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Ask an expert - neuro and psycho logical

222 questions

A: Let's start with the relatively easy part of the question. Charges for acupuncture treatment vary across the country, and also vary within a region. As with all businesses, if the surroundings are in the more expensive area of town then the overheads will be greater and the cost will reflect this.

A first session of acupuncture can take up to an hour and a half while the practitioner gathers a great deal of information. In the Greater London area the cost of this is probably going to fall within a band from £50-£70. Subsequent sessions can be anything from half an hour to an hour, and the charge will be in the £40-£60 range. Outside London this might be close to £40-£60 for the first session, and £35- £50 for subsequent sessions.

There is an increasing number of what are called multibed clinics to try to make acupuncture more accessible to people who might find the costs a little steep, and while the treatment will be very similar it will take place in a group setting. Some people like this, others want a greater deal of privacy.

The number of sessions is impossible to say; each case is unique and different. What we would expect is that a practitioner reviews progress after the first four or five sessions, and proceeds from there with the full agreement of the patient. What has to be avoided is a kind of habit energy which leads to weekly bookings extending over months. It does happen! It is also important to try to establish effective measures of progress. Anxiety sufferers have good days and bad days, and it is helpful if there can be something which will let both patient and practitioner know that things changed. Otherwise it might depend on how someone feels that day, which is not a good marker.

As far as the value of treatment, we answered a similar query recently as follows: 

We produce a number of factsheets on the treatment of named conditions with acupuncture, one of which is on anxiety

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

The evidence is fair, and would appear to justify giving acupuncture treatment a go. It certainly won't do any harm, and will very possibly help.  Most of us treat a substantial number of patients with anxiety, although it would be fair to say that many come along for a different problem and find their anxiety lifting against their expectations. This does not surprise us; traditional acupuncture treats the person, not the condition, and it is quite common for people to feel 'better in themselves' after treatment for something as prosaic as sciatica or headaches. Obviously some of the 'feeling better' will be 'not being in pain', but people are very good at recognising the difference between not feeling pained and having a renewed spring in the step.

We wrote an article for Anxiety UK a couple of years ago, and we reproduce it here because it is a worthwhile summary of what we are trying to achieve:  ANXIETY AND ACUPUNCTURE

Anxiety is more than just being anxious. Just as migraine sufferers get righteously indignant when someone claims to be a fellow sufferer but can still get to work, eat and stand the daylight, so anxiety sufferers know that they bear only the slightest resemblance to people who feel a bit nervous or have ‘butterflies in the tummy.’ Clinical anxiety is a crippling affliction which can sometimes defy all of the medications and talking therapies that someone can throw at it.

Why, then, has acupuncture been found to be successful in treating it? The main reason is that in conventional medicine, there is no single treatment for each sufferer as each person has differing symptoms. However, in traditional acupuncture every patient is considered to be unique, and this means that the practitioners will be looking and listening very carefully to everything that the patient says to establish a diagnosis and find the specific keys to unlocking the patterns of the symptoms the patient is suffering. They will aim to identify the imbalances which cause the symptoms of anxiety, not just treat the symptoms themselves. This whole ‘package’ – taking the patient’s individual story seriously and giving them time to tell it, trying to hone precisely the diagnosis, and selecting the optimum way to use the least needles to achieve the greatest effect – has been found to be very effective.

The theory of traditional acupuncture is very straightforward. The free flow and internal balance of energy (Qi) is seen in eastern medicine as essential for good health. Any prolonged exposure to extremes or intense situations, be they physical, mental, emotional or spiritual, will cause the flow and balance to be affected. This disruption in balance then ripples through the whole system, causing symptoms which sometimes bear little apparent relation to the underlying causes. An acupuncturist’s skill lies in making sense of seemingly unconnected symptoms and understanding the unique nature of someone’s energies in such a way as to restore balance. A treatment plan may simply involve needles and moxibustion, the use of a warming herb, and tui na, a form of traditional Chinese massage, but can extend to address issues in someone’s diet, their exercise patterns and their lifestyle.

