Acupuncture status in the UK
Upgrade of Status for all Acupuncturists in the UK January 2021.
The British Acupuncture Association (BAA) has achieved a landmark re-classification for all professional acupuncture practitioners in the UK.
Both the BAA and the BAF worked tirelessly to support all professional acupuncturists working in the UK.
In March 2020, British Acupuncture Federation (BAF) gained permission for their members to provide healthcare treatments within days of the National Lockdown starting. They rose above all political or association barriers and ensured that this benefit was extended to all.
In June 2020 both BAA and BAF gained permission from Public Health England (PHE) to fully open clinics for all treatments.
The BAA and BAF worked with Public Health England and the Office of National Statistics to raise the category of acupuncture from 3219 - the category of Health Associate, up to 2220 - the level of Osteopaths and Physiotherapists. They achieved this on behalf of all professional acupuncturists who now belong in the category of Healthcare Professionals.
NICE guidelines for chronic primary pain
The National Institute for Health and Care Excellence (NICE) provides national guidance and advice to improve health and social care in England.
NICE guidelines are evidence-based recommendations for health and care in England.
They set out the care and services suitable for most people with a specific condition or need, and people in particular circumstances or settings.
The guidelines help health and social care professionals to: prevent ill health, promote and protect good health, improve the quality of care and services, adapt and provide health and social care services.
Chronic pain is often difficult to treat and can have a significant impact on individuals and their families and carers. Chronic pain may affect between 30% and 50% of the population. Chronic primary pain is the pain with no clear underlying condition or impact of pain is out of proportion to any observable injury or disease.
NICE recommends acupuncture for chronic primary pain April 2021
Acupuncture for chronic primary pain
1.2.5Consider a single course of acupuncture or dry needling, within a traditional Chinese or Western acupuncture system, for people aged 16 years and over to manage chronic primary pain, but only if the course:
is delivered in a community setting and
is delivered by a band 7 (equivalent or lower) healthcare professional with appropriate training and
is made up of no more than 5 hours of healthcare professional time (the number and length of sessions can be adapted within these boundaries) or
is delivered by another healthcare professional with appropriate training and/or in another setting for equivalent or lower cost.
Why the committee made the recommendation
Many studies (27 in total) showed that acupuncture reduced pain and improved quality of life in the short term (up to 3 months) compared with usual care or sham acupuncture. There was not enough evidence to determine longer-term benefits. The committee acknowledged the difficulty in blinding for sham procedures, but agreed that the benefit compared with a sham procedure indicated a specific treatment effect of acupuncture. There was a wide variation among the studies in the type and intensity of the intervention used, and the studies were from many different countries. The committee agreed that the type of acupuncture or dry needling should depend on the individual needs of the person with pain.
Two economic evaluations (1 in the UK) showed that acupuncture offered a good balance of benefits and costs for people with chronic neck pain. However, both studies had limitations; a notable limitation being that the costs of acupuncture seemed low. Threshold analysis based on these studies indicated the maximum number of hours of a band 6 and 7 healthcare professional's time that would make the intervention cost effective.
An original economic model was developed for this guideline, which compared acupuncture with no acupuncture. The model used data from studies with usual care comparisons, not comparisons with sham acupuncture, because the committee agreed that a usual care comparison in an economic model better reflects the real world benefit of the intervention. The model showed that acupuncture was likely to be cost effective. The committee considered the results to be robust, and agreed that the studies used in the model were representative of the whole evidence review. Acupuncture remained cost effective when the assumed benefits and costs were varied (sensitivity analysis).
Overall, the committee agreed that there was a large evidence base showing acupuncture to be clinically effective in the short term (3 months); the original economic modelling also showed it is likely to be cost effective. However, they were uncertain whether the beneficial effects would be sustained long term and were aware of the high resource impact of implementation. Taking these factors into account, the committee made a recommendation to consider acupuncture or dry needling for chronic primary pain, caveated by the factors likely to make the intervention cost effective. These were: only if delivered in the community, and with a maximum of 5 treatment hours (based on the average resource use in the trials in the model and on the threshold analysis), and from a band 7 (equivalent cost or lower) healthcare professional (based on the threshold analysis). It was agreed there may be different ways of delivering the service that enable acupuncture to be delivered for the same costs, which would equally be appropriate. The committee agreed that discontinuing before this total amount of course time would be an option if the person finds that the first few sessions are not effective.
No evidence was found to inform a recommendation for repeat courses of acupuncture. The committee agreed that further research would help to inform future practice (see the recommendation for research on repeat courses of acupuncture for chronic primary pain).
Acupuncture in the UK
There was a new research across surrey in the UK which studied current situation of acupuncture in health care. The data was collected using questionnaire responded by 330 acupuncture practitioners with professional background including 29% doctors, 29% physiotherapists, 15% nurses and 27% independent acupuncturists. 68% of the practitioners are in independent practice. Patient’s ages are from 9 to 94 year old. The most common visits are for pain conditions including low back, neck, shoulder and knee pain, as well as headaches and migraine. Anxiety, stress and depression were the three most common psychological complaints. Treatment for infertility by independent acupuncturists increased fivefold in 10 years. There are many visits for other conditions including obstetric, gynaecological conditions and digestive, respiratory circulatory and skin complaints etc. In the UK, about 4 million sessions of acupuncture were provided each year, two thirds of which were from independent practice. The style of acupuncture is that 67% is western medical acupuncture and 41% is traditional Chinese medicine. About 90% physiotherapists, nurses and doctors use Western medical acupuncture; while 90% acupuncturists use traditional Chinese medicine.
