Gavin Erickson

Gavin Erickson

Q: Does acupuncture help in the treatment of tinnitus associated with severe Menieres Disease? It has left me totally deaf. I have had successful acupuncture before for arthritis and muscle strains.

A: We have been asked about Meniere's Disease on a number of occasions, and a typical answer has been:

There are a number of conditions like Meniere's disease, vertigo, labyrinthitis and so on, where changes in the structure or infections in the inner ear area can cause significant balance problems as well as generating other symptoms like nausea and headaches. Because there is no precise overlap between the classifications of conventional medicine and Chinese medicine, there may be many different ways of treating the same named condition depending on what else a practitioner finds to be out of kilter in a system. This means that it can be quite easy on occasion to identify a group of signs and symptoms which are likely to be amenable to treatment and which enable one to treat with confidence. On other occasions it can be very unclear, and when this happens we have to rely on the very basic premise of Chinese medicine, that if the energy ('qi') of the body is balanced and free-flowing, then symptoms will resolve through the body's capacity to heal itself.
 
There is a fair measure of evidence for a number of balance related problems, as our factsheet shows but we would have to admit that many of the trials which do report success are not conducted by using Chinese medicine as it is practised, and while we would contend that the personalisation of treatment to the unique individual is a far stronger treatment than a treatment repeated formulaically several times, this latter is the basis on which most research is conducted to meet the current 'gold standard.' One trial of this kind, for example,

 
http://www.ncbi.nlm.nih.gov/pubmed/19606509
 
generated some very interesting results, but the formula applied would not be appropriate for everyone.
 
For a generic problem such as this which might present against a vast range of contexts there is no substitute for visiting a BAcC member local to you to ask for a brief face to face assessment of the potential benefits of treatment. This will enable them to give you a far better informed view than we can do at a distance

We think this is about the best that we can say. When patients come to us the first thing we establish is what exactly is wrong with the inner ear. There are a number of physiological changes to the ear which can mean that conditions like this have to be regarded as permanent, so a practitioner will first want to assess whether this is something which is even amenable to treatment - there's no point in wasting time and money on something which isn't going to work.

As far as how long the treatment lasts is concerned, this is the proverbial piece of string. We always aim to treat the overall picture, not simply the symptom as it presents itself, because we believe that doing only symptomatic treatment is like turning off an alarm bell because you don't like the noise. If we treat the whole system, and the treatment is successful, there is no reason why someone who looks after themselves shouldn't remain relatively symptom free. In reality this tends to be a little less likely than a case where someone will experience some positive change which they have to 'top up' from time to time.

What we always aim to do, though, is to review progress after four or five sessions, and if there is no obvious sign of improvement to draw a sharp line in the sand before committing someone to what may turn out to be a long, fruitless and expensive process.

We believe that this still covers most of the ground pretty well. We have undertaken a survey of more recent research and there is a paper
https://www.ncbi.nlm.nih.gov/pubmed/26055400

which gives a guarded but generally positive view of the value of acupuncture treatment for these types of cases.

This doesn't mention tinnitus directly, although the studies often mention tinnitus and deafness as a part of the constellation of symptoms, and where the deafness accompanies balance problems there is often an all-round improvement.

We have had a further look at papers which directly refer to hearing loss and tinnitus, and we found this one

 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4980515/

which concludes that balance problems can be helped but not hearing problems. However, the selfsame reason why the authors qualify positive statements about balance - small trials, poor methodology - are the ones which they cite to not write off acupuncture for hearing problems too quickly.

We used to be quite downbeat about tinnitus treatment, but as a recent answer said:

Our experience in practice was that tinnitus could prove intractable to treatment. However, as our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/tinnitus.html

and as some recent personal experience in clinic has shown too, there may be some hope.

The problem with measuring the success of treatment for tinnitus is that its appearance and disappearance can be entirely random. If you read the tinnitus association's magazine you will see stories along the lines of 'I tried everything and then x worked' and an equal number of stories which say 'I had tinnitus for five years and then one day it just went.'  Research trials tend to be quite reliable - it would be a remarkable coincidence if half the trial participants experienced a spontaneous improvement - but one-off cases could be a coincidence, with acupuncture just happening to be the therapy of choice when the change happened.

