating the person as much as the problem, and the attitude of the ancients to specialists was somewhat derogatory!

We hope that you manage to track down someone who offers this specific treatment and that it works. If it fails to do what you would like, though, don't forget that the ancient system of traditional acupuncture may yet offer treatment possibilities. Western medical acupuncture is mainly symptom orientated, and from a Chinese medicine perspective, the symptom is merely an alarm bell which tells the practitioner that the system is out of balance; it may not be the problem itself.

We often make this point to people who try western medical acupuncture. We have the greatest respect for our medical colleagues who use acupuncture, and this expert's view is that they are bringing acupuncture to the attention of a much wider group. Our task is to make sure that people are aware that there are different types of acupuncture, and if one fails to deliver, that doesn't necessarily underpin the conclusion that 'I tried acupuncture and it didn't work,' 

Q: ] I have been diagnosed with Spondylolisthesis (slipped disc).  I have spent  approximately £600 on chiropracty and podiatry and  would like to know if acupuncture would be effective. 

A:  We are always a little reluctant to make claims for the potential success of acupuncture treatment when there has been structural change in the body that is unlikely to reverse. In some cases, for example, the use of acupuncture treatment to strengthen muscles which then cause someone's posture to revert to its normal position is well-documented, and many practitioners work alongside osteopaths to off a two-pronged approach to treatment. If the spondylolisthesis you have involves a relatively short forward displacement, there may be some possibility that this may be of considerable benefit. In this case, however, we would usually be guided by the osteopath's view of what is happening; they are, after all, the experts in bone and structure.

Conventional treatment is generally about pain management through anti-inflammatories, steroids and some physiotherapy. Acupuncture treatment has a long history of being used for chronic pain; indeed, this is one of the more frequently researched areas, mainly because the markers of pain and pain relief in body chemistry are easily measured and mean that research can be quantified easily. Our factsheet on chronic pain

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/chronic-pain.html

is generally pretty upbeat about what can be achieved. In clinical practice most of us do not find the reduction of pain difficult to achieve. What really matters is the extent to which the pain is relieved and how sustainable the relief is. In the end it may come down to a financial equation - if someone needs weekly treatment almost indefinitely but as a result can function nearly normally, that hay be the equation they have to deal with. We know that some practitioners are not happy to work indefinitely without making long-term improvements, but occasionally treatment can be about stability or ever getting worse slower, so if a patient is happy to be kept going in this way, so be it.

Since each case of a condition like this is likely to be unique, we think that the only realistic advice is to visit a BAcC practitioner near and ask for a brief face to face assessment of what they think they might be able to achieve. Most practitioners review progress after the first four or five sessions when dealing with chronic conditions, and if there is no improvement consider the benefit of continuing while the bill has only reached the £200 mark. If the practitioner can sense changes in some of the diagnostic signs which make them believe that change is on the way, then the patient can make an informed decision about whether to continue rather than simply run up a large treatment bill without tangible results.