Acupuncture – A Guide

Introduction

Acupuncture is an ancient Chinese medicine

It is a complementary or alternative medicine (CAM). This means that acupuncture is different in important ways from treatments that are part of conventional western medicine. Unlike conventional treatments, the use of acupuncture is not always based on scientific evidence.

Theory

Acupuncture is based on the belief that an energy, or ‘life force’, flows through the body in channels called meridians. This life force is known as Qi (pronounced ‘chee’). Practitioners who adhere to traditional beliefs about acupuncture believe that when Qi cannot flow freely through the body, this can cause illness. They also believe that acupuncture can restore the flow of Qi, and so restore health.

Uses

Practitioners – called acupuncturists – use acupuncture to treat a wide range of health conditions. It is often used to treat pain conditions such as headache, lower back pain and dental pain, but is also commonly used against conditions ranging from infertility to anxiety and asthma. To learn more,see Common uses of acupuncture.

The availability of acupuncture on the NHS is limited. Most acupuncture patients pay for private treatment.

Does it work?

There is some evidence that acupuncture works for a small number of conditions, including migraine and post-operative nausea. However, there is little or no scientific evidence that acupuncture works for many of the conditions for which it is often used. More scientific research is needed to establish whether acupuncture is effective against these and other conditions.

There is no scientific evidence for the existence of Qi or meridians. Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for the beneficial effects that have been observed in some scientific trials. More research is needed before acupuncture’s method of action is fully understood.

For more information, see Evidence for acupuncture. If you choose to have acupuncture, make sure that your acupuncturist is fully qualified and practises the treatment under safe and hygienic conditions.

Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option only for lower back pain.

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How acupuncture is performed

Typically, an initial acupuncture session will involve an assessment of general health, a medical history and a physical examination, followed by insertion of the acupuncture needles.

Most acupuncture sessions last between 20 and 40 minutes. Typically, acupuncturists say that patients need between 6 and 12 sessions of acupuncture to get the most from the treatment, but this varies depending on the acupuncturist and the patient.

Assessment and examination

The acupuncturist will ask you about your general health and your medical history. If your visit is due to a specific health condition, they will ask about the symptoms of this condition and about any other treatment you have received for it.

After this, the acupuncturist may do a physical examination.

Insertion of the needles

Once the acupuncturist feels they have a clear picture of your health, they will move to the insertion of the acupuncture needles.

These needles are inserted into specific places on the body, which practitioners call ‘acupuncture points’.

During the session, you will usually be asked to sit or lie down. You may also be asked to remove some clothes, so that the acupuncturist can access the relevant places on your body.

The needles used are fine and are usually around 30mm long. They should be single-use, pre-sterilised needles, which are disposed of immediately after use.

Acupuncturists believe that there are over 500 acupuncture points on the body. In a session, typically between 1 and 12 points will be used. The needles may be inserted just under the skin or deeper so that they reach muscle tissue. Once the needles are in place, they may be left in position for up to 30 minutes.

When the needles are inserted, you may feel a tingling or a dull ache. You should not experience any significant pain. If you do, let your acupuncturist know straight away.

Common uses of acupuncture

There is no one health condition or set of conditions that acupuncture is meant to treat. Instead, acupuncturists use the treatment for an extremely wide range of health conditions.

Sometimes, patients combine acupuncture with conventional treatments that have been prescribed by a GP or hospital consultant. If you are being treated by an acupuncturist for a health condition, it is advisable to discuss this with your GP.

NICE recommended uses

The National Institute for Health and Clinical Excellence (NICE) provides guidelines to the NHS on use of treatments and care of patients. Currently, NICE recommends that acupuncture is considered as a treatment option for one condition:

• lower back pain

Other common uses

Acupuncture is often used to treat musculoskeletal conditions (of the bones and muscles) and pain conditions, including:

• headache and migraine
• chronic pain, including neck and back pain
• joint pain
• dental pain
• post-operative pain

Many acupuncturists use acupuncture to treat a far wider range of conditions, including:

• post-operative nausea and vomiting
• allergies, including hay fever and eczema
• fatigue
• depression and anxiety
• digestive disorders, including irritable bowel syndrome (IBS)
• infertility and menstrual disorders
• insomnia

Safety and regulation of acupuncture

In England, the practice of acupuncture is not regulated by the government. This means that anyone can call themselves an acupuncturist, even if they have no training or experience. If you want to visit an acupuncturist, it is important to check that they carry out the treatment in a way that is safe, hygienic and acceptable to you.