The available evidence, however, suggests that it might be worth a try with the proviso that progress is reviewed at regular intervals, and some kind of objective measure can be found, i.e. how much it interferes with a radio set at a particular level. It might also repay investigation of what makes it worse and what makes it better. A long n-1 case study this expert conducted had very little impact on the condition but did increase the sufferer's ability to deal with it.

The best advice is to visit a BAcC member local to you  for an informal face to face assessment of what may be possible. There are one or two clearly recognisable syndromes within Chinese medicine which might offer considerable confidence that muting the problem may be possible, but even a general balancing of the system may bear fruit.


Invariably we check for more evidence when we are asked a question to which we have responded before, and the evidence trail for the fact sheet stops some time ago. We found a number of small studies like this one

https://www.ncbi.nlm.nih.gov/pubmed/26747258

which seem on the face of it to encourage the belief that there is a recognised connection between acupuncture treatment and symptom relief. There is also a systematic review, a 'trial of all trials' beloved of researchers because it aggregates to a much more powerful study than the individual ones.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3493359/

This draws the usual sorts of conclusion about the need for more and better trials, but the authors do conclude that acupuncture is worth trying as a safe alternative which seemed to have shown some success in addressing the problem.

The advice we gave before, though, holds good. Each case is unique and different, as is each treatment plan, and the best advice you can get will always come from someone who can see your problem in its overall context.

Tuesday, 06 June 2017 18:25

Annual Review 2015-2016

The British Acupuncture Council Annual review 2015-2016

Q: What are the principles and practices of acupuncture?

A: We like a challenge but this is a little steep even for us. Not that we can't answer your question, but because the answer would run to several thousand words, which is a little beyond our remit.

Our website, www.acupuncture.org.uk, has a number of sections under the 'about us' and 'traditional acupuncture' buttons which provide a very brief and rudimentary explanation of what we do. For something more comprehensive, though, you would probably need to get hold of a book which explains in greater detail how the systems we use where and how they originated. The 'go to' text when we all trained in the latter part of the last century was Ted Kaptchuk's book 'The Web that has no Weaver' but since that time there have been a few more books by senior practitioners like John and Angela Hicks, or Peter Mole, which give thorough explanations of what we do and why we do it.

The challenge for any author in the West is how to present a 2500 year tradition in a comprehensible way when the very culture in which the original theories was embedded is vastly different from the western culture in which we live. Chinese language is able to express subtle shades between black and white in a way our language cannot, and the kind of internal logic of the language and concepts of yin and yang are embedded in the way that people actually think. Getting this across in a language and structure of thought which is very different can be a problem.

Not only this, whereas western medicine can be viewed as an expanding ball developing from a commonly agreed centre, Chinese medicine is inherently pluralistic. This arises in part from the fact that until the mid-1950s it was very much an apprentice trained tradition. There are many textbooks which have been handed on for thousands of years, but the basic principles have been applied in a myriad ways, some of which can actually be contradictory but nonetheless part of a practitioner's basic skill set. You can imagine the challenge that this represents even to learn the various systems, let alone try to explain the whole field thoroughly to an interested party.

If you are trying to get hold of a much briefer introduction there is a small pocket book which cnan be found here

https://www.amazon.co.uk/Understanding-Acupuncture-Joanna-Trevelyan/dp/1904439268/ref=sr_1_4?ie=UTF8&qid=1496646368&sr=8-4&keywords=understanding+acupuncture

We used to sell copies of this from the office to members who wanted something small to lend or sell to prospective patients. While it could do with a minor update it still offers a very simple but useful overview of what we do.

We are sorry that we can't go into much greater depth here, but the resources available online and in books are now so good that it wouldn't make sense to give a partial and over-short explanation here. We hope that you enjoy finding out about what we do.

