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28 questions

We have to be honest and say that it is highly unlikely that you will be able to find acupuncture for anxiety within the NHS. The last few years has seen a significant shift away from the funding of all treatments which do not have a strong evidence base (as defined in conventional medical terms) and which are not delivered by existing NHS staff. The very few places where we knew of our members being given carte blanche to treat allcomers have seen an almost complete loss of funding. We attach no blame to anyone; the NHS is horribly under-funded, and we can easily understand why a treatment which takes as long as it takes, possible a dozen sessions or more, without a guarantee would not be a first choice.

However, although we are in private practice, most of us are prepared to reduce fees for people who are in genuine need. We don't always openly advertise this because we find that it encourages bartering by people well able to afford the fees, but as long as there is a genuine case of hardship we do what we can. There are also many members now involved in offering treatment in multi-bed clinics at a significantly reduced fee. They are organised in a specialist group called ACMAC whose details you can find here If there is a clinic in your area this might offer a cost effective option.

We do hope that your daughter manages to find someone. As our factsheet shows

there is some evidence even from studies conducted in a non-optimal way which suggest that treatment can be of benefit, and we certainly see a significant number of people with anxiety as a main presenting problem. From a Chinese medicine perspective this can most often involve a stuck response to situations which can often be interpreted within the diagnostic categories and helped to a degree. We also think that there may be some benefit from some form of talking therapy alongside treatment. Many members have counselling skills, but not all, and this may be worth checking in trying to book in for treatment.

We are assuming that you are asking your question from the United States. If you aren't and we have misunderstood, our apologies.

As a UK-centred organisation we are probably not the best placed people to offer comment on this question. As far as we understand it the Medicare system seems to run along similar lines to some of the major private insurance programmes in the UK with a flavour of National Health Service provision, which is practically none.

The problem with acupuncture and other CAM provision is that it lacks the evidence base which is now a requirement for provision in the NHS and with leading private health insurers (PHIs). When allocating funding a provider needs to have some assurance that the modality will work, and an equal assurance that there is a finite limit to what it will cost. Since most research into acupuncture is not accepted (complex methodological issues and funding difficulties abound) and most treatment is offered on an open-ended basis, this is not beloved by the actuaries who have to cost out provision.

We note that that you can get acupuncture if you pay for a higher level of service, and this mirrors some of the PHIs in the UK who offer money purchase packages alongside their main policies which offer additional benefits at a price. This was led, we believe, by patient demand and an awareness that keeping this group of users happy protected the mainstream PHI provision. However, it would be fair to say that as CAM has become more popular so some sectors within conventional medicine have seen it as a subversive threat, and the opposition to its inclusion within mainstream provision has greatly increased, certainly in the UK.

As an organisation we have been making representations to both NHS and PHIs throughout our whole existence to argue for the inclusion of acupuncture free at point of delivery within their offer. Some doctors and physios offer acupuncture within their existing scope of practice, and some PHIs will now pay for limited amounts of treatment. When patients ask for advice along the lines which you have done the best we can say is that you contact the local or national policy makers and try to make a case for your own needs. If you try to argue the national case you will not succeed unless you can get  a huge popular following, but you may be able to make a case for your own personal treatment if:

a) you can show that their is an evidence base for the condition with which you need help

b) you are able to make a case that a course of treatment is likely to cost less than any continuing care by conventional means. When you take into account the cost of doctor/hospital admissions and pharmaceutical products this is not a difficult case to make, especially if you have any low-cost community clinics in your area offering discounted treatment.

The best advice we can offer, though, is to talk to local acupuncture associations to see what they can advise. We are certain that they will have tried to address this issue, and will certainly have contacts whom you can follow up.

We wish you the best of luck!

There is no reason not to have acupuncture every week if it achieves the objective you want, in your case pain relief. We are often asked about treatment for pain, and we usually say that it becomes, somewhat sadly, a matter of how deep someone's pockets are.

From a traditional acupuncture perspective it is not entirely satisfactory to be treating someone every week. Our understanding of the nature of pain is that it arises because of blockages in the energy of the body, or excess and deficient energy in specific area or channels. We always hope that our work will reinstate correct flow, and that the pain will begin to subside such that we can increase the intervals between treatments. However, there are occasions when changes to the physical structure of the body, like arthritic change, are not reversible and will keep on generating inflammation in the same places. In these circumstances we might well consider treating weekly for as long as it takes.When this happens most practitioners tend to come to some sort of arrangement with patients to ensure that the treatment doesn't become a financial burden, but this is a matter for individual negotiation. People have different ideas of financial deprivation, and it call for honest and sensitive discussion. Many practitioners are now involved in the establishment of multi-bed clinics which provide treatment in a group setting at a reduced cost, and there may well be something in your area which offers treatment at significantly lower rates than in private practice.NHS provision, though, is seriously limited, and we have found that a six-session course is about the maximum that anyone is likely to be offered. It might be possible to make a financial case for acupuncture treatment if the alternative is expensive medication and greater costs to the health system as a whole, but there is a principle of equity at play and most Pain Clinics have long waiting lists of patients desperate to get a crack at pain relief through acupuncture, and we suspect that most take the view that if it works then people know that there is an alternative to medication that they can pursue themselves.This is not ideal, and we would be the first to argue for acupuncture to be free at point of delivery and on demand within the NHS, but that day is a long way off while basic services remain under-funded. We do our best to demonstrate that acupuncture treatment is cost effective, and some of our colleagues in York have undertaken research studies which clearly show that acupuncture treatment saves money in the long run, but this hasn't really impacted on policy makers yet.In the meantime we suspect that the best we can advise is that you contact local practitioners and see if anyone is prepared to come to an arrangement which offers the same level of relief at a cost which is not too burdensome.

We're not quite sure whether you are asking about having sessions of acupuncture with your GP or whether you are considering asking your GP whether it is OK to have acupuncture.

If it is the former, then we suspect you may not get very far. There are quite a few doctors who now incorporate acupuncture within their day to day practice, but generally speaking they are normally only allowed to do so when there is an evidence base for the condition which they are trying to treat. For a variety of complex reasons most of the research into acupuncture doesn't pass muster with the UK regulatory agencies, and chronic lower back pain is one of the few that does. Unfortunately NICE, which used to recommend ten sessions of acupuncture for chronic lower back pain, has recently reversed its ruling, so it is now unlikely that your GP will take advantage of this to refer you on or to treat you themselves.

There is nothing to stop you asking your GP if he or she is happy to give you acupuncture treatment, and most GP practices have at least one partner who uses acupuncture regularly. In terms of getting treatment free at point of delivery, this is perhaps your one and only option.

In terms of safety with the problems which you have, there is nothing in the literature to suggest that any of your health issues might make acupuncture a bad idea. We have experience of treating people with all of these problems. We are always careful with epileptic patients, but that is mainly because many want to get off their medications and we would never make that recommendation, however successful treatment may appear to be. When a condition is well controlled even GPs are reluctant to interfere with the treatment plan. As far as mental health issues are concerned we advise members to be aware of their limitations. Although we take detailed case histories and explore many problems with patients there are some areas where a practitioner needs specific skills in addition to acupuncture training to be able to understand the kinds of problems with which they are dealing. We regard mental health issues as one such area, and we are in the process of exploring standards for expert practice which would define what additional training a practitioner should have.

As far as the back problems are concerned, we feel confident that acupuncture treatment may well be able to help, but you may find it worthwhile to discuss your complex health background with a local practitioner before committing to treatment. Most acupuncturists are happy to give up a little time without charge to discuss with prospective patients whether acupuncture is the best option for them.

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 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.



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