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Q:  I’m an Australian and British citizen completing a Bhsc degree of Acupuncture in Australia next month. What are the possibilities of working and registering as an acupuncturist in the UK?

A: There is very little  restriction on working as an acupuncturist in the UK. There is no statutory regulation, and the only laws which govern what we do are the skin piercing regulations under which we have to be registered and which are mainly concerned with hygiene and safety. In mist of the UK this is administered by local rather than central government under Local Government Miscellaneous Provisions Act 1982, and involves a one-off registration payment for every practice in which you work. In Greater London there is annual licensing under the London Local Authorities

Act 1991, but membership of some professional bodies (we are one such) makes members exempt from licensing. In Scotland the Skin Piercing regulations of 2006 mean that all practitioners who are not statutorily regulated healthcare practitioners have to be annually licensed.

Costs vary. One off registration can be between £200 and £400, and annual licensing rather similar. Some authorities have begun to examine qualifications to assess whether someone is fit and proper to practice but the majority don't. An Australian qualification would more than meet the criteria. As long as you have the appropriate visas and work permits that would be that. Professional insurance is essential, and the main broker for individual practitioners currently charges just over £100 per annum for a rather good policy on a 'claims occurring' basis.

Obviously joining a professional body makes life a great deal easier, and while we regard the BAcC as the creme de la creme there are other associations, most of whom would be satisfied by an Australian qualification. Unfortunately at this point we do not have reciprocal recognition of qualifications in the BAcC, so someone from outside the UK has to follow the external applicant rout outlined here

https://www.acupuncture.org.uk/public-content/join-the-bacc/3915-join-the-bacc.html

but eventually we hope to move forward with reciprocity to make transitions easier.

Q:  I am in my final year ( third year) student at Meiji University center for Acupuncture and Physiotherapy in Kyoto, Japan. What should I do exactly to gain membership at the British Acupuncture council?

A: This is somewhat tricky. If you meant coming to work in the UK , then it would simply be a matter of applying to us by following the process outlined on this page of our website

 https://www.acupuncture.org.uk/public-content/join-the-bacc/3915-join-the-bacc.html

 As long as there were no issues about work permits and visas the process is straightforward and takes three to four months from start to finish.

However, if you meant becoming an Overseas member that would be more of a challenge to our systems. Many years ago we amended our constitution to restrict Overseas membership to only those people who had been Full members already or who had graduated from a recognised accredited college in the UK. We had become aware that some Overseas members were using the status inappropriately and implying that we had more jurisdiction over their work than was possible at distance, and could provide assurances about people's standards and insurance. We do not have the resources to do this, so we chose to restrict membership to those whose standards we are more confident about.

 However, there are always exceptions to every rule, and in some cases it might be possible to make an application. We don't think that it is very likely to be accepted, given the rules for Overseas Membership are so precise, but things change, and if you lodge an interest there may be a chance that in future a category of membership will arise and enable you to join.

Q:  A practitioner performed acupuncture treatment on me and inserted a needle on the bottom of my left foot along with other points. I felt some pressure when inserting the needles, but it wasn't too painful. When the needle was pulled out I felt intense pain. The next day, it wasn't quite as painful and I saw a very light bruise on the bottom of my foot. The pain persisted for the week and it was a mild pain and usually comes on when I walk. It was only that particular point that is still painful. I told the practitioner on the next appointment a week after the initial treatment and he told me that its normal for that point to feel discomfort and he didn't seem too concerned. Now its been 11 days, and the mild pain is still there without signs of improvement but the light bruise went away.

I don't suspect any malpractice, but was wondering if this is normal and should I be concerned with anything? Would this mild pain go away on its own? I'm concerned if it could be something more serious like a blood clot, damaged nerve or a damaged tendon as a result of the acupuncture.

A: We think that the advice your practitioner gave you is correct, and that while this seems to have taken a little longer than similar bruising to resolve it will eventually dissipate. It may well be that while the visible evidence of bruising has gone there may still be some deeper bruising which has consolidated and which is impinging a local nerve. This would mean that any weightbearing would be likely to generate a reaction.

 

However, just because serious adverse events are very rare does not mean that they do not happen, and so if the problem persists more than two or three weeks that may well be a good reason to have further investigations. We think it highly unlikely that there has been any permanent damage to nerves because if the practitioner had hit a nerve on the foot you would have known all about it. A blood clot sounds dramatic, but that is all that deep bruising is and it isn't likely to travel from the area. Tendon or ligament damage is possible, but our experience has been that if there are reports of tendon damage the point where they are caused is painful at the moment of insertion. In short, if the problem didn't resolve quietly over the next few days we would be puzzled!

You can discount bits of needle. The standard of needle manufacture has improve dramatically in the last twenty years, and the fact that all needles are now used only once and then thrown away in the sharps box means that broken needles are almost unheard of. The principle cause of what even then was a rare event was the constant autoclaving to sterilise a used needle which made the steel brittle. As we said, now a thing of the past.

 We confidently expect this pain to diminish and go away within the week, but if it does remain into a third week we would certainly recommend that you let your GP have a look to see what may be going on.