People sometimes ask why, if acupuncture is so successful, there isn’t much research to back up its claims and make it more freely available within conventional care. A major reason for this is the unique nature of treatment which resists putting people in pigeon holes and which changes as the person’s balance begins to improve. Both of these confound attempts to organise research according to western models where a named condition receives a single treatment and all other variables are taken out of the equation. In Chinese medicine the variables are called patients!

Where do our patients with anxiety come from? Word of mouth still remains the most common and most reliable form of referral, and more people have had acupuncture than you think. If you ask around your support groups you are almost certain to find someone who has tried acupuncture and found that it works. Perhaps this time it’s your turn!

People also usually want to know whether the treatment will ‘stick’, whether they have to keep on having acupuncture. Some don’t – a single course of treatment can set them on a good path which, as long as their life remains well-balanced and relatively stress-free, means that they will stay anxiety-free. Many, though, like to keep ‘tuned up’, and realise that spending a fraction of what they spend on keeping their cars roadworthy keeps the driver in good shape too.

As far as the number of sessions  is concerned it is very difficult to say.  Some people respond quickly and well, while others make only very slow progress. The key thing is to ensure that there really is some progress rather than just treating away month after month, and for this it would be important to set down some measurable outcome markers to know if things have changed. Anxiety is not consistent; sometimes people feel OK, sometimes they don't. Trying to find something which is based more on intuition and feeling is hard. The main thing is to establish when and whether to stop if the treatment is not producing much in the way of change.

Invariably we advise people to visit a local BAcC member. So much depends on the individual nature of someone's balance and energy that it is very hard to give generic answers offering precise advice. Most members are happy to give up a little time without charge to discuss what treatment may offer, and we are sure that you will enjoy talking to someone about what treatment may be able to offer you. 

Q:  I have been recommended to have acupuncture for possible migraine. I have polymyalgia rheumatica and take steroids. Is it ok to have acupuncture ?

A:  There is no reason of which we are aware that suggests that acupuncture treatment was at all contra-indicated for someone taking steroids for PMR. In fact, a great many patients using steroids as a long term treatment for PMR seek treatment to see if over time they can reduce their steroid use. Clearly our members are very cautious in these situations and always advise the patient only to reduce a dose of medication with the knowledge and prior agreement of their doctor. As you are no doubt very well aware, a sudden reduction in a steroid dose can have serious consequences.

 As far as the treatment of migraine itself is concerned, you may well have looked at the details on our website, but if you haven't there is a fact sheet

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

 which provides some of best current research information about the treatment. In clinical practice migraine remains one of the more frequent reasons why patients seek acupuncture treatment. 

 As long as you are very clear about your situation when your practitioner goes through the initial interview there will not be a problem. Our members are all highly trained and take a full medical history to ensure that any and every factor in someone's health is taken into account.

Q:  I have chronic headaches as a long term after effect of viral meningitis 15 months ago. Drugs reduce the severity but do not cure the pain completely. Could acupuncture help?

A: We always tread a little cautiously around the treatment of headaches which arise from distinct pathologies like post-viral conditions. In general, the use of acupuncture treatment for headaches is both well-researched and promisingly so, as our two factsheets on headaches and migraine show:

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

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

This has even led to acupuncture being recommended in one set of NICE guidelines for cluster headaches.

 However, post viral conditions often present greater difficulty when they generate specific symptoms, as you can clearly see when you look at thee evidence for the treatment of the various chronic fatigue/post viral/ME style of problems. What would be a relatively straightforward 'fix' for some of the symptoms here does not always seem to 'take'.

 Two factors, however, predispose people to have a go at acupuncture treatment for these types of headache. First, acupuncture treats the person, not the condition, and is aimed at much on the overall recovery of balance in the system as it is in simply reducing the effects of the symptoms. I many cases the body's ability to correct its own imbalances is severely impaired by viral infections, and anything which helps the whole system to function better is likely to have great impact in retaining any benefits a treatment may have.

 Second, the Chinese medicine practitioners have looked at all of the different types of headaches for over 2500 years through an entirely different conceptual structure centred on the flow of energy. The exact nature of the presentation will point to specific types of imbalance for which there will probably be considerable secondary diagnostic information available to the practitioner. This might be in the form of changes to routine patterns which someone has just grown used to over the years, or in some cases signs from pulse or tongue diagnosis of which the patient would not be aware. This would probably give the practitioner some confidence that they could help.

