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Q: I recently watched a programme on television in which it was stated that acupuncture can be obtained free or at a greatly reduced cost if you volunteer to be a guinea pig for students to practice on. I have had acupuncture in the past for allergic rhinitis and found it to be very helpful but just could not afford to keep the treatments up. I enquired at my GP if I could have the treatment on the NHS but they only provide it for tennis elbow.

A:  The short answer is, we're afraid to say, 'no'. The list of training institutions which are in a formal relationship with the Accreditation Board can be found here:http://baab.co.uk/study-acupuncture/accredited-courses.html
 
and you will see that none is particularly close. In most cases the cost of travel would exceed the cost of treatment.
 
However, it would be fair to say that the great majority of our members are not driven by money, although clearly they have to pay bills and eat just like everybody else. Many members are willing to discount fees for patients who are genuinely hard up, and it may well be worthwhile asking the practitioners close to where you live whether they would be prepared to reduce fees.
 
However, this can get into some interesting discussions about what counts as hardship, and all of us have been 'burned' at least once in the early stages of our career by people pleading hardship when the patient's definition has extended to 'down to the last million and the Rolls has a puncture.' This particular expert let someone have treatment for £5 per session over several weeks on pleas of poverty, and was surprised, when asking whether the patient was booking in next week, to be told, 'oh no, dear, can't do that, we're off to Barbados for six weeks.' 
 
The vast majority of people who seek reductions are bona fide, however, and if you happen to live near BAcC members whose primary concern is helping people to get better, all shall be well. 
 

A:  A great deal depends on which type of diabetes you are asking about. Type-1 diabetes, the insulin dependent variety, is not likely to be amenable to acupuncture treatment. In nearly all cases there is no residual pancreatic function, and the sufferer will have to take insulin by injection for life. There may be a case to be made for using acupuncture to enhance the whole system in an attempt to reduce the long-term impact of circulatory problems which tend to develop in later years, but there is no evidence to back up claims that treatment can do this. Anecdotally we hear of patients who believe that some of the numbness, or neuropathic pain or erectile dysfunction which accompanies the condition has been resolved to a degree, but the evidence is not plentiful.
 
The situation with Type-2 diabetes, non-insulin dependent diabetes, is not a great deal more positive as our factsheet
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/type-2-diabetes.html
 
shows. There is very little research on which to base positive recommendations, although the paper does say that acupuncture can be a valuable part of an overall strategy to bring all aspects of long term care - diet, exercise, etc - together.
 
We have heard of occasional cases where there has been some residual pancreatic function which has responded well to treatment, and many practitioners warn NIDDM patients to taske care in the days after a first session in case a sudden revitalising of the insulin-producing cells causes an renewed production which in turn could cause a hypoglycaemic coma, but we have never heard of this happening.
 
   

We are not quite sure whether there is a specific ranking system which you have heard of; we ourselves are unaware of any such system and can't quite imagine how it would work. Although Chinese medicine is a comprehensive system of medicine, there are areas of treatment with which it cannot deal, such as emergency medicine or surgery, and comparisons with other forms of treatment.
 
When asked about the WHO attitude to acupuncture we usually refer people to the following document
 
http://apps.who.int/medicinedocs/en/d/Js4926e/5.html
 
which outlines the WHO's assessment of the efficacy of acupuncture treatment over a wide range of conditions. The strength of this document is that it covers a broader range of 'proofs' than are usually accepted in the West. The standard used in conventional medicine, the so-called randomised control trial, is not an effective instrument for testing acupuncture, and this means we have ended up with a rather stark works/doesn't work contrast which sets the bar very high and discounts trials which, while not RCTs, show that there is a great deal of evidence that acupuncture works for conditions. The WHO  has four grades of evidence, and assigns a wide range of problems to what it considers are appropriate points on this scale.
 
The document explains very clearly what these four standards of proof are, and many of our patients have been both helped and reassured by the comprehensive nature of the list and its assessment of problems for which they are considering acupuncture treatment. 

As our factsheet shows
 
http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/gout.html
 
there have been a number of studies, mainly in China, which seem to show encouraging results in the use of acupuncture treatment for gout. As the sheet sasys, however, these are few in number, and because they were conducted in China, doubt is often cast on their methodological soundness. This is often a little unfair, because the focus of Chinese research is often a little different - they are sometimes less concerned to establish whether acupuncture works than what works best. In the West, the former question is paramount and the inappropriate model of drug testing, the randomised control trial, used as the standard test.
 
Since the factsheet was written there has been a systematic review of trials
 
http://www.ncbi.nlm.nih.gov/pubmed/23424263
 
which again gives some very encouraging evidence that acupuncture treatment may be of benefit.
 
There is no doubt that in conventional medicine the use of allopurinol together with a sensible approach to diet, can minimise the attacks that a gout sufferer has. When we take on patients with conditions like this where the medication works, we are always very careful not to let patients stop medication which has been working well. The danger with stopping allopurinol is that it cannot be used to treat an acute attack, and a sudden rise in uric acid caused by a peremptory break might bring one on. If you were considering coming off long term medication we would advise that you discuss the situation with your GP.
 
In summary, though, you could do well to visit a BAcC member local to you to discuss your specific case. Gout appears in many joints, and some are more treatable than others. There are also on occasion a number of ways of understanding the inflammation from a Chinese medicine perspective which offer more clearly defined treatment strategies than others, but this would require a brief face to face asssessment. 
 

Q:  My first visit for acupuncture was nearly 2 weeks ago. I wanted to try it for my hot flushes, itching skin(due to a medication I am on) and arthritis. Unfortunately that evening I realized I had a heavy ache in the whole length of my left arm. I can use the arm as usual but I am aware of the dull ache, at nightime it seems to trouble me so much more and I have to take painkillers or use ibroprufen gel.

On my 2nd visit 3 days ago the acupuncturist was obviously concerned that I was still suffering this ache, I did not have needles on that occasion in the arm, but she tried massage etc all to no avail. She said she had never heard of anybody having this ache for this long before.

I did have a fracture of the wrist on this arm before, but this was about 9 years ago; no pins or anything so she presumed it was nothing to do with this.

I would be glad if you could be of any help as this ache is now causing me sleepness nights, (it wakes me when the medication has worn off).

A: This is a most unusual outcome. There are a number of rare short term adverse effects associated with treatment, but most disappear after 24 to 48 hours. There are also a number of normal treatment effects, and a dull aching sensation where the needle has been inserted is relatively frequent, but this again disappears within minutes of treatment, although occasionally lasting a little longer.
 
The only thing we can think may have happened is that there has been a slight bruise created by the treatment adjacent to a nerve, and the impingement is causing the sensation you are experiencing. In any event we think that it would be best to visit your GP and ask for a neurological assessment to see whether there is a specific nerve which is being affected.
 
We also need to emphasise that all of our practitioners are fully insured so that if this problem continues and is a direct result of treatment you would be entitled to make a claim for any disturbance or distress this may have caused.
 
However, we hope that it proves to be a consequence of minor bruising within the underlying tissue, and in our experience where this kind of problem does occur it does resolve within a week or two, gradually diminishing in intensity and discomfort. We are sorry that you have had this happen, and hope that it does not deter you from having further treatment. 
 

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