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Ask an expert - general

235 questions

Q. My son has recently been diagnosed with stage 3b/4 chronic kidney disease. He would like to use acupuncture to help him through this challenging life changing period. Our insurance will cover the costs of this type of treatment.

However, he is unable to get a Doctors note to support this type of treatment either from his GP or from his kidney consultant. Therefore he cannot make a claim from our insurance.

How can I arrange a consultation with a doctor to support his acupuncture treatment?

A. We are very sorry to hear of your problem. We have seen this a number of times where the insurer is apparently happy to cover acupuncture as an option but requires the GP or consultant to act as a gatekeeper in providing a referral letter. We are not sure which scheme provides your cover, but we are aware that the scheme providers are wary of writing a blank cheque to scheme members for treatment where there isn't an agreed protocol which offers a realistic chance of success within a fixed number of treatments. Traditional acupuncture, which is as much about maintaining health as it is repairing damage and disease is potentially open ended and contextual, i.e. the same problem occurring in twenty people might arise from twenty different causes, some of which might respond quickly and some of which might not.

Since the schemes are created on an actuarial basis, where the provider has to have a realistic idea of what the commitment is, then the doctors and consultants are often instructed only to refer those patients with conditions for which there is a goof evidence base and standard treatment. This reduces the number of referable conditions dramatically.

It may be possible to locate a doctor who is prepared to refer your son; many private hospitals have GPs who are able to see patients at a price. Whether this would count as a referral is another matter; there's no point in spending £100 for a letter which your insurance company will repudiate anyway. We have seen patients whose companies have larger schemes which they control use this as a bargaining/blackmail chip by threatening to pull all their staff our of the scheme and go elsewhere, but this does have the disadvantage of a fresh start for people with pre-existing conditions whose cover lapses immediately.

We have found that talking directly to the insurance providers is often the best bet, both for throwing yourself on their mercy and also for finding opportunities within the system which you might be able to use to your advantage. Companies are run by human being who are often predisposed to help.

Another option is to use the PALS (Patient Advisory Liaison Service) which, in our experience, is pretty effective at fighting patient's corners. If you son is under hospital supervision, which we are sure he is, then this may well be worth a go. it won't be costing the hospital a bean, and consultants do not generally want the hassle of people nagging them when they might be shown to be unsympathetic. At very least it offers you something concrete about why they are refusing to sign, and that gives you are starting point for further negotiation.

There isn't a great deal of research we can point you to to support your case, and studies such as this

https://www.ncbi.nlm.nih.gov/pubmed/28422526

are few and far between. However, if you do get to a point where evidence might help to sway someone's mind then we will do what we can to help you.

Q. I suffer from sciatica and had my first acupuncture treatment 5 days ago. I had my second treatment 2 days ago. For the past 3 nights, I have been running a temperature of 101. I only have fever @ night. I am afebrile during the day. Could this be from the acupuncture? I asked my acupuncturist but her English is very difficult to understand and I felt like she brushed me off. She basically told me that I may have an infection. If I had an infection, I would be febrile all the time. Please advise. Thank you!

A. We think that it is highly unlikely that you have an infection from the acupuncture treatment itself. We keep very detailed records about what are called adverse events after treatment, and also look at world-wide databases in case patterns emerge to which we ought to alert members. Infections are very rare in the West, although in countries with primitive conditions they do happen, and when they do happen it usually arises from malpractice. These sorts of problems always tend to be local if they occur at all, i.e. something unpleasant at the needle site which spreads.

There are one or two possibilities within Chinese medicine itself. Although we treat specific problems, we always look at them in their overall context because they often arise on top of systemic weaknesses. Our job is not to turn off the alarm but to find the cause of the fire, so there are times when we treat systemically and it can cause a re-balancing of the system as a whole. This might, in some circumstances, cause the release of internal heat, and there are one or two syndromes where the body may become warmer at night.

101 degrees is much more likely to indicate an infection unrelated to treatment, and this is not entirely unexpected. There are over 4 million treatments administered every year in the UK and there are bound to be times when someone gets ill at the same time as their treatment and wonders whether they have been made ill by the treatment. In these cases we always advise people to see their doctors, because if it is a separate phenomenon it makes no sense to be arguing about what caused it and every sense to get it sorted. This invariably reveals the cause.

