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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:  My son, John aged 31 years, has just been diagnosed with a very large ganglioglioma tumor 9,5cm x 6cm x 4,5cm on the right hemisphere. He has been living with this tumor since a child. So far  he is only suffering headaches, no convulsions. We understand that he will need neuro surgery which may take a couple of months to organise. Our question is what can we reasonably expect from acupuncture whilst waiting for the operation?

A: As you might expect there is no research save a few case studies which we can find about the treatment of ganglioglioma itself with acupuncture, so there is nothing we can usefully add about the treatment of the problem. Surgical resection, especially in the young adult otherwise in good health, shows a reasonably high rate of success, with recurrence levels being quite low unless the tumour has been difficult to remove fully because of its location.

 We are aware that there are ways of looking at problems like this from a Chinese medicine perspective which might give someone expectations that acupuncture treatment will offer a 'cure'. The ancient Chinese did not have the benefit of MRI and X-ray images, and from their perspective any accumulation of fluids or tissue in the body represented a functional disturbance whose origins could be traced to particular Organs of the Body (capitalised because this means something specific and different in Chinese medicine). If this were the case then there would be other signs and symptoms to guide the practitioner, and some hope of dealing with this as a systemic functional disturbance.

 However, it is very dangerous to translate between 'oranges and apples' medical systems because there will be unintended implications that working in one will deal with a problem in the other. What we can say, however, based on our own experience is that acupuncture treatment can have a demonstrable effect in reducing someone's anxiety levels, and anecdotally appears to aid recovery after surgery. The early systems of acupuncture were largely asymptomatic but aimed primarily at establishing balance and harmony in the body's energetic flow and functions in the simple belief that a system in balance was best placed to address any health issues it had. 

 On that basis we would certainly be happy to recommend that your son has treatment in preparation for what might be some very difficult times ahead, but not with any expectation that it would reduce or delay the need for surgery. The fact that he has been carrying this for over twenty years suggests that it is not rapidly growing, and that surgery will be successful. We certainly hope so for his and your sake.  

Q:  I had acupuncture for the first time  and felt very energised after it. By the afternoon I was experiencing lower back pain - which I normally do not have. 2 days later and the lower back pain is still there. Could this have anything to do with toxins being released in the session and if so can I expect relief from the pain anytime soon?

A:  We have to say that we have not encountered any instances where someone has reported lower back pain as a direct consequence of acupuncture treatment, and we have searched the databases to check.

 That is not to say that it didn't come out of the session itself. Our colleagues in the physiotherapy profession who also use acupuncture do say that there are occasions when a rigid back is actually guarding and holding in place a problematic disk, so releasing the muscles by relaxing everything can actually cause problems to appear. However, in this instance there is almost always some case history of back problems before which would support this as a causal pattern.

 You don't mention whether or not you have had back pains before, but there are also occasions when a symptom which has cleared earlier in life can reappear for one last time. This is more common with problems like migraine, where someone can end up with a one-off 'special' but we have heard of the same happening with back pains. This will almost definitely be a transient reaction if this is the case. The same would apply if there were a general release of toxins, but in that case we would expect a slightly more extensive range of odd symptoms.

 

Of course, there can sometimes we simple mechanical reasons. We have heard of people who found that the couch on which they were treated was lumpy or unbalanced, and the back pain literally arose from the treatment because of this.

 Finally we have to say that the appearance of the back pain may be coincidental. This does sound horribly like 'it wasn't me' but with over 4 million treatments a year there are bound to be some cases where the problem appears after but not because of the treatment.

 In nearly all cases, though, the pain will be transient and probably have gone by the time you read this. If if hasn't then it is worth talking through in detail with your practitioner what they did and how this might have been implicated in what happened. If it does carry on, though, it may well also be worth talking to your GP in case it is a sign of an underlying problem which needs to be followed up, or worth seeing an osteopath trained to make precise judgements about someone's physical structure. There are a number of internal problems which can manifest as back pain, and your GP is the best placed person to see if there is anything going on. 


Q: I am pretty confused because I would like to study Microsystems Acupuncture to use it in my relaxation therapy sessions.  I've found different short courses open to anyone. I wonder if they are reliable courses and if I will be able to perform ear, hand and face acupuncture safely.   My concern is can I do it  without breaking the laws about the practice. I see a full acupuncturist degree lasts 3 years so I am pretty perplexed by the difference. 