 The best advice we can give, and which we invariably give with problems like this, is to visit a BAcC member local to you for an informal assessment of the situation based on what they find. In most cases they may well see an immediate set of signs and symptoms which will enable to say with confidence that they think they might be able to help. In some cases they may decide that other forms of treatment may be more suitable, and we have certainly heard of people using herbal medicine, cranial osteopathy and homoeopathy to good effect.

 In summary, we think that there may well be some benefit to be gained from acupuncture treatment, and for us the issue with headaches is usually the extent of the improvement and how sustainable this is. We hope that in your case this proves to be considerably so.

Q:  My father suffered from brain stroke 5 yrs ago. He is getting physiotherapy but his left hand is still not working. Can he have acupuncture therapy for this? Does this procedure have any side effects?

A: We are sorry to hear of your father's continuing problems.

Let's deal with the easy answer first. There are very few side effects from acupuncture, and the vast majority are transient. We put together a safety website with the two leading medical acupuncture organisations (www.acupuncturesafety.org.uk)  which quotes a number of research studies. These show that acupuncture ranks as one of the safest therapies around. There are occasionally minor reactions to treatment, like headaches or tiredness, and very rarely an injury caused by the needles, but when you consider that there are over 4 million treatments being given each year the number of these is remarkably low.

The other side of your question is more difficult to answer. We have on the BAcC website a very thorough review paper

 http://www.acupuncture.org.uk/arrc/public-review-papers/stroke-and-acupuncture-the-evidence-for-effectiveness.html

as well as a simpler factsheet

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/3894-stroke.html

which are both very encouraging about the use of acupuncture for the after effects of stroke. In China, however, it is common practice to start treatment on the day of the stroke itself and to treat daily or more to try to restore the 'lost' functions as quickly as possible. The received wisdom is that if the treatment is delayed it becomes progressively more difficult to achieve the same level of result and the final outcome may not be as good. This is paralleled by some treatments in the west, where drug intervention on the day may work when a gap means it won't. The fact that your father is now five years on from his stroke suggests that where he is now may not improve a great deal.

However, there's no point in being unduly pessimistic. All of us have taken on cases like this and managed to achieve a great deal more than we expected. The great strength of Chinese medicine is that it treats the individual, not the condition, and there is always a chance that if someone's baseline constitution is strong they may be able to achieve quite a great deal of improvement. Full restoration of function would be a stretch, but some gain may be possible.

The best advice, which we invariably give, is to visit a local BAcC member with your father to get a face to face assessment of what may be possible. Most of our colleagues are more than happy to give up a little time without charge to see whether acupuncture treatment may be of benefit.  

 

A:  We would perhaps need a little more information before we could give a more definitive view.

 We imagine that by 'fear in certain situations' you might mean a specific phobic response, like to heights, dogs or even some people! A great deal would depend on whether the fear was consistent with some of the patterns in the body's energy, and therefore a rather more extreme reaction of a kind which was commonly experienced, or whether it was caused by a specific primary event. If it was the latter we suspect that other forms of treatment like hypnotherapy or even cognitive behavioural therapy might be a more precisely targeted response.

 That said, the word 'appropriate' appears in a great many explications of ancient texts, and arises from a basic premise that a person in balance will experience all emotions in reasonable proportion to the circumstances which cause them, Everyone grieves when they lose a loved one, but to grieve for twenty years or to not grieve at all would be unusual reactions. Of course, no-one is in perfect balance, and there are many imbalances which predispose people to have rather unpredictable emotional responses in certain situations or occasionally a stuck response, 'angry at everyone and everything.' In such cases, there may well be remedies within Chinese medicine which can point to ways of balancing the system up and reducing the impact of some of the emotional responses.

 In short, if the fear which you experience in some cases is an extreme case of a pattern which tinges all of your experience then acupuncture treatment could well help. The best thing to do, though, since we do not really have enough to go on here, is to contact a BAcC member local to you for advice. Most are very happy to give up a little time without charge to discuss whether treatment would be of benefit, and they will also almost certainly know of reputable therapists in other fields if they think that something like hypnotherapy would be a better bet.

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