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Ask an expert - about acupuncture - How often?

13 questions

A:  This depends a great deal on the kind of condition which the practitioner has been treating, and in every case it is a judgement call. 

There are some conditions where the body simply reverts to good health, and it is quite clear that no more treatment will be required. This is often the case in helping recovery from a sports injury or a digestive problem brought on  by specific causes. In these cases the practitioner will usually advise the patient to contact them at the first sign of some return of the problem.

At the other end of the spectrum are the conditions where it is quite clear that someone is going to need maintenance treatment for a very long time, even though the immediate presenting symptoms have gone. When helping people through acute episodes of depression or anxiety, or when dealing with an age related deterioration in the lower back, getting past the initial acute phase of trouble may well need to be supplemented by regular maintenance treatment, and this was very much the understanding of acupuncture treatment in ancient times. The job of the doctor was to keep you well as much as to get you better.

The trickiest cases are where someone looks like they have got rid of a problem but may need further treatment. In this expert's experience migraines often respond very well to weekly treatment, and after five or six sessions there has often been a tremendous change. However, there may be a need to treat someone monthly for two or three months to consolidate the progress, and just telling people to give you a call in a month's time never seems to work. People forget, and then two or three months later get a migraine and conclude that acupuncture didn't work. It is sometimes  a challenge to book someone a month ahead when they feel better, but experience suggests that this is the best way to make conditions like this stay gone.

Each person is unique and different, however, as is their treatment, so although we can offer general guidelines like this it would really be a matter to discuss with your practitioner. Most are keen not to over-treat, and will review progress at regular intervals to make sure that treatment does not become a 'habit', however enjoyable. It is fair to say, though, that many of us take the view that the ancient system of staying well rather than getting better is the right way to work, and encourage patients to start to take this view of their health with regular treatment and with adjustments to their lifestyles. It was an often repeated saying in the old days of training, and maybe still is, that patients will not give a second thought to putting their car in for an annual service costing over £1000 but will baulk at five sessions a year to keep themselves in trim.

Q: Is there a minimum number of sessions needed for acupuncture to reduce pain levels in a chronic (symptoms of 6 months or more) TMD sufferer?
How many sessions, as a ballpark figure, would you estimate to be reasonable to achieve reductions in pain levels that would be present 3 months after the last treatment?

A:  We're sorry to say that there is no real answer to this question. From a Chinese medicine perspective each patient is unique and different, which is its very great strength since it individualises treatment. The obverse, of course, is that any symptom needs to be seen in the context of someone's overall balance, and for this reason the answer could be anything from one session to fifty sessions. The same applies to the enduring effect of treatment. In someone who is otherwise healthy (in Chinese medicine terms), a symptom can sometimes go and stay gone. However, if there are constitutional weaknesses it may be necessary to continue to have maintenance treatment every 6 to 10 weeks to maintain progress.

Were you to present at our clinic we would be immediately asking questions about how the problem developed. TMD and related TMJ disorders often have their roots in things like aggressive dentistry or minor accidents which slightly displace the jaw, and this can have a major impact on the assessment and treatment of the problem. However, there is far from general agreement about the causes of the problem, as you will see from any medical advice sites.

Many patients find it very useful to combine acupuncture with cranial osteopathy which can often realign the bones in subtle ways which enable the acupuncture treatment to encourage better functional support in the musculature to retain the re-adjustment. We believe that this would also be a productive line of enquiry.

As far as research is concerned, there is a systematic review of trials which makes encouraging noises, as they often do, with the proviso that more and better research is undertaken.

http://www.ncbi.nlm.nih.gov/pubmed/20401353

You than have a number of individual studies like this one

http://www.ncbi.nlm.nih.gov/pubmed/17095133

which report favourable results but not the detail of how many sessions.

We think the best advice we can give is that you visit a BAcC member local to you who can probably by face to face assessment give you a far better view of how rapidly you might progress and how sustainable that progression might be.

A:  A great deal depends on where you are and what you are trying to deal with. In most cases practitioners in the UK see people weekly because the majority of treatments are constitutional in nature, i.e. aimed at balancing the system as a whole, and the received wisdom is that it takes a week to get a clear picture of what has changed since the last treatment. There are as many analogies as there are practitioners, but many talk about re-arranging things in a pond and waiting until the ripples have ceased to see what has changed.

In some cases, a practitioner might see someone twice or even three times in a week if there are acute problems to address. It is not unusual with acute back sprains to see someone more than once weekly. This is more a matter of reinforcing the treatment regularly to make sure that it 'holds'.

If you were to visit a practitioner in China, however, it would be quite normal to see someone daily for ten days. This constitutes a 'course of treatment', and many Chinese people with a chronic or acute on chronic condition will trot along to the local out-patients department at the hospital to have treatment every day. With an increasing number of Chinese practitioners in the UK it is possible that this may begin to happen more frequently here, although the crucial difference is that in China the treatment is free at point of delivery within the national health system. In this country ten sessions, one a day, would probably be beyond most people's pockets unless the practitioner had come to an arrangement over the overall fee.