This always sounds defensive but isn't we have decades of experience and we are very aware of what can happen from acupuncture treatments. With the safety standards in place in the West infections from treatment are very rare.

We are sorry that your practitioner's English was not able to help you. We do find that some practitioners who have English as a second language often sound like they are giving someone the brush off but this is more often to do with making what they believe to be a statement of fact without the usual sugar coating that we tend to apply. So you'll more than likely get the answer 'no' with no embellishment, which is often not reassuring. Information dispels fear!

We hope that by the time you read this the temperature has normalised, but in any event we would recommend that you talk to your local surgery and seek advice about whether to drop in so the doctor can take a quick look at what is going on. 

Q. If I want to set up my own practice and currently not a member of the BACc but have a BSc degree level in acupuncture in the UK what steps do I need to take in able to practice safely within the law..any help would be grateful ..many thanks

A. The first thing that we'd always recommend is that you join a professional body, even if it isn't the BAcC. Our experience is that it can be a lonely world as a practitioner without back-up and regular contact, and we have seen many solo practitioners fall away very quickly, which is a sad waste of the training. If you have other healthcare skills that will help, but being able to turn to fellow professionals in your own trade is vital.

There are a few legal requirements, the main one being that you are registered or licensed with your local authority. In most of the country that will mean a one-off registration under Local Government Miscellaneous Provisions Act 1982. In London it will mean an annual licence unless you belong to an exempt professional body, and in Scotland an annual licence unless you are a statutorily regulated healthcare practitioner. The local authority licensing or environmental health department will sort you out.

You will need to be insured. Indeed, most authorities will want to see this in place as a condition of licensing or registration. Some insist on membership of a professional body, but this is rare. You will also need to set up a contract with a clinical waste disposal agency for removal of sharps boxes and clinic waste.

If you work in an established practice you need to make sure these things are in place. Registration is for every person in every place they work, so anyone telling you that the practice is registered without you being is wring.

If you work from home you need to check that there are no problems with planning - parking is the major issue - and although you are legally entitled to work from home neighbours can object if the parking or volume of business becomes a nuisance. If you work from home you also need to check the situation with business rates; you may become liable for them with an attendant reduction in your council tax being possible. You also need to check whether you mortgage allows this to happen, and also whether running a business from home invalidates your contents insurance.

Aside from that, the main issue is maintaining the currency of your skills by doing relevant CPD and staying in touch with what is happening within the acupuncture world.

More than that, ....... well, that's why our members pay to belong! That is enough to ensure that you stay within the law and suitably protect your patients and the public.

Good luck!

We have generally tended to be quite upbeat about treating shingles, as this sample 'nested' response

shows:As you might imagine we have been asked about this many times over the years, and a recent answer was:
Shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet

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

says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

We have had a good look through the research databases to see what further evidence is available (the factsheet seems to stop around 2008) and we have found a few which are positively encouraging, such as:

https://www.ncbi.nlm.nih.gov/pubmed/21639941

https://www.ncbi.nlm.nih.gov/pubmed/22502623

but the systematic review proposed in 2014 has still to be completed (at least we can find no trace of a publication by the principal author).
The advice we gave earlier holds good, and that is to visit a local BAcC member for an informal chat about what may be possible. This is by far the best way to get a clear idea of your prospects, and most members are only too happy to see prospective patients in this way.

However, your symptoms seem to us to be particularly severe. This does not mean that it won't be amenable to treatment; there have been many occasions when severe symptoms improve quickly while mild symptoms remain intractable. Common sense dictates, though, that the fact that this has endured for two years probably means that it will require an extended course of treatment to see whether change is possible.

This can often generate problems because whereas we normally say that a practitioner should review progress after four or five sessions, if something might take twenty sessions to deal with there is something of a leap of faith about what can be a quite considerable level of expenditure. Difficult as it is to establish meaningful scales for pain or movement we encourage practitioner and patient to work together at finding an objective measure of improvement which can help both to assess whether there is sustainable progress. Anyone can have good or bad days but objective measures allow a better perspective for making decisions about carrying on.

