All posts by Helen

Chronic Pain

Acupuncture and Chronic Primary Pain: the new NICE draft guidelines

You may have seen the recent press stories about acupuncture being one of the suggested treatments by NICE for the management of chronic primary pain.  This is an interesting headline and is in development, so we thought it would be useful to explain a bit more about what this means, and how it has come about.

What is NICE?

NICE is the NHS advisory body, which looks at the scientific evidence, cost and practicalities of treatment options for specific conditions, and produces guidelines for the NHS doctors and clinicians as to what they should prescribe, and/or where they should refer patients – to consultants or surgery for example.

What is chronic primary pain?

This is condition that is ongoing, and which isn’t caused by another diagnosis or condition.  It is difficult to treat, and can have a big impact on the lives of patients and their families, with many of them being unable to work, and half of them being diagnosed with depression. 

What has NICE said about acupuncture?

Chronic Primary Pain: NICE recommends acupuncture in new draft guidelines, Aug 2020

NICE has said that the emphasis needs to be shifted to place the patient at the centre of the care provision, and makes clear that there is a need to reduce the amount of opioid-based painkillers as a front-line treatment, shifting the long-term care focus toward including non-drug interventions, of which acupuncture is an important one.

NICE stated that commonly used painkilling drugs have little evidence to support their use, and that supervised exercise programmes (cardio, mind-body or a combination) and certain types of psychological therapy (CBT or Acceptance and Commitment Therapy), acupuncture, and some types of antidepressants are more suitable approaches.

What was the evidence for acupuncture?

27 studies showed acupuncture helped this type of pain, and was cost-effective and the evidence was considered robust by the NICE committee

What sort of acupuncture?

The draft guidelines state that both Traditional acupuncture and western medical acupuncture are suitable for this, and that they wish this to be delivered in a community setting (i.e. not in hospital), and by a health practitioner lower than band 7 (i.e. not by a doctor).

What about other physical therapies?

Other manual therapies were not recommended as there was not enough evidence (e.g. osteopathy, chiropractic), and the researchers recommended further research.

What will happen next?

These are draft guidelines, open to consultation until mid-September, after which a set of formal NICE guidelines will be produced.  NICE guidelines are set out in a format where they explain when each approach should be used, dosages or length of treatment for example, so it is likely that after these refinements we will know a bit more.

In the meantime, this is a very encouraging story as using a patient-centred approach is beneficial for patients and their families, and in view of acupuncture, it shows that the increasing, high-quality research evidence for acupuncture is able to support its effectiveness to an extent where the NHS recognise and adopt its usage.

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Coronavirus Update

Coronavirus Update

We’re open for practise with COVID-19 secure gudelines

We are now open for all treatments, in line with the British Acupuncture Council COVID-19 Secure Guidelines

Risk Assessment

We have undertaken a risk assessment on the premises and practise, and have made the necessary changes to mitigate and minimise all identified risks, as per BAcC and HSE and government guidelines.  The important aspects you need to be aware of, are as below.

The acupuncturist carries out a risk assessment regarding each patient, to ensure that attending in person is appropriate, as for example if you are shielding or in a high risk group, this still will not be possible for the time being.

Telephone triage/screening before you attend

Please also note that your practitioner will contact you on the day of treatment to check that you are not symptomatic of Covid-19, and other related checks to ensure it’s safe for you to attend.

The acupuncturist will do as much of the verbal consultation on the telephone prior to the appointment to minimise the amount of time exposure in the treatment room.  They will discuss your symptoms and circumstances with you.

All this is in line with the guidelines for safe practise of our regulatory body, the British Acupuncture Council (BAcC), and national government guidance.

Consent

You will need to complete a specific consent form in order to undertake  treatment at this time, your acupuncturist will advise on the specifics of this.

Changes to the rooms and equipment

In accordance with government guidelines and those of the BAcC British Acupuncture Council we have made changes to the rooms in which we practise, and the way in which we work in order to do so safely in this unprecedented time.  You will notice less chairs, no waiting area (a chair is provided for emergencies) and you are encouraged not to use the toilet onsite unless in an emergency.  You’ll notice more posters and safety equipment, as well as the use of PPE for you and the practitioner in the treatment room.

You’ll be asked to wash your hands or use alcohol gel on entering the premises, and you’ll see more in the way of cleaning equipment occurring.  You’ll be reminded to keep 2 metres away from anyone from outside your household, including the practitioner; with the exception of the treatment itself where PPE is used due to unavoidable proximity.  Your treatment may be shorter than usual, as we will have completed the talking element of the treatment by phone, prior to the treatment. We intend to minimise the time we spend in the 2-metre zone, to less than 15mins,- minimising both our risk.  We will leave larger gaps between patients so that cleaning can take place between patients.

