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com

Practice
Audit in Acupuncture
FacialPain:A Reviewof 200 Cases
Treatedwith Acupuncture
Nazim Merchant
Thisarlicle is basedon a presentationat tha BMASSprinEMeetin! at Warwickin May 1995
CenerJldeital pra.l tioneG
Summary
l8.l t
Ceneralmed .al practitonrs
A group of 2Al patients who hacl rec-.ived
tants
in
other
special
ties
Cons!
acupuncturefor chronic facial pain during the last
Accidenland emeEencydepatment
6.0.t,
10 years was reviewed. Of patientswith temparo0.5,/.
mandibular jaint of muscular pain, 16y" claimed
Prior to attendance,6,+% had had no treatment,
full recovery alier acupunctureand 61yo reparted
anaigesics
had been used rn 3l.57o of casesand
benefit. In tigeninal neural]ia there was a 30.Byo
antibioticsin ,+.5"1,.
Afterassessment
at the hospital
claim of considerableimprovementwith a 69.2%
patients
60'%
of
these
were
trcatcd
by other
clinic,
tn
o\.rtll b"n"[i'. ll ',1.\ lpll ]ltrt BrpJler rttu!.r\
methodsprior to acupuncture.
In the rcmaining80
interpretingresponserateswould resultfrom the Ltse
patients(40'l.) acupuncturewas the first line of
of a visualanaloguescaleto recordpain; so this was
treaLmenl,
and of these,34 had no treatmentother
assessedin a small group, in which 75',1,showed
n
tha
acupuncture.
i nprovement afteracupuncture.
ThedLrration
trealrfentrangedfrom
ol acupunclLre
- o r l h . . $ r l L - B o oo t p J l r p n l .e e r \ r n t
I
u
B
l
Key words
The numberof
Acupuncturc, Audit, Facial pain, Tetnporc- treatmentfor lessthan 3 months.
{rom
1 to 14,1with
acupuncture
treatments
ranSed
tnandi buIar jo i nt pain, TriBenri naI neural9ia.
/07oof patientsreceiving
lessthan4.

Intrcduction
Acupuncturepoints
Manypatients
with chronicfacialpainareseenby oral l h el o l o $ r t p o r t . $ p r p r , . e d r o e p , lrl 8 :
TriBgerpoints,11.4.
and maxillofacial surgeons.Three quaftersof these TemporonandibuIaI jolntlmusc/esr
joint (TMJ)problems, h igemi naI neLtraIgia (SecondD iv isiotl): L|.4,19,2A,
patientshavetemporomandibular
which are conventionallytreatedby one or more ot
s T , 2s,t . 1 B .
severaltherapies:analgesics,jaw exercises,physio- higeminal neuralBia(ThirdDivision):
therapy (shortwave diathermy or ultrasound),bite
MFJ ldl .ut. mtsr, \4d\\ele 'l., la, L;B. .
raisingappliancc,antidepressants,
arthfoscopy
and In cases of Trigeminalneuralgia,needleswere
eventually,in a few cases,sLrrgery.
Belween1984 and insertedinto the triggerpointson the affectedside
1993, 2O1 oi these patientsat CrosshouseHospital withoutprecipitating
the pain.
receivedacupuncture.This has previouslybeen Migraine:C,B.2o,21
.
reportedas beneficialin TMj pain (/). Somc other
casesof facialpainweretreatedwith acupunctureand
lhesearealsoincludeclin lhe feviewaZll.
PROBTTMSTREATED
Thereviewwascarriedout retrospecti\,ely
andlhe resLrlls Diagnosis
Numbcr of Patients
relyingon patientasseisnrenl
were purelysubjective,
ol
15) t76"/,,)
TMJdyftnction/mlscr ,r p.)in
No formalrrrethod
such
thesymptorns.
ol painassessment
21 111
.9"1)
P o nl r a l m a
used.
asa visualanalogue
scale(VAS)was
I I (6.5'1,
d e u r d8 i r
it was decidedto repeatthe study T r i S e m i n N
Subsequently,
MiSrainc
I {0.5%)
prospectively,
this time usinga VAS to assess
the
O t h c r( a t y p i c a l f a . i ap a i n )
l0 (5.0%
results,and the first 12 cases assessed
by this
m e - h o t. lr r e. n L l u d eddl . h e . n d u f t h J r e \ c \
Method
Thestudygroupof 201 patients
wasmadeup ot I64
femalesand 37 malesrangingin age irom 13 B0
w i t h5 0 % u n d e r3 5 .
The referralswere from the followingsources:

