We are really sorry to hear of your wife's problems. It must be extremely hard for all of you.

First, let us say that acupuncture and herbal medicine are two distinct and separate disciplines, although in China they are usually learned together. For historical reasons in the UK there were already existing traditions of acupuncture and western herbal medicine, and the two eastern modalities developed separately. So, if you go to an acupuncturist the chances are that they will not be using Chinese herbs as well. If they are you can be assured that they are very well trained, and are particularly careful when someone is already taking medications which have a serious impact on their functioning. Herbalists will know what the potential interactions of the medications are, and will make sure that nothing they do will interfere with your wife's treatment.

Acupuncture itself is extremely unlikely to cause any problems for your wife. The main source of adverse effects from treatment, other than minor transient ones, is from insertion of the needles themselves, not from the energetics of what is going on. There are no case reports of which we are aware which suggest that acupuncture treatment can do anything other than good when treating people with serious mental health issues.

 As far as the treatment itself is concerned, we were asked a question about schizophrenia a while ago, and although this is a very different problem the response we gave captures some of what we would like to say. We responded:

We have to say that although the World Health Organisation's list of treatable conditions does include schizophrenia as a condition for which some evidence of efficacy exists, the overall position is that there is nowhere enough evidence to suggest that acupuncture would be able to deliver a solution to this problem.

However, when we talk about evidence in this context, we are talking about the kind of randomised control trials beloved of drug testing regimes, which are not the most suitable way of testing a complex multivariate process like traditional acupuncture. Is there a history of acupuncture and herbal medicine for serious mental disorder? Well, the answer would be a qualified yes. There are a number of presentations for groups of symptoms which could well be characterised as psychosis which are recognised syndromes in Chinese medicine with clear treatment protocols. This is even more the case with Tibetan medicine which uniquely in Far Eastern medicine has a very complex and enduring tradition of using herbal medicines to treat a number of what we regard as sectionable mental disorders. However, this tradition has barely travelled to the West, and few practitioners have the necessary skills to offer solutions.

The major issue would be to locate someone with the requisite skills and experience. Although we have few recognised specialisms in traditional acupuncture we have been developing areas like paediatrics, obstetrics and mental health issues where we believe the special nature of the client group may require additional skills which we would recognise as expert practice. Although in theory, as generalists we should all be able to help any patient we take the view that serious mental disease needs some familiarity with the field and some experience of how to work with people in extremely distressed states. Not everyone has this experience or skill, and it would not help your wife is someone is out of their depth. With that caveat it may be possible to locate someone through our searchable database who is skilled in this area and willing to have a try. The chances are that anyone working in an area will know which of their colleagues is most likely to be able to help,

We think that there is still some wisdom in these words, and our advice is pretty much always to visit a local BAcC member for a brief informal assessment of what might be possible. These situations are so very complex that it is nigh on impossible to give a definitive view at arm's length. We always feel confident that we can help everyone to a degree, but when a situation is quite fraught it is always best to make sure that a patient gets the help they need, even if that means referring them to other forms of treatment.

We have to be honest and say that it is almost impossible to predict how many sessions someone will need. We can make educated guesses with some problems, but I suspect all of us have had the experience of saying 'two or three sessions should do it' and then found ourselves ten sessions down the line with a better but unnecessarily disappointed patient. All that we can do is to make sure that we review progress on a regular basis (every four or five sessions) to assess what progress there has been and whether it is worth continuing.

Anxiety can be particularly difficult to treat, although the research does point in favour of acupuncture, as our factsheet shows

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html.

However, the causes of anxiety and the different types are so many that it is very difficult to make predictions. If someone has been anxious for thirty years, though, it might be reasonable to expect that it will take a while to unlearn some of the behaviour patterns that have developed.

That said, we do often see people change after the first session, sometimes in terms of feeling that they are now oriented in the right direction and able to start a journey towards better inner states. This change can be subtle but anxiety sufferers who are often very tuned in to their inner states can often perceive the difference. Progress can sometimes be unpredictable, though, and life cna often generate challenges which cause setbacks.

On balance, though, we see many people for the treatment of anxiety, and we get many of our referrals by word of mouth, so as smart lawyers say, res ipsa loquitur!

We are not quite sure from your question whether you are not paying for your treatment because it is being paid for by a health insurance company or whether it is being provided free at point of delivery within an NHS Pain Management Unit or perhaps delivered by an NHS physiotherapist. However, we are pretty sure that you would know if you were covered by private insurance so you must be one of the fortunate ones who has managed to find treatment inside the NHS. This is not as common as it was, say, a decade ago, although more prevalent in Pain Management facilities.

