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Q: What was the qualification to study for acupunture, and what is the cutoff  to study for acupunture?

A: Your question is a little unclear, but we think we can cover all the bases!

In order to enrol for a training course in acupuncture, most UK students have an A level standard of education which would be the normal entry standard for a university degree course, which many UK courses now are. There are obviously alternative routes depending on the kind of experience and life skills a person has. With a career on acupuncture it helps considerably to have some life experience behind you before starting to train, and many courses will offer partial exemptions and deals for people who can demonstrate that as a mature entrant, for example, they have skills which would enable them to train, even though these may not be reflected in formal qualifications.

As far as the qualifications gained are concerned these are usually licences to practice or diplomas, although the university qualifications will be degrees, usually a Bachelor of Science (BSc).

As far as cut-off is concerned, there often isn't one. In the UK it would actually be in breach of formal guidelines to refuse to take someone on as a student on the grounds of age. All that a training establishment can do is assess whether someone is fit to take the course, not factor in whether or how they can practise the skills learned or the length of time they could possibly practice.

The website of our sister institution, the British Acupuncture Accreditation Board has a wealth of information on training and a career in acupuncture, and we can think of no better resource to which to direct you.

Q: I am 78 and had my third session of acupuncture yesterday to relieve soft tissue problems in my upper leg and hip. I had six needles. Today I feel exhausted, light headed as if I had vertigo and my eyes are jumpy and feel as though they are trying to cross. I feel very unsafe walking about. Would you advise me to discontinue the acupuncture?

A: We are sorry to hear of your problems. In our experience it is possible to have short term adverse effects from treatment, but these generally last for a maximum of 48 hours, if that, and then vanish.

There are a number of reasons why this can happen. As you are aware, treatment is aimed at restoring the flow of energy in the body, and this can quite often produce some odd reactions as the body adjusts. Occasionally the treatment can be a little too energetic for someone, and the practitioner needs to be made aware of this so that they can reduce the number of needles and use less manipulation. Some people are very sensitive to treatment, and can react over-strongly, although the fact that this has happened after your third treatment would suggest that this is not the reason. Sometimes it can be as simple as the fact that the treatment took place on an empty stomach, and the body is a little ungrounded and over-reactive.

In any event, there is no reason to discontinue treatment, and every reason to discuss what has happened with the practitioner. All of us are more than happy to talk to patients who experience odd reactions to treatment, and in this case the person will know exactly what they did and why, and perhaps be able to make sense of the reactions. This should give you the reassurance you need.

However, we do have to add one word of caution. Just because something happens after treatment does not mean that it has happened because of it, and we have seen cases where people have experienced some odd problems after treatment which were entirely coincidental. If the feelings persist for more than 48 hours you might want to contact your GP just to make sure that this is not something entirely separate.

The most likely explanation is that it is a period of adjustment after an effective treatment, and we hope that by the time you are reading this everything has reverted to normal, hopefully with an improvement in the problems which took you to treatment initially. If this isn't the case, though, then a call to your GP would be advisable.

Q: For over a year now I've been suffering with a frozen shoulder. I went to see a specialist who said I had a nerve problem because the pain moves around my neck, arm and shoulder. The pain was really bad and I couldn't move my arm. I was given Morphine for the pain and a steroid injection into a different part of my shoulder. I also have Type 1 diabetes and thyroid problems. After the injections the pain went but after a few months it's back but not as bad as the first time. The doctor has now told me that because I have Type 1 diabetes I cannot have any more steroid injections, so has prescribed me ibuprofen and advised me to go back and see a physio. But the physio said he can't treat me if I'm in pain and the ibuprofen doesn't work, so I was wondering if I could have acupuncture?

A: The very simple answer is that there is no reason why you cannot have acupuncture as a Type 1 diabetic. The only caution which a practitioner will have is that with Type 1 diabetes there can sometimes be reduced sensitivity to the extremities. In our Guide, which we publish for our members, we say:

Diabetes mellitus It is recommended to ask diabetic patients about neuropathies they may have developed. In severe neuropathies the patient may experience loss of sensation. Due to impaired blood circulation to the affected area the patient may also be at a greater risk of developing a localised infection.  

Needling into the affected area should be done with particular care and strong manipulation of the needle avoided. Patients with poorly controlled diabetes, especially if insulin-dependent, may experience greater than normal fluctuations in blood sugar levels.

As strong acupuncture treatment can lower the blood sugar levels and occasionally induce some drowsiness, it is recommended that you treat such patients with particular care, especially on their first acupuncture treatment, and ensure that they have had something to eat before the treatment.

This just about says it all, really. We have come across the very occasional patient in whom the treatment triggers a release of additional insulin and can steer them towards a hypo, but most long term diabetes patients are usually very much on top of maintaining their sugar balance.

The reason for stopping steroid injections may also be that there is an upper limit beyond which most doctors will not go anyway. Three or perhaps four usually represents the safe number, after which there is an increasing risk of local damage to tissue in the area.