NHS acupuncture outcome
Most patients pay for private acupuncture treatment, because use of acupuncture in NHS is limited. There is a survey by Robinson TW from Barton House, Beaminster UK published in J Altern Complement Med (2012). This study was to investigate the response to Western acupuncture performed in a National Health Service (NHS) general practice. This is a good survey which included 3 year patient feedback. The outcomes, patient experience, impact on conventional therapies, and appropriateness of acupuncture in general practice were assessed. The patients received acupuncture treatments from all age groups and female to male ratio is 64%:36%. Following the course of acupuncture,
75% of patients noted an improvement in their presenting condition;
26% of patinets were reported complete improvement and 38% major improvement. 24% noted no change.
72% of patients thought that their quality of life was improved.
69% of patients had a reduction or cessation of painkillers and/or anti-inflammatory drugs.
57% of patients thought that referral to hospital specialist or physiotherapist was avoided due to the acupuncture treatment.
23% of patients found acupuncture to be painful; of those 60% said the pain was only mild.
72% of patients were treated within 1 week of being seen by the general practitioner (GP).
81% of patients had one to three treatments.
The patients’ response scores from an anonymised questionnaire showed beneficial outcomes from acupuncture.
Acupuncture is still the most popular CAM treatment option in the UK
In many countries, complementary and alternative medicine (CAM) usage during the last decade is increasing. Perry R et al from University of Exerter, Devon, UK conducted a survey to study the current situation of usage in CAM. They posted a questionnaire to GPs to ask them if they treat, refer, endose or discuss eight common CAM therapies including acupuncture. They also asked about their views on NHS funding, effectiveness, CAM training needs and theoretical validity of each therapy. They compared the results with those from the similar survey collected in 1999. They found that the response rate from GPs was low (30%) compared with that in 1999 (52%). The result showed that the most popular therapies were still acupuncture, hypnotherapy and chiropractic and the least popular therapies were aromatherapy, reflexology and medical herbalism. They suggested that GPs felt most comfortable with acupuncture, with greater belief in its theoretical validity, a greater desire for training and a greater support for acupuncture to receive NHS funding than for the other CAM therapies under question. Opinions about homeopathy ad become less supportive. In my opinion agreed with GPs, acupuncture indeed does amazing job to many people, as I can see many patients have been benefited from acupuncture treatments.
What do GPs think about acupuncture?
More people recognised that acupuncture can help them to get better and use acupuncture for various reasons. What is the opinion of GPs? There was a survey studied the opinions of GP on acupuncture in Italy. Among the responders of GPs, 95% are in favor of acupuncture, 84.2% believe that it is scientifically based, 6% practice acupuncture, 25.2% use it on themselves, and 66.2% have sent at least one patient to an acupuncturist in the last year. 82% of responders are in favour of adding acupuncture training to their own professional practice, and 71.9% believe it would be useful to include acupuncture in specific training for general practice. 64% believe that acupuncture should be included into the benefits offered by the NHS. Data show that interest for acupuncture is higher than that observed in previous international studies carried out on the same topics in the last 20 years. From this study, we can see an increase in confidence and trust in acupuncture.
What is health professional’s opinion about acupuncture in the UK?
British Medical Acupuncture Society is a registered charity and an association of medical practitioners interested in acupuncture. It was established in 1980. There are over 2700 members who use acupuncture in primary or secondary care. They promote the use and scientific understanding of acupuncture as part of the practice of medicine for the public benefit. It also provides education and training of qualified practitioners. What do these health professionals think what sorts of conditions respond to acupuncture treatment? In their opinion there are many conditions responding to acupuncture treatments. For example, Acupuncture is effective in a broad range of painful conditions such as back, shoulder, neck and leg pain; headaches, migraines, trapped nerves, chronic muscle strains and rheumatic and arthritic pain. Some other conditions include functional bowel or bladder problems such as IBS and urinary incontinence; allergies; sinus problems and chronic catarrh; stopping smoking; weight loss and women’s problems etc. This is not complete list and there are many more conditions that can be treated by acupuncture.
Pregnancy acupuncture in the UK.
Recently a survey in the UK was to explore how acupuncturists used acupuncture for maternity care within their women's health practices. 114 survey forms were sent and 99 replies were received, a response rate of 86.8%. The result has shown that in addition to fertility and menstrual conditions, the majority of the practitioners (87 [87.8%]) had treated at least 1 pregnant woman each. The most-common maternity situations encountered were: birth preparation (84 [96.5%]); nausea & vomiting (82 [94.2%]); and inducing labor (79 [90.8%]). More than 50% of the practitioners were also treating lower-back and pelvic pain (77 [88.5%]), breech presentations (74 [85.0%]), threatened miscarriages (55 [63.2%]), and headaches/migraines (46 [52.8%]). Greater number of referrals were received from medical health professionals for pregnancy (54 [65.8%]) than for fertility (16 [19.5%]) or menstrual conditions (8 [9.7%]). They concluded that The most frequently treated menstrual conditions were for irregular periods, menopause, and premenstrual syndrome, while women seeking treatment due to a medical diagnosis, general fertility health, and stress and relaxation were the most-frequent fertility issues. Although the most frequently treated pregnancy conditions concerned nausea, birth preparation, and labor induction, more than half of the practitioners were also treating pregnancy-related lower-back and pelvic pain, breech presentations, threatened miscarriages, and headaches and migraines. Referrals from Western medical practitioners were more common for maternity acupuncture than for fertility or menstrual health.
Hopton AK et al BMJ Open. (2012)11:2-9
Robinson TW J Altern Complement Med (2012) 18:555-60
Perry et al Prim Health Care Res Dev (2013) 10:1-6
Betts D et al Med Acupunct. 2019 Oct 1;31(5):274-280. doi: 10.1089/acu.2019.1386. Epub 2019 Oct 17.