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Ask an expert - about acupuncture - How often?

18 questions

 A: This is a very difficult question to answer. Although twenty people might present with exactly the same symptoms in traditional acupuncture the emphasis is on the unique nature of the balance of someone's energies, and that might mean twenty different treatments. If someone is in great shape and there is a mechanical reason why the sciatica has developed, such as an injury, then it would be a great deal easier to shift than a sciatica which was set against a backdrop of general poor health.

 The old received wisdom used to be that a condition took as many months to treat as the years that it had been a problem, but we have never found this to be the vase with sciatica. The crucial issue is that the practitioner draws a line in the sand if nothing is changing and stops treating. If after, say, five or six treatments there has been no improvement, even for a short time, then it might be worth looking at other options like osteopathy or chiropractic or other form of manipulation. While traditional acupuncture can and does sort our structural problems there are times when it is easier to go to a manipulative therapy first and then use acupuncture to consolidate the gains.

The best way to proceed is always to seek the advice of a practitioner based on a face to face consultation. This can give you a much clearer idea than we can at a distance.


Q: Can I have acupuncture treatments two days in a row? Is it harmful in any way? I am in a time crunch before vacation so hoping it’s ok!

A: There is no safety reason to stop you having treatment on consecutive days. Indeed, in China it is not unusual for someone to have a course of treatment daily for up to two weeks.

However, this is usually reserved for acute conditions of chronic conditions which are proving stubborn to shift. For most of the regular constitutional work it wouldn't be necessary, and might even be a waste of money. One of our old teachers used to say that if you were clearing mud from the bottom of a garden pond you would stir the water up and wouldn't be able to see how effective you had been until a couple of days later when the remaining mud sank. He always believed that it was impossible to judge whether what you had done was the best possible treatment until you had given the body time to react.

Our advice, then, would depend on the kind of condition which took you to acupuncture treatment. If it is a long term hard to shift problem or a short term acute one then consecutive treatments might be advisable. If it is a more subtle problem there is probably nothing to be gained by having more treatments. Your practitioner is best placed to advise you. They will be able to make a professional judgement about what is best for your unique circumstances.

A:  There are many ways of assessing whether a treatment has achieved anything. Many patients have a 'headline' condition for which they have sought treatment, and if this is the sole determinant of success, then we would have to say 'it depends what this condition is.' Some conditions do move slowly towards being cleared and there is a sense of progression - a backache not lasting as long as usual or needing as many painkillers, a migraine that is less frequent. In some cases, however, a problem can remain much the same until the change reaches a tipping point after which progress is discernible and quite often rapid. Knowing which is the more likely reaction is guesswork, and although nothing may have shifted yet there is often diagnostic information which points towards a likely change.

This is where secondary information plays its part. Quite often people have what we might regard as second-string conditions, ones which would not have seen them seeking treatment but are nonetheless a nuisance. It is quite common for someone to report that a problem like acid reflux or poor sleep has resolved, and this can often be an indicator that the main problems are likely to shift.

Many patients also report a more general and diffuse sense of 'feeling better in myself' which, vague as it sounds, is often a really goo indicator that there are some significant changes in progress.

The bottom line, though, is that there comes a point where we all have to admit that the treatment is changing things enough or at all, or the changes are short-lived, and the challenge then is to use the evidence of what has happened and reactions to treatment to determine what may be the next best option to pursue. Your practitioner should be only too happy to sit down and review progress with you, and tell you what they have found in your energies and what they think the prognosis is. If they are convinced based on what they have seen that the treatment will work, it is important to set a limit at which you review the decision to continue.

It may also be important to review the markers for progress which you have adopted. These sometimes need to be really clear to record exactly what may be happening. People occasionally make a little more progress than they think, and clear outcome measures are essentaial to establish this.

Q:  How long for treatments to show they are working. I've been having acupuncture for 2 times a week for about 2 months. I have stiffness in the back of my neck that reduces my ability to turn my head side to side. I still have stiffness and a clicking sound in my neck.

A:  This is always very difficult to say. A great deal depends on factors like the time which the problem has been around, the extent of the physical change which the body is trying to achieve to restore proper function, and the person's overall energy levels. If someone has a difficult problem but excellent constitutional condition they might make faster progress than someone with a relatively minor problem in a weaker system.

The crucial issue is trying to set measurable outcomes, and then to hold regular reviews of progress. With many problems it may feel as though there has been no progress at all until it has nearly been fixed, so trying to establish independent measures of progress is really important. These are often called ROM (range of movement) measurements and can involve degrees of turn. They can often demonstrate that change has taken place even where it may not feel as though this were the case.

There is always a need to review progress every four or five weeks. Otherwise it is easily possible to get locked into a kind of treatment 'habit' where both practitioner and patient start saying 'same time next week' without reflecting on the fact that five or six weeks have elapsed and change has been slight. Not every case responds to acupuncture treatment, and acupuncture treatment may not be the best option for every problem. It is very important to draw a line if there has been no real change either in the patient's condition or the diagnostic signs which a practitioner uses to determine what has happened.

The very fact that you are asking means that the time has come to sit down with your practitioner and have a serious talk about what they are finding and whether, based on their experience, they feel that they are actually making a difference. If you both feel that this isn't working then it may be time to explore other treatment options. The practitioner will almost certainly have other recommendations as fallback options.

Q:  I've had 2 acupuncture treatments so far in the same week. Unfortunately, the physician is then off on vacation and can't see more until  2 weeks later. Will the fact that the treatment gets interrupted for 2 weeks after only 2 treatments means I'm starting at 0? Am I better to wait till she returns? FYI: I'm going to seek treatment for neuropathic pain in the neck and back.

A:  There are no hard and fast rules about the frequency of treatment. Most of us tend to see people weekly for the majority of problems, occasionally making that more frequent if someone has an acute problem. Once a start has been made many of us then start to space treatment out. Many use the analogy of watering a plant - enough to get it started and then what it needs as appropriate. A more common problem than spacing out too soon is carrying on too long with weekly treatment, and we get the occasional question about the necessity for continued frequent treatment.

It would be unusual to lose anything that you have gained over a fortnight's break. While it is good to establish a bit of momentum, if the treatment is working in the right direction the treatment will generally hold. The system works towards balance naturally and all we do is to make this possible. For things like neuropathic pain you are often trying to break a long-standing pattern, and once the system responds it has some sense that the fixity of the existing pattern is not as great as it might have assumed. Two sessions in close proximity might well be a good start whose benefits will continue for a couple of weeks.

Generally speaking we all tend to make professional judgements about when and whether to start treatments around our annual breaks and in the majority of cases you will find that a practitioner is usually pretty clear which cases he or she can start safely and those which need to have a consistent pattern of weekly treatment. Your practitioner has probably made this assessment and reckons that it is worthwhile kicking off.

We hope the treatment does ease your pains.

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