Useful to know on the day

If you are attending for urgent care the following is a useful reminder (although not exhaustive and you will have discussed with your acupuncturist):

  • Check your symptoms and those of your household – your acupuncturist will make a pre-appointment phone call to screen for this
  • Use the toilet before you leave home as we need to keep the numbers of users to a minimum as cleaning is needed between users (you can of course use it in an emergency but must let your practitioner know so that they can arrange cleaning)
  • Be on time, and not early as there is no waiting facility. We recommend travelling by car, walking or cycling.  If you must use public transport, there are specific government guidelines on this here including mandatory masks on public transport, for example
  • Do not wait outside the front door, or use the buzzers, instead text your practitioner from your car, or text from the car park or pavement outside whilst keeping socially distant from anyone else who is waiting
  • Bring the minimum of items with you, so no shopping or large bags, and please bring the items your practitioner requests, e.g. face mask, towel, bottle of water

Further information

Specific government advice for this sector, should you wish to read it first-hand is here: Close contact working

Bear in mind that guidance changes, sometimes daily as a result of the R number and the government’s 5 tests, and therefore and we will keep this up to date as this happens, but the primary source of what can and cannot be safely done remains government guidelines here: https://www.gov.uk/coronavirus – which over-arches all of the above.

Information correct per government websites at 14/07/2020

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Can acupuncture help me reduce my medications?

I am often asked permutations of this question, and my answer is that acupuncturists are not doctors, and deciding to change or reduce medication must always be done under a doctor’s supervision. It is important to have these conversations with your medical team, and it’s crucial if you are considering making changes to medications, that your GP and any consultants whose care you are under, are up to date on what you are doing.

Pharmacists can also be a very helpful resource, and in particular if you are using over the counter medications, they can advise you of contraindications and interactions they may have with your prescribed medications.

In terms of acupuncture and working with patients, some of the reasons people are looking at introducing complementary medicines and coming to us, is for example to help them reduce the number of painkillers they are taking, or see if we can do something to help their side-effects.  This can be very helpful as long as we have a team approach, realistic expectations and discussions, and the patient is also working with their GP or consultant.

The research evidence for acupuncture is growing, and we find that medical professionals are more and more aware of what we do, in some cases recommending acupuncture for particular conditions, so be sure to tell you GP if you are thinking of acupuncture, and keep them up to date on how you are getting along.

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Acupuncture and the menopause: the evidence base and how it works

Acupuncture and the menopause; hot flushes

Acupuncture is increasingly used for many different conditions, but one that may not at first be obvious if that of menopausal symptoms, where acupuncture has been shown in studies to be of benefit. Here I will present information on acupuncture for hot flushes, and other menopausal symptoms of sleep quality, mood and anxiety, memory and cognition and general quality of life.

I’ll also discuss theories and scientific studies showing how acupuncture may be achieving these effects.

I will also touch on hot flushes of other causes, in males and females after cancer-treatment using hormonal drugs these can also cause “vasomotor symptoms”, also known as hot flushes.

I’ll discuss how research shows acupuncture to affect the hormonal system, and finally I’ll leave you with some information and links to follow up for the references and bibliography relating to this area.

Read More Acupuncture and the menopause: the evidence base and how it works

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The importance of integrated working

Some common questions on how we work alongside allopathic medicine

“But what will my doctor say?”

Take a look at Helen Smallwood’s video about this exact question, which shows that acupuncture is popular and well-supported by the medical professionals.

Studies have shown that majority (83%) of GPs agree acupuncture can be clinically useful and 72% that it can be cost effective. (Lipman et al, 2003), and 65% agree acupuncture is effective (White, Resch, & Ernst 1997).  In a study by the British Medical Association

“Overall 79% of the GPs agreed that they would like to see acupuncture available on the NHS” (BMA, 2000 p76).

Where GPs recommend acupuncture to patients, it is mostly for pain relief, musculoskeletal disorders, psychological conditions, stress, skin diseases and chronic illnesses (BMA, 2000; Giannelli, Cuttini, Da Fre & Buiatti, 2007; Adams 2001a; Ernst 2000b; Desser, 2003, Lewis & Halvorsen, 2003). Their support is shown by the fact that between 59% (BMA, 2000) and 79% (Lipman, 2000) of GPs would like to see acupuncture available within the NHS.

Read More The importance of integrated working

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Is acupuncture just a placebo?

We are always happy to answer any questions that people put to us about acupuncture. One of the ones that used to take me by surprise was “but it’s just a placebo, right?”
Really? What a question. I was surprised to consider it possible that anyone would believe that an entire profession, training colleges, regulatory boards and research bodies would be built on a treatment that was placebo. Where would the ethics and justification come from? Why would acupuncture still exist?
Read More Is acupuncture just a placebo?

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Acupuncture and depression, mental health

by Helen Smallwood, acupuncturist, Shaftesbury Clinic

This blog post will concentrate on the use and research regarding acupuncture and mental health, and with a particular focus on depression.

Acupuncture is known by many as being holistic, which means it looks at the workings of the body and the mind overall in an integrated way, as opposed to seeing them as separate entities. Some people are surprised when I tell them acupuncture can be very beneficial for mental health as their first impression is that acupuncture is a very physical therapy and they are mainly associating it with its uses for pain and injuries.

Read More Acupuncture and depression, mental health

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Acupuncture for anxiety and stress

I am often asked about acupuncture for anxiety and stress. We see a lot of patients for anxiety, stress, depression and other mood or motivational issues. Acupuncture is something that a great number of these patients have said has changed their daily lives for the better. This works best if they can address other lifestyle issues (e.g. diet, exercise, relaxation strategies), and we can very often recommend strategies and experienced colleagues to concurrently support these aspects if this is desirable.
Read More Acupuncture for anxiety and stress

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