Generally speaking, we have always heard that people referred to Pain Clinics are offered a fixed number of sessions in order to ensure that everyone can have access to the service. The NHS Choices website says that up to ten sessions of acupuncture may be available in a course of treatment, but this can vary greatly with supply and demand. Your doctor, through whom you presumably were referred, can both let you know and make a case for you if you feel that the sessions are of benefit and need to be carried on.

While NHS provision is the only treatment free at point of delivery you will find that many acupuncture practitioners are prepared to discount treatment fees if someone is in need of help but not able to pay the standard fee. There has to be an element of professional judgement in this; not everyone shares the same sense of poverty. This 'expert' was asked for reduced fees through poverty by a patient who revealed during the session that his brand new BMW had broken down but it was under warranty so he was happy.

There are also a growing number of community acupuncture clinics which offer treatment in a group setting for a lower fee, partly to ensure that all income groups can have access to treatment. A national listing of clinics in this scheme can be found here http://acmac.net/. This might provide another option if your NHS funding ceases.

We hope that you manage to get your MRI within the limit of treatments you've been offered, but if that doesn't work we hope that we've given you other useful options.

 Interestingly enough, the issue of treating children is very much a live one in the BAcC at the moment. Our members have always treated children, but over the years there has been an increasing recognition that children are not the same as little adults. Specialist courses have developed, and the BAcC has now recognised that there are expert levels of practice which might entitle a member to advertise themselves as an expert in treating children. The guidelines which will underpin this are not quite ready for publication, and so at this point we cannot give out the names of members who might meet these standards.

 However, if you use google with your location, 'acupuncture' and 'children' we are fairly confident that you will quickly identify someone local to you who has undertaken specialist postgraduate training. That is not to say that the ordinary BAcC member cannot treat children, only that someone who makes the treatment of children a focus in their practice is likely to have greater experience about dealing with children and recognising the patterns of disease unique to children.

Using google will also very rapidly identify the two or three major course providers for paediatric acupuncture, and some of these provide drop down lists of practitioner by area.

It is also commonly held view in the profession that skin problems are particularly benefited by herbal medicine, and finding someone with this additional string to their bow might be an advantage. Our members are often very helpful at directing prospective patients to members within their area whom they know personally and trust as experts in their field, and if all else fails you could almost certainly get a good steer from a practitioner local to you.

This remains the best advice that we can offer. We have checked the research databases to see if anything further has been published than the studies reported in our factsheet

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/eczema-and-psoriasis.html

but the evidence is a little thin. However, it would be fair to say that the trials which have taken place are not always accurate reflections of how we treat people, so the fact that results are not that impressive doesn't surprise us.

We often find that there are complex reasons for someone having eczema, but the crucial thing is finding something which breaks the cycle leading to a flare-up. If this can be done then it can stop the feeling that once it appears a little it will become a full-blown attack, as the worry of a possible recurrence can sometimes do.

We hope that you manage to track down a suitably qualified practitioner. In our experience children are great responders; if treatment is going to work it usually does so quickly.

We are sorry to hear about your experience. We tend to the view that most adverse effects of treatment are transient, and we tend to advise patients that the next 48 hours could see some reactions, especially after a first session. If the person is highly sensitive to treatment, then this can extended a little further, but certainly there should be no continuing reaction after a week.

What happens after that will depend on the practitioner. We are all able to tone down the strength of treatment by using fewer needles, gentler insertions or less manipulation of the needle, and a sensitive practitioner will treat with great caution when he or she gets feedback like this. If the reaction kicks off while you are being treatment common sense suggests that the treatment proceeds slowly to ensure that you don't feel sedated. First treatments can often be more likely to generate side effects, especially if they unlock blockages in areas like the lower back, and subsequent sessions are rarely as disconcerting.

Of course, the other interpretation is that the vertigo is not connected to the treatment itself but has arisen independently. With over 4 million treatments in the UK each year there could well be times when a problem appears alongside treatment, even alongside transient side effects of treatment, and have nothing to do with the treatment itself. Dizziness and vertigo 48 hours after a session would be very unusual, and if this continues into the next few days you need to get this checked out with your GP. It may be a sign of a contingent infection affecting your inner ear, but it is important not to assume that it is acupuncture-related and wait to see what happens. If it something which would have made you see a GP if you hadn't had acupuncture then you should head off their as soon as possible to find out what is happening.

We hope that by the time you receive this the side effects will have subsided, and if so, we hope that the treatment of your lower back pain is successful. Many people get very good results from acupuncture for lower back pains, and even the NICE guidelines until recently recommended this as one of the better treatment options.