Q. I have been receiving acupuncture for chronic migraines in the last 6 weeks (twice a week). It has improved a lot but it has been expensive and my acupuncturist is still advising me to attend twice a week. This is something I cannot keep up with financially and I believe she has her own interests in mind with the advice she is giving. I'm asking for some impartial advice on whether I should cut down to once a week at this point? Many thanks.

A. We are all too aware that because the majority of us are in private practice the cost of treatment can sometimes become an issue. Until and unless acupuncture treatment by a properly qualified traditional acupuncturist becomes free at the point of delivery inside the NHS this will remain the case.

We have to say in all sincerity that only on a couple of occasions over the last thirty years have we come across situations where we have had a suspicion that frequency of treatment was driven by the practitioner's need to bump up their income, and in both cases the circumstances were exceptional. When someone asks a person to attend twice a week it is almost always to try to bring a difficult situation under control. This is often the case with acute problems, but can sometimes be the case when someone has a problem which has lasted for years. The body develops a kind of 'habit energy' and it can sometimes take frequent reminders to maintain changes. This is not a problem unique to acupuncture; you will find that many Alexander teachers have to begin with similar levels of frequency to encourage change.

Our advice in these situations will always be to talk to the practitioner about the difficulty of keeping up a twice weekly treatment schedule. If someone told us that we would probably be looking at some form of discount if we felt that continued frequent treatment was going to be of benefit. This can be finessed by making one session the major one and the other one a more brief top-up. We do have sympathy with practitioners who rent space by the hour or day for whom each space must pay for itself, but most people can squeeze a few minutes extra out of a schedule.

If the practitioner doesn't bend or won't discount fees, then it is a hard thing to say but there are usually plenty of others in most areas, and you could well find that someone else will be able to help you at a price you can afford. There are also more multibed clinics which offer treatment in a group setting where you might be able to carry on treatment at greatly reduced fees.

We suspect, though, that after six weeks of bi-weekly treatment it may well be time to step back to once a week sessions, and your practitioner will probably agree. It will only be an issue if as a consequence the migraines return, in which case you might need to have that talk.

We do hope that you continue to make progress and become migraine-free .


We are all too aware that because the majority of us are in private practice the cost of treatment can sometimes become an issue. Until and unless acupuncture treatment by a properly qualified traditional acupuncturist becomes free at the point of delivery inside the NHS this will remain the case.

We have to say in all sincerity that only on a couple of occasions over the last thirty years have we come across situations where we have had a suspicion that frequency of treatment was driven by the practitioner's need to bump up their income, and in both cases the circumstances were exceptional. When someone asks a person to attend twice a week it is almost always to try to bring a difficult situation under control. This is often the case with acute problems, but can sometimes be the case when someone has a problem which has lasted for years. The body develops a kind of 'habit energy' and it can sometimes take frequent reminders to maintain changes. This is not a problem unique to acupuncture; you will find that many Alexander teachers have to begin with similar levels of frequency to encourage change.

Our advice in these situations will always be to talk to the practitioner about the difficulty of keeping up a twice weekly treatment schedule. If someone told us that we would probably be looking at some form of discount if we felt that continued frequent treatment was going to be of benefit. This can be finessed by making one session the major one and the other one a more brief top-up. We do have sympathy with practitioners who rent space by the hour or day for whom each space must pay for itself, but most people can squeeze a few minutes extra out of a schedule.

If the practitioner doesn't bend or won't discount fees, then it is a hard thing to say but there are usually plenty of others in most areas, and you could well find that someone else will be able to help you at a price you can afford. There are also more multibed clinics which offer treatment in a group setting where you might be able to carry on treatment at greatly reduced fees.

We suspect, though, that after six weeks of bi-weekly treatment it may well be time to step back to once a week sessions, and your practitioner will probably agree. It will only be an issue if as a consequence the migraines return, in which case you might need to have that talk.

We do hope that you continue to make progress and become migraine-free .

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