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Ask an expert - general
A: In the case of treatment for tinnitus, we have expressed some reservations about how responsive to acupuncture the condition can be, and we have reproduced below our last answer which addressed this problem:
Can acupuncture help with severe tinnitus?
As you can imagine, we have been asked this question on several occasions, and our replies have not been that encouraging. The fact sheet which we have on the website
is quite upbeat about a number of small studies, but our clinical experience is not as good, with tinnitus among the more intractable conditions with which patients present. In a recent answer, to which we can probably not add a great deal more, we said:
A. Tinnitus is one of the more intractable conditions which people seek acupuncture treatment for. Our Tinnitus fact sheet, found at lists a small amount of research which suggests that acupuncture may help, but there have been no significant trials which provide solid evidence. It is also fair to say that many practitioners are very cautious about taking on patients for whom tinnitus is the primary problem. It is quite easy to spend considerable time and money and be no better off than when you started, and the individual case reports in the tinnitus sufferers' magazines often have the same shape.
However, what many practitioners do find when treating people with tinnitus is that while the noise remains largely unchanged their ability to cope with it seems to improve. Evidence for this is largely anecdotal, though, and it would be wise to discuss carefully with any future practitioner whether they think that they might be able to help. In all events we would recommend that frequent and regular reviews of outcomes and progress are essential.
We don't think you can say more than this. There are two or three clearly identifiable patterns in Chinese medicine, described as syndromes, where tinnitus is a specific named symptom which frequently appears, and it is possible, if your tinnitus has arisen as a part of the syndrome, that there may be some help which acupuncture treatment may offer. An experienced practitioner should be able to make a very straightforward determination on whether this is the case. Overall, however, there is not a great deal of cause for optimism about getting rid of the unwanted
A: We are happy to say that the majority of health insurers are now happy to fund acupuncture treatment. The fact that NICE (the National Institute for Clinical Excellence) has now included acupuncture as a treatment of choice for chronic low back pain has also meant that some policies which were more restricted in cover have now accepted acupuncture treatment as an option.
We are still mid-negotiation with BUPA and AXA/PPP, the two major insurers who have until now not accepted BAcC members as traditional acupuncture providers, but restricted their cover to acupuncture provided by members of the British Medical Acupuncture Society or statutorily regulated healthcare professionals. Their criteria for acceptance even of these are quite strict, and many doctors do not meet them. However, BUPA are on the verge of accepting BAcC members as eligible providers, and we are hoping that where they lead, AXA/PPP will follow.
The majority of insurance providers, as we said, are more than happy to cover acupuncture treatment to a certain limit. Where there has been any reluctance we have known patients to win ad hominem concessions with the threat of taking their business elsewhere, but we always counsel caution to our patients considering this as an option, because if the company calls their bluff and they have to find a new insurer, many policy providers will not take on pre-existing conditions. If someone has a long history of claims for a chronic problem, the last thing they want to do is undermine their cover by going elsewhere.
There are no age restrictions on acupuncture treatment. The only limiting factors are the informed consent necessary for treatment and relatively small number of clinical circumstances where treatment is contra-indicated or inadvisable.
At the 'lower' end of the scale, children under the age of 16 have to be accompanied by a parent or guardian, and consent lies with the parent. A child of 14 or 15 is now deemed by case law (this used to be called 'Gillick competent') to be able to refuse to have treatment, but we have not yet encountered any cases where a 14 or 15 year old has sought treatment when accompanied by a responsible adult who is not their parent or guardian. We would take legal advice should this question be asked of us; it is a highly technical argument.
At the other end of the scale the question of competence is just as important. From a Chinese medicine perspective based on the balance of energy and the enhancement of the quality of life there is never a stage where treatment would not be deemed beneficial. However, if someone is starting to exhibit clear signs of dementia or other forms of mental incapacity, a practitioner may need to proceed with caution. The issue of who has authority to give consent is a tricky one, and questions of a highly technical nature abut power of attorney start to present themselves. It is not, as is widely believed, simply a matter for the next of kin to decide.