Q: I went to see a physiotherapist after having severe spasms in my side from a pulled muscle.
He recommended acupuncture to "reset my nervous system" and put about 6 or 8 needles in my lower back. The first session was fine, I hardly felt anything. I went back a week later and my side was 90% better so he recommended more acupuncture. This second session was kind of uncomfortable and for hours afterward I had a feeling like a bee was stinging me in the lower back. The next day this was gone but I then I kept feeling like I had little electrical shocks in my lower back. The feeling lasted one day and then was gone, but I have had a throbbing ache in my lower back ever since. This is about 4 weeks now.
I went to see my family physician and she thinks he hit a nerve and I have inflammation and that this pain could be permanent.
I saw my physiotherapist last night. He thinks it is unlikely that he hit a nerve and said that some people just don't take to acupuncture well. He has given me some exercises to do.
I am really concerned that this pain won't go away......I am a self employed (female 56) house painter and have not worked in a month due to this pain.
Any suggestions?
Thank you.

A: First, let us say that we are sorry to hear of your experience. Adverse events after acupuncture treatment are relatively rare, and the vast majority of them are transient, wearing off after a day or two at most.

From what you report we would be very surprised if the practitioner had hit a nerve. This is a generally unmistakable sensation (this expert has been on the receiving end!), and there is absolutely no doubt when it happens. What can happen, though, is that a needle inserted deeply into the tissue of the back or elsewhere can cause a small internal bruise which forms beneath the skin and then becomes more condensed. If this sits near a nerve then every time you move it is going to impinge the nerve and cause pain or discomfort. That certainly sounds like what the 'little electric shocks' could be.

However, these would, or should, have subsided well before four weeks have passed, and certainly would not account for a pain of sufficient intensity to stop you working for this time. There are two possibilities. The first is that the treatment has been a little too successful. The physios'professional association warns its members that occasionally deep needling can relax muscles which, while tense, are actually guarding the back. When these stop doing this job it can mean a back problem which has been under control can suddenly cease to be so. This is quite rare; the BAcC keeps records of reported adverse events and insurance claims, and there have only been a couple of instances over the last twenty years where this may have been the case.

The other possibility is that this problem is unconnected with the treatment, and has just happened coincidentally. This is not so odd as it sounds; with over four million treatments being administered every year there are going to be a few cases where something happens after a treatment which has nothing to do with it. The problem is that patient and practitioner can get then get into debate about whether the treatment caused the problem while it goes undealt with. We always advise members to get their patients checked by the GP and referred on if need be, because eventually the diagnosis will point clearly to the probable cause.

The fact that you may have told the GP that the pain was caused by the treatment may have discouraged them from further investigation. We tend to think that if something is bad enough to keep you off work for a month it needs to be checked out immediately.

We have to say that you physio may be right insofar as acupunbcture isn't always the best treatment for someone, and we have seen several patients for whom it was too powerful an intervention. Where this has happened, though, we have never seen an adverse event lasting this long. The most that we have seen hs been a couple of days.

Hopefully your pains do derive from an accidental nerve impingement, and will subside soon. If they don't, though, we would be pushing for an X-ray or scan to find out what is going on.

Q: My son who is 14 has had Labyrinthitis for two weeks and slowly recovering. His dizzy spells are reducing but he still haves some vertigo.
Is it possible that Acupuncture could help?.
He is one of the countrys top bmx racers in his age group and due to race in the World championships
in the USE at the end of July. At the moment we are very worried he may not be able to compete.
Your early reply would be most appreciated.

A: We are sorry to hear of your son's predicament. We have a factsheet on our website

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/2599-vertigo.html

which gives a fair bit of evidence for trials which are very encouraging about the use of acupuncture for a variety of balance problems. We quoted this some time ago in an answer about the generic problems of the inner ear, in which we said:

There are a number of conditions like Meniere's disease, vertigo, labyrinthitis and so on, where changes in the structure or infections in the inner ear area can cause significant balance problems as well as generating other symptoms like nausea and headaches. Because there is no precise overlap between the classifications of conventional medicine and Chinese medicine, there may be many different ways of treating the same named condition depending on what else a practitioner finds to be out of kilter in a system. This means that it can be quite easy on occasion to identify a group of signs and symptoms which are likely to be amenable to treatment and which enable one to treat with confidence. On other occasions it can be very unclear, and when this happens we have to rely on the very basic premise of Chinese medicine, that if the energy ('qi') of the body is balanced and free-flowing, then symptoms will resolve through the body's capacity to heal itself.
 
