Complementary and Alternative Medicine: Acupuncture

Acupuncture, despite the negative publicity and the general lack of knowledge surrounding Chinese Medicine, is available on the NHS, but its use is limited and is only for lower back pain.

Stemming from the Latin, 'acus,' meaning 'needle,' acupuncture is based on the theory of disease of Traditional Chinese Medicine, which, in itself, is a whole system of medicine comparable to western, 'conventional' medicine.

It is currently available for free on the NHS for patients who have had lower back pain for over six weeks (and no other therapies have worked, or the patient does not like other existing therapies), but less than a year (as per the NICE guidelines). Contrary to what the media may tell you, the National Institute for Health and Clinical Excellence (NICE) guidelines are not just for the willy-nilly use of acupuncture; it is for the 'early management of persistent non-specific low back pain.'

There are many reasons for this implementation:
  • Better results for patients with pain or disability
  • More efficient use of NHS resources - what is the use of offering the same cheap treatment constantly if it does not work for a particular patient when one session of 'expensive' acupuncture may cure pain for good? 
  • More choice for patients - some patients may not want to be treated with drugs that they may feel are 'poisoning' their body
  • More education for self-management of pain
Besides acupuncture, the implementation also discusses the use of manual therapy, exercise, x-ray and MRI, electrotherapies and pharmacological therapies (what drugs to prescribe).

Acupuncture is based on the beliefs in Chinese Medicine that illness is caused by an imbalance of the life forces yin and yang in the body; the therapy aims to balance the energy by manipulating the Qi, pronounced chee. It involves painlessly and bloodlessly inserting fine, sterile needles into the skin at certain points called acupuncture points, which are found on 'meridians,' which are invisible channels through which the energy flow. These have not been found by conventional medicine, which is why its use in the NHS is controversial.

Private treatment of acupuncture can be expensive (20 to 40 minute sessions may cost between £25 to £50), which is another reason why certain newspapers (no names shall be given, but I'm sure a quick Google search will reveal which!) stir up a controversy over its use.

Although acupuncturists claim that can treat a wide variety of diseases like anxiety, obesity, infertility problems and diabetes, western scientists have only found evidence for it to work on dental pain, osteoarthritis of the knee, migraine, post-operative nausea, pain and discomfort, especially after gastrointestinal endoscopy and oocyte retrieval (an IVF procedure) and chronic back pain. Its mechanism is still unknown, although the most accepted theories range from the release of pain-relieving endorphins in the brain, the placebo effect and the stimulation of certain nerves and muscle tissue.

For most conditions, there is a lack of evidence about the efficacy of acupuncture but there is some evidence that acupuncture does NOT work for the following conditions:
  • rheumatoid arthritis
  • stopping smoking
  • losing weight
Patients given acupuncture on the NHS are only allowed a maximum of 10 sessions for the back pain over a period of up to 12 weeks. The evidence for the efficacy of acupuncture for lower back pain comes from four randomised controlled trials and a systematic review which revealed that patients had pain relief up to three months after the acupuncture therapy compared to 'fake' acupuncture or no treatment, which is when the needles are inserted at the wrong points.

The reason that the acupuncture is limited to 10 sessions over a period of 12 weeks is that it has been shown to be cost-effective in the short term, but there needs to be further evidence for its effects in the long term before these limits can be raised. NICE said that acupuncture is actually a cost effective alternative to 'usual care' for lower back pain such as taking paracetamol, ibuprofen, morphine, etc.

But what actually happens during acupuncture?

Acupuncturists may use up to 12 points (although usually this is much lower). Sterilised needles are inserted just under the skin and the acupuncturist may rotate the needle to either improve or weaken the flow of Qi. The needles may be left there for half an hour, during which the patient may feel a dull, heavy pain (not acute, sharp pain) and tingling.

Although acupuncture is not regulated by the government, there are governing bodies under which qualified acupuncturists may be registered. Qualified acupuncturists, especially those who work with the NHS, should give safe treatment, with little if any side effects.

Any side effects are short-term and mild but can include pain on the acupuncture point, bleeding, drowsiness, infection, etc., most of which occur in less than 1 in 10 patients. Patients with haemophilia, other bleeding disorders or those who take anticoagulants such as warfarin and enoxaparin, may not be able to have acupuncture due to the risk of bleeding.


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