The other factor in the treatment of children, especially the very young, is that although we do not require members to have undertaken specialist training, we have now published recommendations for what we would regard as minimum levels of postgraduate training and experience for treating children. While it is perfectly safe to treat children of any age with generalist skills, we do recognise that optimal treatment sometimes requires additional training; children are not simply small adults, and there are variations in children's energies which is it valuable to understand.
A: Pins and needles, often called paresthesia in conventional medicine, is usually associated with poor circulation or some kind of interference with the nerve pathways. Generally speaking, it is self-correcting, so when it occurs all the time it needs to be investigated thoroughly. We don't want to sound like harbingers of doom, but there are several quite serious conditions for which constant pins and needles are a symptom or general warning sign. It is really important to discuss this with a GP and possibly arrange for a consultation with a neurologist just to be sure that this is not the tip of a much larger iceberg. The chances of it being more than it appears are remote, but we have a duty of care to our patients to ensure that there is nothing for which conventional treatment is required.
There is, as you might imagine, very little research in this area under the general heading of paresthesia. What you will find is a certain amount of research on peripheral neuropathy, which is one condition where pins and needles sensations are among the range of possibilities. We answered a question on this a short while ago, and you can see our answer here:
However, symptoms like this have existed since we started walking upright, and Chinese medicine, which has a 2500 year history, has been addressing such problems within its own conceptual framework. As you may already know by looking at our website, Chinese medicine is based on a theort of energy, called 'qi', which flows around the body in specific patterns whose flow, rhythm and balance are a precondition of good health. When the flow is disturbed or blocked, then ill health in the form of symptoms will start to emerge. The flow is maintained by the Organs of the body (always capitalised in Chinese medicine because these are groups of functions overlapping with the physical organ as it is understood in conventional medicine), and when symptoms like pins and needles appear, it usually points to a number of specific possibilities for Organic malfunction.
Nothing is as straightforward as that, however! The interconnections of all parts of the system mean that there is a considerable art and skill in the practitioner's interpretation of what is happening. That a part of the system is causing a problem is not difficult to determine. Whether that is the source of the problem or whether that part of the system is reacting to imbalance elsewhere is critical. Treating in the 'point and shoot' manner of cookbook formulae may help for a while, but if the underlying problem is not addressed the symptoms will come back or worse still, be suppressed while the problem continues to develop. This is why the BAcC sets so much store by the degree-level training our members have; it takes that long to be able, in our view, to begin to master these skills.
The best advice we can give in situations like these, where the range of possibilities tends to be quite wide, is to arrange a visit to a BAcC member local to you for a brief face to face assessment and discussion of whether acupuncture treatment is appropriate for this problem. Most members are very happy to do this, usually without charge, to ensure a good 'fit' in terms of type fo therapy and patient. If they feel that there may be other better options, be they conventional or complementary, they will probably say so.
Q: I have just graduated with a bachelors degree from Changchun Chinese Medicine University. I would like to know if you can advise me, what is needed in terms of licensing and registration to open my own acupuncture clinic in the UK.
A: It basically depends where you intend to work in the UK. If you are based in Greater London, most boroughs have adopted the London Local Authorities Act 1991 which means that unless you belong to an exempt body, such as the BAcC or the ATCM< you will have to pay for an annual licence. In Scotland, a similar situtation obtains, insofar as unless you are a statutorily regulated healthcare professional, there is a requirement for annual licences. As you are probably aware there is currently no statutory regulation of acupuncture, nor likely to be in the short term.
In the rest of the UK the Local Government Miscellaneous Provisions 1982 Act applies which requires a one-off registration for the practitioner in each practice in which they work, i.e. if someone joins an existing registered practice they have to register personally, and they are already registered in a borough but set up a new practice in the same borough they have to register that.
The registration and licensing processes involve an inspection of premises, and usually also a check on the training of the person who is applying to work there.
You will also need professional indemnity insurance, and the local authority will almost certainly want to see proof of this.
There are no other statutory requirements for setting up in business asa practitioner, but clearly quite a lot of planning legislation of which one must be aware, as well as some keenly policed restrictions on marketing and advertising which can be found on the Advertising Standards Authority website.
We believe that the wisest course of action is to join a professional association in order to benefit from updates about the current legislation and also to belong to a network of fellow professionals. It is tough setting up business at the moment, and the support and advice of professional colleagues is invaluable.