When it is carried out by a qualified practitioner, acupuncture is safe. Serious side effects or complications arising from treatment are extremely rare.

Regulation

There are a number of acupuncture organisations in the UK that practitioners can join if they hold certain qualifications and agree to work according to certain codes of practice.

If you decide to have acupuncture, you can visit the websites of these organisations to find a qualified acupuncturist near you. The qualifications and codes of practice that they require of their members are also available on their websites.

These organisations include:

• British Acupuncture Council(BacC)
• The British Medical Acupuncture Society(BMAS)
• British Academy of Western Medical Acupuncture (BAWMA)

Risks and side effects

When conducted by a qualified practitioner, acupuncture is safe.

Mild, short-lasting side effects occur in around 7-11% of patients. These include:

• pain where the needles puncture the skin
• bleeding or bruising where the needles puncture the skin
• drowsiness
• worsening of pre-existing symptoms

Serious complications from treatment, such as infections or damage to tissue, are extremely rare. They usually occur only as a result of bad practice, carried out by an acupuncturist who has not been properly trained.

Who may not be able to have acupuncture?

Due to the slight risk of bleeding, people with bleeding disorders, such as haemophilia(where blood is unable to clot) may not be able to have acupuncture. People who take medicines that prevent the blood clotting, called anticoagulants, may not be able to have acupuncture. If you have a blood disorder or you are taking medicine that prevents blood clots, talk to your GP before you have acupuncture.

It is generally safe to have acupuncture when you are pregnant. Let your acupuncturist know if you are pregnantbecause certain acupuncture points cannot be used safely during pregnancy.

Evidence for its effectiveness

There is some scientific evidence that acupuncture is effective for a small number of health conditions. However, for the majority of conditions for which acupuncture is used, the scientific evidence is inconclusive or there has been no attempt to collect good-quality evidence. For a small number of conditions, there is evidence that acupuncture does not work.

More research is needed into the effectiveness of acupuncture on a wide range of conditions.

It is important to remember that when we use a treatment and feel better, this can be because of a phenomenon called the placebo effect and not because of the treatment itself.

When scientists gather evidence on the effectiveness of a treatment, they take the placebo effect into account.

Positive evidence

There is reasonably good evidence that acupuncture is an effective treatment for:

• chronic back pain
• dental pain
• pain and discomfort during gastrointestinal endoscopy
• headache
• nausea and vomiting after an operation
• pain and discomfort during oocyte retrieval (a procedure used during IVF)
• osteoarthritis of the knee

Scientific trials conducted to investigate the effect of acupuncture on these conditions found that acupuncture had a beneficial effect.

However, because of disagreements over the way acupuncture trials should be carried out and over what their results mean, this evidence does not allow us to draw definite conclusions.

Some scientists believe that good evidence exists only for nausea and vomiting after an operation. Others think that there is currently not enough evidence to show that acupuncture works for any condition.

More research is needed to investigate whether acupuncture works for these conditions.

Negative evidence

There is some evidence that acupuncture does not work for:

• rheumatoid arthritis
• stopping smoking
• losing weight

This means that when scientific trials were conducted to see if acupuncture helped patients in these cases, they found that the treatment had no effect.

As with the positive evidence on acupuncture, this evidence does not allow us to draw definite conclusions. More research is needed into the effectiveness of acupuncture for these conditions.

Inconclusive or no evidence

For most conditions against which acupuncture is used, we do not have enough good-quality evidence on the effectiveness of acupuncture. More research is needed before we can draw conclusions on whether acupuncture is effective forthe followingconditions:

• addictions
• asthma
• chronic pain
• depression
• insomnia
• neck pain
• sciatica
• shoulder pain
• stroke
• tinnitus

Further reading

This information is based on The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach (2006). 2nd edition. Ernst E, Pittler MH and Wider B, eds.