I have had five acupuncture treatments with little improvement. Is it worth paying for another course?

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.

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