Acupuncture and the NHS
Acupuncture and the NHS
Use of acupuncture in the NHS is limited.
Most acupuncture patients pay for private treatment. The cost of acupuncture varies widely between practitioners. Initial sessions usually cost between £35 and £60, and further sessions between £25 and £50.
Acupuncture is a form of ancient Chinese medicine in which fine needles are inserted into the skin at certain points on the body.
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.
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.
Some scientists and acupuncturists believe that acupuncture may stimulate nerves and muscle tissue, and that this may be responsible for any beneficial effects.
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.
The availability of acupuncture on the NHS is limited (see box, left). Most acupuncture patients pay for private treatment.
Does it work?
Currently, the National Institute for Health and Clinical Excellence (NICE) recommends acupuncture as a treatment option only for lower back pain. NICE makes this recommendation on the basis of scientific evidence.
There is some evidence that acupuncture works for a small number of other 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. 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.
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.
The use of acupuncture is not always based on scientific evidence. This means that practitioners may use acupuncture to treat a certain health condition, even though there have not been scientific trials showing that acupuncture works for that condition. For more information about the evidence on acupuncture and specific 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:
persistent 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
Some acupuncturists use acupuncture to treat a far wider range of conditions, including:
post-operative nausea and vomiting
allergies, including hay fever and eczema
depression and anxiety
digestive disorders, including irritable bowel syndrome (IBS)
infertility and menstrual disorders
Safety and regulation of acupuncture
In England, there is not statutory regulation of acupuncture. But acupuncturists are required to register with their local authority.
Practitioners of conventional medicine, such as GPs, are subject to statutory regulation. This means that there are special laws to ensure that they are properly qualified, and adhere to certain standards or codes of practice.
There is no statutory regulation of acupuncture in England. But anyone practising acupuncture must register with their local authority for health and safety reasons. This is because of the risk of blood-borne diseases from piercing the skin with acupuncture needles. These rules also cover tattooing and cosmetic piercing.
The local authority must also ensure that it has byelaws that govern the cleanliness of the acupuncture premises, practitioners, instruments, materials and equipment.
When it is carried out by a qualified practitioner, acupuncture is safe. Serious side effects or complications arising from treatment are extremely rare.
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 Register of Complementary Practitioners (BRCP)
British Acupuncture Council (BacC)
The British Medical Acupuncture Society (BMAS)
British Academy of Western Medical Acupuncture (BAWMA)
Acupuncture Association of Chartered Physiotherapists (AACP)
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
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 pregnant because 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.
The National Institute of Clinical Excellence (NICE) say that acupuncture is an effective treatment for persistent lower back pain.
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.
There is reasonably good evidence that acupuncture is an effective treatment for:
chronic back pain
pain and discomfort during gastrointestinal endoscopy
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.
There is some evidence that acupuncture does not work for:
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 for the following conditions:
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.