Please read this information carefully, before starting treatment and keep it for future reference. It will provide information on the possible use of acupuncture in your individual treatment plan. Please use it in conjunction with any advice given by your physiotherapist.

Acupuncture and physiotherapy

To complement conventional treatment methods, some physiotherapists in the NHS use acupuncture, mainly for pain relief. It has increasingly become a part of physiotherapy practice in the UK and has been used in the NHS since 1982. The National Institute for Clinical Excellence (NICE) supports the use of acupuncture in the treatment of chronic primary pain and tension type headaches.

What is acupuncture?

Most people know that acupuncture involves inserting needles through the skin. It is one of the oldest forms of treatment and has been used in China for more than 3,000 years and may have been used in Europe by pre-historic man. The needles may be inserted in the vicinity of the pain, away from it or often a combination of both. The time they are left in varies but is usually no longer than 20 to 30 minutes.

Some therapists are trained to perform electro-acupuncture which can be applied by using a low intensity current through the inserted needles. Our understanding of the mechanisms by which acupuncture works is constantly being refined and updated in the light of research. Therefore there are two common approaches to its use.

Western scientific explanation

Modern science has shown acupuncture can work in a number of ways, particularly to ease pain. One way is by stimulating the nervous system to produce its own natural pain and stress relieving substances, such as endorphins and oxytocin. Another is by acupuncture stimulating nerve fibres that carry other sensations in order to block out the painful ones, releasing or relaxing muscles. As more research is carried out, the number of possible ways by which acupuncture works is increasing.

Traditional Chinese explanation

According to traditional Chinese medicine, in addition to nerves and blood vessels there are other channels (meridians) through which energy (Chi) flows throughout the body. If this energy is flowing freely, the body is in a healthy state. Illness and injury can stagnate or excessively increase the flow of energy and give rise to a variety of signs and symptoms. The energy flow can be affected by inserting needles into acupuncture points. The aim is to restore the normal flow of energy and relieve signs and symptoms, including pain.

Will acupuncture work for me?

Physiotherapists use acupuncture for a number of reasons, mainly to reduce pain. It can be used in the treatment of a variety of conditions, such as acute and chronic injuries, arthritis and rheumatism, back and neck pain, muscle and joint problems and sports injuries.

Research has shown that most people gain relief from pain with acupuncture. It does not work for everybody and every condition, but good results are frequently achieved when more conventional treatment has failed. There is nothing spiritual about it and you don’t have to believe in acupuncture for it to work for you.

The effects of acupuncture are cumulative, with the pain relief building up as the treatment progresses. Some people respond well, while others may see little benefit until they have had a few treatments; this is more likely with a chronic condition. Occasionally, the condition may become slightly worse at first. This isn't a bad sign as it usually means the condition will respond eventually.

The results of a number of controlled clinical trials have been used by NICE to inform their recommendation of acupuncture as a treatment for chronic primary pain and tension type headaches.

Is acupuncture safe?

All treatments – just as all activities and even inactivity – carry some degree of risk. But research has indicated the risks associated with acupuncture are small compared with many other treatments, especially when carried out by a trained practitioner with sterile needles.

Your acupuncture will be carried out by a registered physiotherapist who has been trained in the technique, however, certain conditions are unsuitable for acupuncture or require a more cautious approach. Please let us know if any of the conditions listed below apply to you:

• allergy to metal
• anticoagulant (blood thinning) medication, for example warfarin
• anxiety or fear of needles
• blood donor
• circulatory or clotting disorders (including haemophilia)
• diabetes
• epilepsy, convulsions or uncontrolled movements
• extreme tiredness or frailty
• fasting or dieting
• flu, cold, viral or other infection
• heart problems, including valves
• hepatitis/HIV/AIDS
• high risk of infection, such as following surgery
• lymphoedema/cancer past or present
• pacemaker or other electrical implants
• pregnancy (or possibility of)
• skin problems.

If you have any other cause for concern, please raise this with your physiotherapist.

Treatment

After the initial examination and assessment the physiotherapist will decide if acupuncture is appropriate for you. Treatment may start immediately or may take place at a future appointment.

Please make sure you have eaten within two hours, as it is not advisable to go for a long time without food prior to treatment.

When the needles are inserted you may feel a sharp pricking sensation, which should only give a mild temporary discomfort. During treatment, you may experience a sensation spreading from the point selected. This is called the ‘Chi’ sensation and can be felt as heaviness, numbness, or mild aching. This ‘needling’ sensation often indicates effective stimulation. You may also feel a little light-headed or relaxed. There may be some redness or mottling of the skin around the needle sites. These are all normal occurrences and should not cause any alarm.

If at any time during the treatment you are uncomfortable, or even if you just require reassurance regarding any strange sensation, do inform the physiotherapist immediately.

Several needles may be inserted and may be adjusted periodically by the physiotherapist to enhance their effect. The initial treatment may be short in order to gauge how responsive you are. Subsequent treatments tend to be longer, approximately 20 minutes. After the needles are removed it is usual to rest for a few minutes before leaving.

Following treatment

After treatment you may feel immediate relief of symptoms. Some people feel no immediate difference but a gradual improvement while others may feel an initial increase or intensification of symptoms. The latter may last for up to 24 hours but is normally followed by a period of marked improvement. Some people feel refreshed and relaxed following acupuncture while others may feel very tired. It is a good idea to arrange appointments, at least initially, so you may go home and rest afterwards. It is best to avoid driving long distances or carrying out strenuous activity immediately following treatment. If you do feel unusually tired, you should avoid driving or operating machinery until this feeling passes.

The number of treatments varies according to the response. Generally it is clear after a few sessions if acupuncture is beneficial and a decision will be made whether to continue or not. Please advise the physiotherapist if you experience any adverse effects following treatment or if there is anything you have not understood and would like explained in more detail.

Useful websites

• www.aacp.org.uk
• www.medical-acupuncture.co.uk
• www.acupuncture.org.uk