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Ask an expert - about acupuncture - How often?

16 questions

A:  There are many ways of assessing whether a treatment has achieved anything. Many patients have a 'headline' condition for which they have sought treatment, and if this is the sole determinant of success, then we would have to say 'it depends what this condition is.' Some conditions do move slowly towards being cleared and there is a sense of progression - a backache not lasting as long as usual or needing as many painkillers, a migraine that is less frequent. In some cases, however, a problem can remain much the same until the change reaches a tipping point after which progress is discernible and quite often rapid. Knowing which is the more likely reaction is guesswork, and although nothing may have shifted yet there is often diagnostic information which points towards a likely change.

This is where secondary information plays its part. Quite often people have what we might regard as second-string conditions, ones which would not have seen them seeking treatment but are nonetheless a nuisance. It is quite common for someone to report that a problem like acid reflux or poor sleep has resolved, and this can often be an indicator that the main problems are likely to shift.

Many patients also report a more general and diffuse sense of 'feeling better in myself' which, vague as it sounds, is often a really goo indicator that there are some significant changes in progress.

The bottom line, though, is that there comes a point where we all have to admit that the treatment is changing things enough or at all, or the changes are short-lived, and the challenge then is to use the evidence of what has happened and reactions to treatment to determine what may be the next best option to pursue. Your practitioner should be only too happy to sit down and review progress with you, and tell you what they have found in your energies and what they think the prognosis is. If they are convinced based on what they have seen that the treatment will work, it is important to set a limit at which you review the decision to continue.

It may also be important to review the markers for progress which you have adopted. These sometimes need to be really clear to record exactly what may be happening. People occasionally make a little more progress than they think, and clear outcome measures are essentaial to establish this.

Q:  How long for treatments to show they are working. I've been having acupuncture for 2 times a week for about 2 months. I have stiffness in the back of my neck that reduces my ability to turn my head side to side. I still have stiffness and a clicking sound in my neck.

A:  This is always very difficult to say. A great deal depends on factors like the time which the problem has been around, the extent of the physical change which the body is trying to achieve to restore proper function, and the person's overall energy levels. If someone has a difficult problem but excellent constitutional condition they might make faster progress than someone with a relatively minor problem in a weaker system.

The crucial issue is trying to set measurable outcomes, and then to hold regular reviews of progress. With many problems it may feel as though there has been no progress at all until it has nearly been fixed, so trying to establish independent measures of progress is really important. These are often called ROM (range of movement) measurements and can involve degrees of turn. They can often demonstrate that change has taken place even where it may not feel as though this were the case.

There is always a need to review progress every four or five weeks. Otherwise it is easily possible to get locked into a kind of treatment 'habit' where both practitioner and patient start saying 'same time next week' without reflecting on the fact that five or six weeks have elapsed and change has been slight. Not every case responds to acupuncture treatment, and acupuncture treatment may not be the best option for every problem. It is very important to draw a line if there has been no real change either in the patient's condition or the diagnostic signs which a practitioner uses to determine what has happened.

The very fact that you are asking means that the time has come to sit down with your practitioner and have a serious talk about what they are finding and whether, based on their experience, they feel that they are actually making a difference. If you both feel that this isn't working then it may be time to explore other treatment options. The practitioner will almost certainly have other recommendations as fallback options.


Q:  I've had 2 acupuncture treatments so far in the same week. Unfortunately, the physician is then off on vacation and can't see more until  2 weeks later. Will the fact that the treatment gets interrupted for 2 weeks after only 2 treatments means I'm starting at 0? Am I better to wait till she returns? FYI: I'm going to seek treatment for neuropathic pain in the neck and back.

A:  There are no hard and fast rules about the frequency of treatment. Most of us tend to see people weekly for the majority of problems, occasionally making that more frequent if someone has an acute problem. Once a start has been made many of us then start to space treatment out. Many use the analogy of watering a plant - enough to get it started and then what it needs as appropriate. A more common problem than spacing out too soon is carrying on too long with weekly treatment, and we get the occasional question about the necessity for continued frequent treatment.

It would be unusual to lose anything that you have gained over a fortnight's break. While it is good to establish a bit of momentum, if the treatment is working in the right direction the treatment will generally hold. The system works towards balance naturally and all we do is to make this possible. For things like neuropathic pain you are often trying to break a long-standing pattern, and once the system responds it has some sense that the fixity of the existing pattern is not as great as it might have assumed. Two sessions in close proximity might well be a good start whose benefits will continue for a couple of weeks.

Generally speaking we all tend to make professional judgements about when and whether to start treatments around our annual breaks and in the majority of cases you will find that a practitioner is usually pretty clear which cases he or she can start safely and those which need to have a consistent pattern of weekly treatment. Your practitioner has probably made this assessment and reckons that it is worthwhile kicking off.

We hope the treatment does ease your pains.

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.

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