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Ask an expert - about acupuncture

325 questions

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.

 

 

Q: I have been for 3 acupuncture session over the last week. I am going for various reasons, CFS/ME, anxiety and the flu amongst some other moans and groans. After the first session I was pretty ill with indigestion and nausea and aching. Nothing much after the second session but a headache. After the third session however I am feeling very strange, I feel almost out of it for lack of a better description. I cant seem to get myself to focus at work no matter what I do and had a panick attack which I don't usually suffer from. I am spaced and feel removed. I am also a bit nauseous. Is this normal and has anyone else described this. When will it pass? I need to work and I am getting anxious. Is it a good sign.

A: It's always very difficult for us to comment when we do not have a full case history in front of us, and better still, an actual patient. We are always aware that if we take issue with what someone has done without knowing the full picture we might make an unfair criticism for which we might be held to account.

What we do wonder, though, is whether it is entirely wise to do as much treatment in a week to someone with a background of MS/CFS who has reacted very strongly to the initial session. In people whose immune systems have been weakened by long term illness it is always wisest to start slowly with the strength of treatment and to row back if they throw quite severe reactions. This is not a universal rule, but it is impossible to tell after a single session whether the effects are a clearing of imbalances or an adverse reaction to treatment.

We suppose that since the second treatment didn't really cause anything over-dramatic the practitioner decided that it was the former, a mild-ish reaction which could indicate the beginning of the process of healing, and treated again. In the event, the further reactions after the third session might call for a review of that judgement.

It is highly likely that if you have been slightly overtreated the effects will not last that long. Acupuncture is a remarkably safe therapy, and the only serious incidents involve the penetration of organs with needles, and these occasions are very rare. If someone has a strong reaction to treatment then it normally lasts no more than 48 hours at most, and usually less. We suspect that by the time you receive this you will already be feeling a great deal more 'normal'.

It may, of course, be that the problems are not at all connected to the treatment; CFS issues can often come up at any time. However, it does look like the treatment is implicated, so it is really important that you discuss this with your practitioner in determining how to proceed. This might mean less frequent or less powerful treatment, and we are sure that a properly trained and qualified practitioner will listen to your concerns and respond accordingly.

We did say, though, that without looking at you and the case history we could not say for sure whether the practitioner was in any way at fault, and it may well be that he or she is surprised by this outcome and well able to respond positively to the feedback you are providing. Treatment is sometimes like a voyage of discovery where a practitioner can only find out what the best strategy is by setting off as normal and then reacting if the signs are that the treatment is too much for the patient. The practitioner may well have made a judgement that you needed frequent treatment based on your case notes, but your reactions might suggest that this is not the best way forward.

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: Doed obtaining the Chiway swiss Diploma in Acupuncture and Tuina entitle one to be registered in the Uk as a licensed acupuncturist?

A: The first and most important thing to say is that in the absence of statutory regulation in the UK there is no single registration process for someone to become a licensed acupuncturist. Under what is termed common law, anyone can set up practice without any restriction. The only legal requirements are those which involve registration with local authorities under a number of different byelaws which regulate skin piercing activities. These mainly concern the standards of hygiene and waste disposal in a practice, but in recent years there has been an increase in interest in the standards of training which people who are trying to register have. We have heard stories of people with very short training courses behind them, perhaps a two weekend course, being refused registration. However, the majority of courses of this nature are provided for medical health professionals like doctors and physios who are usually exempt from registration anyway, so in practice there are very few people trying to become licensed as traditional acupuncturists on the basis of rudimentary training.

The majority of UK practitioners belong to one of a number of different acupuncture associations, membership of some of them giving people exemption from licensing in the Greater London area. Most have clearly identified and published entry standards, and it would really be a matter of whether your training from Switzerland met the minimum criteria for membership. None of the associations of which we are aware has any reciprocal recognition of qualifications, so we suspect that you would have to make an individual application and be interviewed about the extent of your training. We have looked at the website of the school which provided your training, and on the surface it looks fairly comprehensive, but we have seen similar programmes for course which lasted a couple of weeks, so without a course transcript detailing hours of training it would be difficult to say how easy it would be to register in the UK.

Our own standards and entry process are to be found here:

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

where our Admissions process is described, and a broader outline of training standards can be found on the website of our sister organisation, the British Acupuncture Accreditation Board here:

https://www.baab.co.uk/

The documentation here outlines the degree level training which accredited courses have and which lead to automatic eligibility to join the BAcC. All other applicants are interviewed and assessed individually.

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