As far as frozen shoulder itself is concerned, as our factsheet shows there is some fairly good evidence that acupuncture can be helpful. This is far from conclusive, so we can't make specific claims, but the evidence does suggest some benefit as well as some reduction in pain. The only problem is that it is difficult to stop someone using the shoulder while it improves, so progress can often be hampered by unintended setbacks when people reach out automatically and trigger pain and discomfort.

The best advice that we can give is for you to visit a local BAcC member for an informal chat. Most are more than happy to give prospective patients some time without charge to take a look at what is going on and will be able to give a better informed answer than we can about what prospects there are for benefit from treatment.

Q: My doctor advised me to contact a physio as I was experiencing joint pain in my knees. I had acupuncture on my first visit and after three days my shoulder blades and upper neck are in excruciating pain. Painkillers are not even helping and I don't know what to do. I can't deal with this any longer. Why Am I experiencing this and will it ever stop?

A: We would probably need a little more information before we could give a definitive view. The first question we would ask would be where the needles were inserted. Acupuncture is a very safe treatment with very few serious adverse effects, and most, when they do rarely occur, are the result of damage caused by the needles themselves, hitting nerves, causing deep bruising, etc etc. If someone throws a very specific pain then the first thing to check is whether the treatment as a physical act of needle insertion could have caused it.

The second thing to check is whether the treatment has caused a change in your posture, especially if needles have been applied to the lower back as well as the knees. The physios pay particular attention to this, often because they use slightly more vigorous techniques than we do as traditional acupuncturists. Occasionally a muscle might be tense and 'guarding' because it is supporting an inherently unstable spine. If this relaxes then it can generate problems locally or even higher up. It can even be the case that the correction of gait problems can affect the spine which in turn can make a change higher up for which the muscles are not yet prepared. The physio may well be able to recommend some exercises if this is the case.

Of course, a third possibility is that by using  acupuncture from a physical/medical perspective only the treatment has caused systemic effects in a wider way of which the practitioner may be unaware. It has been one of our constant themes with western medical acupuncturists that using points within a medical context does not mean that you can switch off the effects they have from our perspective in Chinese medicine. Why this might have resulted in neck and shoulder pain would very much depend on the nature of your energetic balances from a Chinese medicine perspective.

What we think is very likely, however, is that unless a needle has caused physical damage in the area where your pains are they are very likely to subside within the next few days. You would be well advised to contact the physio anyway to ask what it going on, and any of our members would in the same circumstances be only too happy to discuss the problem and perhaps invite you back to take a look at what is happening. Nobody wants a patient to be in pain after treatment. It may well be that further discussion reveals why this is happening and also go a long way to ensuring that the same thing does not re-occur.

The other thing we should say, though, is that although it looks fairly likely that the treatment was causally implicated in the pains it may not be the case. If by the time you get this response the pains continue and are beyond simple pain control you would be well advised to see your GP in case this is something different which has by pure coincidence happened at the same time. With over four million treatments in the UK each year there are bound to be occasional coincidences, and the key thing is to get problems checked out first before getting engaged in discussions about what caused what.

Q: I am an oncology pain specialist nurse and I am currently doing a Masters in nursing. My question relates to 'self Acupuncture for chronic Cancer pain'. I appear to be struggling for published data on this topic so wanted to ask if there are any trials in this area or who I could ask?

A:To be honest there isn't a great deal of information about self-needling, although there have been some interesting articles over the years. A relatively recent one discusses the use of self needling in research trials for breast cancer treatment. You will need to find someone in your section with access to research databases to download this, but it looks like interesting reading.

We came across a hospital In Truro many years ago where patients were being trained in the use of a specific point (Nei Guan) to reduce post-chemotherapy nausea, for which there is considerable positive research evidence, and they did have some very well laid out and clear instructions.

However, it would be fair to say that we are still very much on the side of the view expressed by Val Hopwood in the article on self-needling to be found in this journal where she says that the risks outweigh the benefits.

We have not tended to encourage people to needle themselves. There are two main reasons. First, acupuncture involves piercing the skin and safely disposing of needles, and a professional practitioner spends a considerable time learning the skills and knowledge necessary to remove any risk of infection or cross-infection from the process. Our main complaint about very short training courses is that while they may train people in useful adjunctive skills they cannot hope to ensure that the person taking them is sufficiently well trained in safe needle practice and all the cautions that go with being a professional acupuncturist.

Second, although the treatment of symptoms has its place in Chinese medicine, symptoms are regarded as only a part of the picture, and are usually indicators of imbalances within the system which need attention. The risk is that using acupuncture in a first aid way, the underlying pattern is deteriorating, but the alarm bell which the symptom represents keeps getting turned off. This is less likely in a controlled setting like continuing treatment under supervision. However, we have to be realistic; for most patients in continuing care this can mean quarterly or half yearly check-ups, and a great deal could happen in between without necessarily being picked up or seen as being masked by a treatment intended for another purpose.

That said, you can find some data by chasing the references in these two papers. There are also a number of recent studies which are well worth looking at. Jacqueline Filshie is one of the UK's experts in acupuncture and cancer treatment, and her paper is as always enlightening and solidly grounded in experience. There is also a useful paper here for a study in which Jacqueline also took part.

We hope that these give you enough to start with and wish you well with your studies.

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