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Ask an expert - about acupuncture - How often?

11 questions

Q:  I am currently at university and putting together a research protocol using acupuncture for TMJ pain relief. I have searched hi and low but can't seem to find a recommended amount of acupuncture for pain relief. Has one been published or can you tell me whether one or two treatments a week is more effective and why for my rational.

A:  We are not aware of any strict rules for the number of treatments someone may need each week for pain relief in these kinds of conditions. A great deal depends on the culture in which the treatment is offered. In China, for example, where treatment is often delivered in an out-patient setting in a hospital it is not at all unusual to be given a course of ten treatments with treatment administered once a day. Some of the high street shops in the UK tried to replicate this practice but ran into a certain amount of consumer resistance because they did not discount the treatment.
Most practitioners make a judgement, based on clinical experience, on the amount of treatment necessary to develop a momentum which preserves the treatment effects. Very crudely put, acute conditons might be treated twice or three times a week initially to bring them under control, whereas more chronic pain might be treated once a week. If you are designing a protocol, the distinction between acute and chronic pain may form a part of your design and protocol, and this will have implications for how often you treat, as will the ease of getting your trial subjects to the treatment setting - more difficulty means higher dropout rates.
There are no textbook 'optimal' solutions, however. The decision about how often to treat would form a part of the design which the researcher would have to make a case for in establishing a sufficiently robust protocol to assess efficacy or effectiveness.  

Q: I have had 13 sessions with someone practicing at a Nuffield hospital. He thinks I should sign up for another 14 when I go next time. He hasn't looked at my tongue or checked my pulse etc, and he uses a TENS type of machine on the needles. Is this OK? I really cannot say whether this is helping me with my back pain as he doesn't advocate much housework and I have to lie on my back for 40 minutes, 3 times a day.

A:  This is a rather difficult one for us to answer. There are a great many ways to practise acupuncture, and not all systems use tongue and pulse diagnosis. There are, for example, some Japanese systems which use palpation of the limbs and trunk as a diagnostic tool, and other systems where the western diagnosis is translated straight into a point selection which is then used for the treatment. Some modern Chinese practitioners work in this way, and many of these use electroacupuncture machines instead of needles. If you are asking whether this is legitimate treatment, the answer is that it could be. However, if you wanted someone who used tongue and pulse diagnosis, then the choice would have to be to go to another practitioner who works as you wish, or to ask the existing practitioner if he can, and will, work in this way.
It does seem like a great deal of treatment without any discernible change, although of course without knowing the exact clinical presentation it is not really fair for us to comment. We would normally hope that there would be more frequent reviews of treatment, and clearer outcomes, but there are many experienced members who have been working for over forty years whose own skills and experience are exemplary. It may well be that this is the opinion of one such, and to be respected.
This may also explain the advice to rest three times a day. Current orthodox medicine policy is to encourage movement and to avoid bed rest, which is thought to hinder recovery. If someone has had a great deal of clinical experience and this works for them, then it would be prudent to follow their advice.
The bottom line does appear to us, though, that you are not entirely happy with the way things are going, and the best advice we can offer is that you raise this as an issue with the practitioner himself. If he responds well to your concerns and you feel reassured, all well and good. If you are not satisfied with his responses, then we would probably suggest that you find another practitioner.


Q:Would it ever be a useful thing to have acupuncture every day - if someone was very ill, for example.


A:  This is very much the case in China, where acupuncture is often administered in a ten-day course for acute conditions. The big difference, of course, is that acupuncture is funded within the hospitals and delivered free at point of treatment. Many BAcC members will treat daily if there is an acute condition, but this is not always possible if practitioners work on different sites in a week and can't always be available every day at the same location.
The only sticking point we hear of is the fee structure. Most practitioners come to an arrangement where this is an affordable option by setting an agreed fee for a whole course of treatment for an emergency or acute situation. Our hope is that this is done with sensitivity, although we have no direct influence over what members charge.

There are no hard and fast rules about the frequency of treatment. The majority of BAcC members tend to see patients weekly, often beginning with a course of four or five sessions, and then reviewing progress to decide how much further treatment may be required and whether acupuncture remains the best option. For more acute situations it is not unknown for someone to have two or even three sessions in a week for a short period.
In Chinese hospital outpatient departments it is not unusual to have a course of ten treatments with one treatment a day. This would be difficult to replicate in UK practice, though, where the majority of practitioners are self-employed and would not realistically be able to charge patients their normal rates for such an intensive burst of treatment.
A great deal depends on the severity of the symptoms which the patient presents. Lower back problems can be chronic or acute, and it would be normal to treat acute conditions a little more frequently.  

There are no set rules for how long it may take for treatment to show benefits, and most practitioners have lived to regret promising change within a set number of treatments. From a Chinese medicine perspective the symptoms are often less important than the underlying patterns to which the diagnostic systems relate, and this can sometimes lead to confusing anomalies - a serious condition based on a relatively simple imbalance can sometimes clear as if by magic, whereas a minor condition based on a complex chronic imbalance can be almost intractable. All that a practitioner can do is to ensure that they review the situation on a regular basis with the patient. We don't make any stipulations, but most members have often drawn a line at four or five sessions, sometimes a few more, and discussed with a patient how well things are going. Even where the main condition may not have changed at all, there may be changes to diagnostic signs which indicate that there will be progress. If there aren't then the practitioner should acknowledge that there are some people for who acupuncture doesn't work, and work with you to see what other alternatives there may be which suit you better.
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