There is a fair measure of evidence for a number of balance related problems, as our factsheet shows but we would have to admit that many of the trials which do report success are not conducted by using Chinese medicine as it is practised, and while we would contend that the personalisation of treatment to the unique individual is a far stronger treatment than a treatment repeated formulaically several times, this latter is the basis on which most research is conducted to meet the current 'gold standard.' One trial of this kind, for example,

http://www.ncbi.nlm.nih.gov/pubmed/19606509
 
generated some very interesting results, but the formula applied would not be appropriate for everyone.
 
For a generic problem such as this which might present against a vast range of contexts there is no substitute for visiting a BAcC member local to you to ask for a brief face to face assessment of the potential benefits of treatment. This will enable them to give you a far better informed view than we can do at a distance

We think this is about the best that we can say. When patients come to us the first thing we establish is what exactly is wrong with the inner ear. There are a number of physiological changes to the ear which can mean that conditions like this have to be regarded as permanent, so a practitioner will first want to assess whether this is something which is even amenable to treatment - there's no point in wasting time and money on something which isn't going to work.

As far as how long the treatment lasts is concerned, this is the proverbial piece of string. We always aim to treat the overall picture, not simply the symptom as it presents itself, because we believe that doing only symptomatic treatment is like turning off an alarm bell because you don't like the noise. If we treat the whole system, and the treatment is successful, there is no reason why someone who looks after themselves shouldn't remain relatively symptom free. In reality this tends to be a little less likely than a case where someone will experience some positive change which they have to 'top up' from time to time.

What we always aim to do, though, is to review progress after four or five sessions, and if there is no obvious sign of improvement to draw a sharp line in the sand before committing someone to what may turn out to be a long, fruitless and expensive process.

We believe that this still covers most of the ground pretty well. We have undertaken a survey of more recent research and there are a couple of papers

https://www.ncbi.nlm.nih.gov/pubmed/26055400

https://www.ncbi.nlm.nih.gov/pubmed/26055400

which give a guarded but generally positive view of the value of acupuncture treatment for these types of cases.

There is plenty of time between now and your son's championship for acupuncture to take effect, if it is going to work. Even if it didn't do as much as we expect it could, there are other options which you might want to explore. Amongst the more promising is cranial osteopathy, which can often offer help for problems where a small but significant shift in the subtle structure of the skull could have an impact on balance. We would assume that as a serious BMXer your son is used to the odd tumble, and it may well be that a succession of these have contributed to the problem.

Whatever option you choose to pursue we are confident that the network of practitioners in your area will be able to point you towards whatever help will best suit your son.

And if he/you do choose acupuncture and he wins, we'd love a namecheck!

 

 

Q: I am trying to find out if I can have acupuncture as an anaesthetic for a knee operation in the UK. Is this possible in a hospital and are there any practitioners in the UK please?

A: We have been asked about the use of acupuncture anaesthesia a number of times, and a typical answer has been:

The answer to your question is that in theory acupuncture can be used as an anaesthetic, but we suspect that you will find it very difficult to locate a practitioner prepared to do it.

After Nixon's visit to China in the 1970s, and the remarkable pictures of people having some very serious operations using acupuncture anaesthesia (AA) , there was something of a surge of interest in the West in researching the use of acupuncture for pain relief and even trying to use AA. However, what the images from China did not show was that in every case there was a bank of conventional anaesthetic equipment ready for immediate use in case the AA wore off. The effects were not always guaranteed and reliable, and in the past two decades its use has now diminished to being an occasional novelty rather than mainstream practice.