A:  Let's begin with the basics. Since there is no statutory regulation of acupuncture in the UK the only laws relating to the practice of acupuncture are to do with the registration or licensing of premises in which the practice takes place. There are different laws in place depending on where you are based, but they are mainly concerned with the health and safety aspects of practice - clean and suitable premises, proper techniques for the safe use and disposal of acupuncture needles and other clinical waste and maintenance of the premises themselves. An increasing number of authorities are beginning to check someone's training credentials, and this may have an impact on those with very little training, but the majority of bona fide UK courses will pass muster.

 We obviously are committed to the idea of a degree level training as the minimum standard for a traditional acupuncturist in independent practice. However, many of the microsystems in common use, like ear acupuncture, are relatively modern. Auricular acupuncture, for example, was mainly a development by a Frenchman called Paul Nogier in the 1950s, and other systems, while based loosely on classical principles, are often modern innovations, scalp acupuncture being one such.

 When all the acupuncture groups met to discuss the possibility of statutory regulation the microsystems groups worked out pretty quickly that they would be unlikely to meet the standard for statutory regulation, likely to have been agreed at degree equivalent, and formed a working group to seek recognition through the Complementary and Natural Healthcare Council. This they achieved. The CNHC website itself is rather unhelpful, mainly identifying individual practitioners rather than the organisations which generated them and which provided their training. However, you can still find a listing on what had been the site of the Microsystems Acupuncture Regulatory Working Group here http://www.macrwg.org/html/group_members.html, and the names and addresses look pretty current.

 Some of these groups are mainly 5-point detox organisations, and probably not what you have in mind. The others offer different forms of microsystems acupuncture based on holistic principles, and while it is not our place to comment on them individually, the majority are credible bodies which offer specific training within precise limits of competence. As long as someone works within their scope of practice the work they do can be very effective. We would obviously prefer it if everyone learned to practise traditional acupuncture at degree level, but there are likely to be all sorts of constraints which make that impossible for some.

 Of the different varieties of microsystem work the one which does give us the greatest concern is facial or cosmetic acupuncture. We have reservations about the extent to which people are taught how to use needles safely in an area where mistakes could prove very costly for their insurers, and some of the courses we have seen have been very rudimentary. We are also working hard to establish safety standards for regulated healthcare professionals whose short training courses has led to a number of serious accidents, so we would advise that you check this aspect of the training very carefully. We would not wish to see you expose yourself to risk because you don't know what you don't know, if that doesn't sound too cryptic. Acupuncture seems to deceptively simple at times - find point, stick needle in - that people forget what is going on inside the body they are puncturing, even people who should know better. 


Q:  My toes draw and go crooked and the pain is awful.  It's every day, all day and I wondered  if acupuncture would help?

A: We think that the first thing you should do, if you haven't already done it, is to speak to your doctor about this. There are one or two simple causes of foot cramps like dehydration and mineral deficiencies which may need to be checked (most patients are aware that they don't drink enough water but few realise how little they actually take in), and one or two slightly more serious neurological disorders which can generate these symptoms. We think it is highly unlikely that this is the case, but it would be our duty of care as practitioners if you came along with these symptoms to make sure that you had been thoroughly checked in conventional medicine first.

 As far as acupuncture treatment is concerned there are both local and systemic reasons why this might be happening. Tight cramping pains are often caused by blockage or stagnation of energy, or 'qi' as the Chinese called it, and this can be either a local or systemic problem. If it is a local problem it can sometimes be traced back to a particular event or series of events, especially since i Chinese medicine terms once the body has been 'invaded' by cold it sometimes needs to be removed rather than just being left to dissipate.

 The other possibilities are what we would call systemic, involving the under-performance of parts of the system which supply energy to the extremities. If this is the  case they are very likely to be generating other symptoms in the body that someone may not even recognise as symptoms, like bloating after eating or becoming slightly less good at concentrating. A skilled practitioner looks at the way the system is performing for even the smallest of problems in the extremities because the small symptom can be the tip of a much larger iceberg.

 The best advice we can give, and which we invariably do, is to visit a BAcC member local to you and seek a brief face to face assessment. Most members are happy to give up a little time without charge, and this gives you a chance to meet them and see where they work before committing to treatment. Seeing the wider context within which you have this problem is invaluable in giving an informed view of whether acupuncture can or may help. 

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