Many of us believe that there can be a tendency to over-treat unless one is careful, and again the often-used analogy is that of watering a plant. There is only so much watering that one can do before leaving the plant to make its own progress, and that is why we are very insistent that BAcC members maintain a rolling review of progress to assess how much treatment is needed and how frequently. This is a matter of professional judgement, because each patient is unique and different, and even though two patients may apparently have the same problem, the underlying cause could mean one gets sorted in two sessions where the other one needs ten sessions.

Covering all bases in our reply, we have to say that you can never be harmed by over-treatment, so if someone were treating too often there is no damage that can be done. The worst that can happen is that nothing happens or the system may feel a little unsettled, but the inbuilt safety margins of the system usually ensure that the body re-sets to a good working balance very quickly. That is why any adverse effects, like tiredness to a mild headache, tend to go very quickly.

Q: I have had acupuncture for a specific problem (achilles tendon pain) which has responded very well. Now it has been suggested that regular visits for acupuncture are beneficial to overall health and balance. Is this a generally recognised approach and if so is there a frequency of visits that is recommended e.g. is once a month too much, too little etc.

We are very pleased to hear that your ankle responded well to acupuncture treatment. Although it would be fair to say that the majority of patients in modern times consult us with a specific health problem, in ancient times the idea of staying well rather than getting better was central to the use of acupuncture and herbal medicine. Going to a doctor and seeking help when ill was said to be 'like forging a spear after the battle has started or digging a well when you are already thirsty.' The ancient practice was to have treatment to stay well, and it is believed that in some cases the doctor was paid to do this on pain of having to keep the patient in the style to which
they were accustomed if they got sick!

The key aspect of maintenance treatment is that each of us has a constitutional balance which predisposes us to certain problems at specific times of year or when we are faced with more mundane challenges of life like stressful times ahead or chronic problems. In China the seasons are very much more distinct than here, but the change of season was seen as critical as the temperature dropped rapidly or the winds picked up. The Chinese saw these as having a major impact on health (as a primarily outdoor agrarian race), and the doctor treated the person just before the season to ensure that the person was well-prepared for the change. With five seasons in the year,
this would have meant treatment every ten weeks, and there are many patients who take this seriously enough to do just that.

We find, though, that the majority of patients find a good balance by trial and error somewhere between four weeks and thirteen weeks, and in fact become very sensitive the idea of 'time for a treatment.' Of course, proving the long term benefits of this approach is very difficult; how do you demonstrate that someone is better than they might have been? However, enough patients have shown an increased resilience and overall health with regular treatment to convince us that the ancients had got it right.

The odd thing is that some people think that five treatments a year at around £200 is a mite excessive but have not the slightest hesitation in putting a perfectly well-functioning car through a full dealer service at £900. We think that the values of modern life have become a little off-centre at times! It is up to us to convince, though, to convince them that good health is more than just absence of illness but an enhanced ability to live well at all levels.

 

Q: I have pcos and persistent rhinitis. I have had acupuncture by two practitioners. One hurt me, I  lost sensation in my head and collapsed when i got off the couch. The other was much kinder, helpful and caring but I felt that i wasn't getting any benefit after 4 months of weekly treatments. How many treatments should I require to notice some difference? I know it depends on the condition and severity but 16 sessions and no difference?

A:As you say, this is getting to be a substantial investment in time and money, and you need to know whether this is actually heading somewhere or has just become a kind of 'treatment habit.'

As you say, these can both be very stubborn conditions. With long term chronic problems it is often quite difficult to establish an analogue scale of improvement. With acutes it is far easier: 'how many out of 10 is your pain now?' With chronic conditions this is often trickier. One of our Japanese colleagues once remarked that if someone tells you they are 10% better, they're just telling you that you are a nice person and keep trying.

The best that one can do is to maintain a regular review, usually every four or five sessions, and to share with a patient the findings from a Chinese medicine perspective. There are a number of occasions where changes in the tongue and pulse can be quite radical without having yet filtered through into changes in the main conditions. If a practitioner is sure that there is progress they need to share this with the patient. It is also important to try to set measurable outcomes, difficult as this can sometimes be. It is very easy to be unable to say what happened last week, and with both problems there are usually some symptoms whose appearance can be charted. This can help to establish just how many episodes there have been and whether there has been a change.

If nothing happens, then there are a number of options. One is for the practitioner to seek a consultation with a colleague present or refer to someone else just to have a fresh pair of eyes looking at the case. Occasionally, though, it just has to be agreed that treatment isn't working, and the practitioner is usually in a good position to suggest alternative treatments which may help. Chinese Herbal medicine is often used alongside acupuncture to good effect, and although homeopathy has had a run of really bad press in recent years, this expert has several patients who have used homeopathy to treat both acute and chronic rhinitis when acupuncture hasn't done the trick (and stayed with acupuncture for other conditions).

The best person to address your concerns is your practitioner, however. None of us minds being asked about the benefits of treatment when results are slow in coming, and sometimes it marks a good time to call it a day. Good communication sidesteps many of the problems which can otherwise emerge.

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