We did have a colleague who agreed with great reluctance to use AA for a rhinoplasty in a patient who could not have a general anaesthetic, but he did have to study books to work out what to do. The fact that the operation went well, there was less bleeding and the patient recovered much faster was not enough to make him succumb to the blandishments of the consultant who wanted to offer him a permanent slot. He found the whole business far too stressful.

If you can find someone willing to do this your best bet may be someone who regularly uses electro-acupuncture (EA). This has the advantage of being consistent over time, and can also be ramped up if the effect starts to diminish. You might well find that some of the medical acupuncturists are more conversant with this than traditional acupuncturists, and indeed some of the physios who use acupuncture may also use EA more. Both of their registers ( http://www.medical-acupuncture.co.uk/ and https://www.aacp.org.uk/) may offer search options, as well as our own. We think you may just have to ring around until someone points you towards a practitioner they know of who regularly uses EA and may be prepared to do AA.

We are not sure that we can say any more or better than this. The only times we have come across someone having AA in the West are when an operation is necessary but for some reason the patient cannot tolerate either general anaesthetics or epidural injections. There would have to be a very strong reason for doing it, we suspect, for a consultant to be able to take what may be an enhanced risk in working in this way.

That said, a great deal depends on the operation for which you are lined up. If we are talking serious surgery like knee replacement or similar then we think it is highly unlikely. However, for arthroscopy and a number of much simpler procedures you may be able to make a case. You would probably have to sign some very serious disclaimers and make a very robust case for sidestepping the usual procedures, but nothing ventured, nothing gained.

We wish you luck, and hope that you do manage to find someone who can help you.

Q: how does acupuncture help in managing osteoarthritis. Does it only relieve pain or can it also slow down the progression of the disease

A: There is a very large and increasing body of evidence for the use of acupuncture as a treatment for osteoarthritis, as our factsheet shows

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

Many of the studies are quite clear that reduction in pain with acupuncture is a reasonable expectation of outcome for treatment, and many of the studies cited here speak of the reduction in physical dysfunction which acupuncture treatment seems to achieve.

However, it is a fairly large step from pain reduction and functional improvements to statements about slowing down the progression of the disease. To the extent that changes in physical movement wrought by the pain and inflammation can both make the situation worse, any reduction or change in either will stop the condition feeding off itself, i.e. the symptoms become a part of the causal pattern which causes deterioration. However, the factors which predispose someone to osteoarthritis may still be as active as they were before, be they genetic, environmental or lifestyle, so it would only be reasonable to say that unless these change then slowing down the disease progression may not as easy to achieve.

This is to look at things from a conventional medical perspective, though. The ancient Chinese were just as prone to osteoarthritis as modern people, but the whole nature of the understanding of disease in Chinese medicine is different, and from this perspective there may be something which a practitioner could reasonably hope to achieve to remove some of the causal factors. Chinese medicine is predicated on an understanding of the flow of the energies of the body, called 'qi', and its patterns of flow and balance. Factors which affect this are often described in physical terms  - heat, cold, damp, etc - as a reflection of the conditions in which most people worked on the land. The Chinese would see the joint being directly affected by these conditions and use acupuncture and herbs to reduce the impact on the body.

In doing so they would also be mindful of the unique balance of the individual and the constitutional patterns which they had inherited which made some people more prone than others to develop osteoarthritis (the Chinese called it Bi Syndrome, and classified it according to its presentations - Hot Bi, Cold Bi, Damp Bi, etc). In this sense an experienced practitioner might hope to reduce the symptoms as well as addressing some of the deeper factors which predisposed someone to suffer with OA. From this perspective it might well be possible to look at slowing down the disease progression.

No treatment for OA works in isolation, though. An integrated approach, involving not just acupuncture but physical therapy, diet and exercise, will always offer the best chance of making life more tolerable for an OA sufferer.

Tuesday, 30 May 2017 08:32

I suffer from ventricular ectopics

Q: Hi. I suffer from ventricular ectopics,I have seen Drs regularly and take beta blockers which work to a degree. I have periods when things aren't too bad and periods when things are really bad,I do get quite down during these times. Do you think acupuncture would help?