Q:  I have a big problem with cigarette smoke I hate the smell and it makes me feel sick I do get anxity and stressed when smelling it making me very unsocialabe do you think acupuncture would help thank you in advance

We are sorry to hear of your problem with cigarette smoke. Clearly your problems will have eased a little over the last few years as the smell has become less prevalent, but we are sure that you have experienced that odd sensation that the less common cigarette smoke has become the more noticeable it is when it does turn up.

We have to be honest and say straight away that we have never come across anyone with the same problem and as you might expect there is no research of any kind into this specific problem. We do occasionally come across people with phobias, and we wrote a long answer last December about the fear of flying in which we said:

It was always said that if you wanted to get a straight answer from a doctor, you should ask them, 'would you be happy for your wife to have this treatment?' So, I suppose if you said to us, 'would you recommend acupuncture to your family to overcome a fear of flying?', the answer would probably be 'no'. This is not to say that it might not work; over many years of practice we have heard of a number of almost incredible stories about changes which people have managed to make thanks to treatment, and quite often by the practitioner simply sticking to very basic traditional acupuncture. 

Extreme reactions of any kind are, from a traditional acupuncture perspective, indications that a part of the system is out of balance and generating inappropriate emotional or mental responses. It is sensible to be mildly apprehensive about flying, just as it is to be mildly scared of heights. If the faculty of sensible fear is out of balance, then extreme reactions abound.

However, with a problem such as this there are other possibilities which seem to us to go to the heart of the problem much more directly. Hypnotherapy or CBT (Cognitive Behavioural Therapy) are both well tried approaches for phobias, with the added advantage in the case of hypnotherapy of being able to do trial runs under the power of suggestion. There are a great many forms of hypnotherapy, all of which have their strengths, but those based around NLP and the work of hypnotherapist Milton Erickson seem to have the most well attested handle on treating phobias.

There is no doubt that you would probably derive some benefit from acupuncture treatment in terms of a reduction in anxiety, as our factsheets show, and always the possibility that a skilled practitioner might look at your overall balance and get that feeling that there is something obvious to be done which may help. It is more probable, though, that they would do as this expert would, refer you to a trusted colleague who does hypnotherapy or CBT to ensure that your needs were skilfully and professionally met. Because traditional acupuncture treats the person, not necessarily the condition they have, there is a danger that this can be re-framed as 'acupuncture can treat anything', and occasionally incautious practitioners let patients' expectations run away with them. 

 If you substitute the words 'extreme reaction to cigarette smoke' for 'fear of flying' the same advice holds good. It might well be worth your while talking to a local BAcC member about your problems because in conversation they may see that the issue is really your anxiety which has latched on to a specific trigger. In this case they may well think that something could be done. If not, then it is a trusted source of a good referral to other forms of treatment. It's often very difficult to know where to turn in the field of CBT and hypnotherapy, and personal recommendation is usually the best way to find a good practitioner.

Q:  I'm trying to find help with my (central post-stroke pain syndrome) I've had for 28 years after a stroke hemorrhage in 1990. I have tried everything from oramorph , Trans cranial magnetic stimulation, deep brain stimulation, spinal cord stimulation HF10 and other interventions all with no benefit so would acupuncture help?

A:  We have to be honest and say that if all of the other therapies you have tried over the last 28 years have failed to effect a change it would be a very considerable surprise if acupuncture treatment suddenly proved to be the answer. However, we are not entirely sure what the CVA has caused by way of continuing symptoms under the generic title of CPSP, and there are aspects of post stroke treatment where the blockages which arise at the time of the event will stay blocked until someone clears them. We do occasionally hear of people having dramatic changes twenty or thirty years after a problem began but this is quite a rare event, and we would never use examples like that as the basis for a recommendation.

We have gathered a considerable amount of information about the treatment of strokes in a rather dense review paper which can be found here

https://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

but the short answer to questions about efficacy is that in China acupuncture treatment, when used, commences almost immediately before the system has become 'fixed' in a state of disrepair, and the evidence suggests that this maximises the chances of regaining residual function quickly. The longer people wait for acupuncture treatment, the less well it seems to work and the less overall effect it seems to have.

Pain management is something for which acupuncture has developed something of a reputation since Nixon's visit to China in the 1970s and the sight of people having operations under acupuncture anaethesia. This led to a proliferation of trials and because neurotransmitter levels are easily measured a great deal of good evidence about the use of acupuncture to stimulate their release. Many Pain Management clinics base their work on this. The central question is how much relief and how sustainable, and it may be a matter of weighing up the cost and inconvenience against the amount of relief treatment can offer, it indeed it does work a little. 

The best advice that we can give is that you visit a local BAcC member to seek their view in a brief face to face assessment of what may be possible, depending in the exact presentation it is that you need help with. We also think that cranial osteopathy might be another pathway which might offer some potential for change, but we don't have a central referral point to which we can direct you. Many osteopaths use cranial techniques, but some spend a great deal of time on this work and are often the local 'go to' people for difficult cases. we would hope that any you might contact direct you to the most

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