A: We have been asked similar questions before, and in reply to one we said:

One has to be very careful answering questions such as these. Taking the pulse a the wrist is one of the key diagnostic techniques in Chinese medicine, along with looking at the tongue and a number of other evaluations. The irregular pulse has clinical significance in the tradition, and point to specific disorders of organic function as understood within this paradigm of medicine. However, these may not all involve the heart - in fact, most of them don't - and any suggestion that this is treating the heart as it is understood in the west needs to be set aside.

From a conventional medicine point of view, there is not a great deal of evidence that acupuncture can treat these problems, although what little there is does tend to be very positive, although not always methodologically sound enough to use as the basis for a recommendation. A good example of a systematic review is:

http://www.ncbi.nlm.nih.gov/pubmed/18992625

Some of the published research also involves animal experiments, sometimes called 'ratpuncture' in the trade, and although the results here may be promising it is quite a large assumption to believe that human physiology will respond in the same way.

We think that it would certainly be worthwhile talking to a BAcC member local to you about what the conditions may be telling them about the way your system as a whole is functioning. From our perspective all of our members are equally well-qualified to deal with the vast majority of patients who present at their clinics, and it is obvious from what we have said earlier that there are no specialists in heart problems per se - Chinese medicine primarily treats the person, not the condition which someone has.


There have been a couple of other systematic reviews

https://www.ncbi.nlm.nih.gov/pubmed/28432528

http://www.internationaljournalofcardiology.com/article/S0167-5273(11)00227-0/fulltext

which make largely positive noises, but as in all of these kinds of studies the treatment which is given is largely formulaic, and does not really represent what a traditional acupuncturist does, which is to gear treatment to the individual and his/her unique balance of energies. Where trials offer designs which allow the practitioner to do what they might normally do, so called 'black box' trials, the results tend to get better and better.

The bottom line, though, is that from a Chinese medicine perspective there are often functional disturbances which can generate symptoms, often far away from the source of the manifesting problem. The skill and art of the practitioner is to make sense of the diagnostic information and treat the root of the problem. This can often cause a symptom to reduce or even disappear without there having been any apparent connection between where the needles were placed and the part of the body in distress.

The advice we gave before still holds good, to visit a local BAcC member for advice and a short face to face assessment of what may be happening. Most BAcC members are only too happy to give a small amount of time without charge to prospective patients to enable them to assess whether acupuncture is the best treatment for their problem. This will obviously give a far better idea of what may be possible than what we can say at a distance.

Q: I had chemotherapy 4years ago, I lost my finger and toe nails. Since I have suffered terrible discomfort in my feet. I now find it hard to sleep because of the pain. Would acupuncture help?

A: We are sorry to hear of your problems after chemotherapy, and hope that the treatment worked for the condition at which it was aimed.

As you can imagine we have been asked before about neuropathy induced by chemotherapy, and a typical answer has been:


There is a growing body of evidence which suggests that acupuncture can be very effective in helping to reduce the severity of peripheral neuropathy (PN) induced by chemotherapy and to speed up the rate of recovery. If you search on google using the terms ' ncbi acupuncture neuropathy chemotherapy' you will access a major American research database gathering studies from all of the established online collections like PubMed and Medline. The first half dozen results point to a number of recent studies which show very encouraging results, but most of which conclude that a much larger study is warranted before any definite conclusions can be reached. This is not uncommon; research funding for acupuncture is not that freely available in the West, and Chinese studies are often regarded as methodologically unreliable. There is certainly enough to say that acupuncture treatment will probably help.

We have to be careful not to get too drawn into a conventional medicine perspective when answering questions like this, though. If there has been physical damage to the nerve endings then the condition is less likely to be reversible, although there is some cutting edge research which does suggest that peripheral nerves can regenerate. If the nerves are not too badly affected, however, it is important from a Chinese medicine perspective to see how the chemotherapy has affected the whole system. A symptom can be generated by any number of functional disturbances as understood within Chinese physiology, and can also arise from a simple blockage in the flow of energy at a local level. Problems like neuropathy are often a manifestation of both phenomena, and offer a number of treatment options. The skill of the practitioner lies in seeing how the system as a whole is functioning to narrow down the possibilities for treatment selection.

This does not mean that acupuncture can achieve miracles where modern medicine cannot. What we find, however, is that where western medicine assumes a direct causal path between the chemicals and the nerve damage or loss of function, Chinese medicine offers a number of potential routes where, for example, the chemotherapy may have affected a functional unit which in turn has weakened the energy at the periphery.  This is turn may offer a slightly different focus for treatment with better chance of success.

It also explains why people are often confused by the fact that the same symptom  can be apparently treated twenty different ways. From the Chinese medicine perspective the symptom is often only an alarm bell sounding for wider-ranging imbalances, and the practitioner will always look at the overall context to determine how to proceed.

Having looked at this as an answer we think it still represents the best advice that we can offer. We have had another look at the databases, and there has been nothing new since we wrote the earlier reply. Franconi's systematic review, a paper which gathers together results from all other papers, is perhaps the most recent and best summary, but as we said in the earlier reply, he concludes that the results, while encouraging, are far from conclusive.

What we didn't say is that most BAcC members are more than happy to take a look at problems for prospective patients by giving up a few minutes without charge. A short face to face assessment is always going to be far more authoritative than anything we can offer at this remove, so it would be worthwhile contacting BAcC members local to you to see what they think. This also gives you a chance to meet them and see where they work before committing to treatment.

Q: I am very interested in Acupuncture.

I am 32+ weeks pregnant and I was thinking to begin acupuncture in the 37+ week. I read it can relief a lot the pain in labour and helps deliver quicker. Could you please advice me? Because it seems that midwifes and GPS don't know much about it.

A: As you can see from our factsheet on obstetrics

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/1592-obstetrics.html

there has been a considerable amount of research into many areas of pregnancy, from early stage morning sickness through breech presentation and on to delivery itself. While the evidence is a long way from conclusive (it does tend to be, but this is more a reflection of the standards used in the West which may not be the most appropriate for evaluating acupuncture treatment), it does show a trend towards acupuncture treatment being worth a try for many of the problems/challenges associated with pregnancy/delivery.

Although we describe ourselves as generalists - we primarily treat people, not diseases or conditions - there are one or two areas where the training which we all have can be usefully supplemented by postgraduate training. In two of the most clear-cut cases, obstetrics and paediatrics, the training is now sophisticated enough to warrant a decision on recognising expert practice, i.e. someone can legitimately claim within our rules to be an expert at treating these specific patient groups. While we are not yet yet in a position to do this, ultimately it will mean that we can specify which training people have had and point to providers who all keep lists of their graduates and affiliates. In the absence of this, the best that we can say is that if you use google and search on 'acupuncture pregnancy' and your home area you will without doubt generate a number of hits, most of whom will be BAcC members.

There are a number of websites associated with the training providers which can be very helpful, often addressing many of the questions which people bring and have brought to their practitioners. The best advice we can offer, though, is that having located a person or people in your area who may be able to help you should arrange to see them for an informal chat to see how they can help you and also to see whether they are people you feel comfortable with. In most cases we would say that one practitioner is as good as any other, but childbirth  is a very intimate process and it would be especially good if you have confidence in and rapport with the practitioner. The earlier you establish this contact the better, even though you may not call on their services until near due date.

We are sorry that there is such a dearth of provision within the NHS. There have been a few hospitals like the Derriford in Plymouth which had a remarkable unit which incorporated acupuncture in all aspects of pregnancy, but that unit, like many others, has closed. The problem for NHS professionals is that most provision is evidence based, and as we said at the top, the evidence for the benefits of treatment is not quite good enough for NHS providers to bring acupuncture treatment within mainstream care. You may find some midwives with training in the basic skills, but these are few and far between.

We hope that you do manage to locate a good practitioner locally, and wish you every happiness with your baby's birth.