A.upun.tute i n Me.licine

Restr/fs
The results
werepurclysubjcctive
and no painscale
was used for these cases.After about 4 scssionsof
acupuncture
the decisionwas left1()the palienlasto
whetherfurtheracLrpunctLrre
shouldbe carriedout
or not-

Lt0

Nov 1995vol l3 Na 2

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visual Analogue scale assessmett

Following this review of 201 palients,it was
the pain by meansol a
decidedto try and assess
(62.7%)
who
locm VAS. Twelve patientswere assessedby this
This makes a total of 126 cases
43.17oir.provedwith methodf/able 2).
improved.Of the remainder,
one patient had a vasovagal react'on to the
other treatments,18.57owere lost to review 3.87.
and developeda rashon the face and
werestill attending,and the restwere reierredto other acupunclure
or neurologrsts. neck, Her acupuncturewas discontinued.(Jne
clinics,i.e.Painclinic,ENTsurgeons,
patienthad no improvernent
at all after9 weeksoi
Temporon andibularjai nt/muscuIar pain
little improvementin
was
and
there
acupuncture
who were
Out of 153 patientswith this diagnosis
9 out of the 12 patients(75' 2t
wereasfollows: one olher.Overall,
the results
treatedwith acupuncture,
with acupuncture.
showedimprovement
wereas follows:
Theoverallresults

(rs%)
2l patienrs
OT PAININ 12 PAfIENTS
VASASSTSSMENT

Thjsgivesa totalof 94 patients(61%)who benefited

fromacupuncture.
TriEeninalneuralBia
ThirteenDatientswith this diagnosiswere treated
wereasfollows:
The results
with acupuncture.
inrprovemcnt
ConslderabLe

vAs (cm)
Patient Follow-up vAs (cm)
(weels) PieacupuncturPostAcupunctur
No.
2
6
t
1
t.5
5
2
3
4.5
4.5
t
9
6.5

4 pailcnts{30.8%)
5 patienrs(38.4%)

who benefited
Thisgivesa totalof 69.2%of patients
lrom acupuncture.
Seven patients were treated with acupuncture
alone,andthe resullswereasfollows:

7
8
9

2
2
2

11
12

l
9

1.5
3
0

t.5

1.5

Conqiderableimpro!-"ment liratient

conclusion
Acupunctlrrehas a significantrole to play in the
Of the 6 that were also given carbamazepine,5 treatmentof facial pain, althoughthere are other
b-reflled, in hrt lor'rerdo.e. o[ tatbomazepine effective methods of treating this. Patients with
ioint or muscle pain benefit
were requiredto control the pain f4,5),but 1 patient ternporomandibular
be
which may sometimes
gfeatlyfrom acupuncture,
had no benfitat all.
and
while
acupuncture
the only treatmentrequired
Migraine
does not usLrallycompletelyrelievethe pain of
from
The 1 patientwith this dia8nosis(6) benefited
is that
the clinicalimpfession
trigerninalnelrralgia,
r h pd , J p u n ,l J e b u tn - - t h p n o - l l o r p \ i e w
ol
in
the
dosage
it can allow a reduction
paLn.
control
the
catbamazepinercquied to
PostTrauma
Twentyfolrr patientswith this diagnosiswere treated It is intendedto repeatthis studymorefully,using
wereasfollows:
the vAS to assessresults.
Theresults
\,\,ith
acupuncture.
Considerableimprovement 50.0"1,
12.5%
29.2%
83%

NazimMerchantBDS FDSRCS
ConsultantOral & Maxillo FacialSurgeon
Hospital,Kilmarnock,Scotland
Ctusshouse

Atypicalfacialpain
Ten patientswere seenwith this dia8nosisaZ).The
resullswereasfollows:
Grai mprovement
S o m ei m p r o v e m e n t
No improvement
Lostlo revie{,

)o1'
10%
50%
1A%

Acuputlcturealone
Of the overallgroup of 201 patients,34 were treated
wjth acupuncturealone and no other treatment
beforeor after The resultswere as follows:
Creat mprovenrenl
5ome mprovement

2 | p a r i e n t(s6 1 . 8 % )
3 p a r i e n r s( 8 . 8 % )
I p a r i e n t( 2 . 9 % )
. l p a r l e n tlsl l . 8 % )

Nov 1.)95Val 13 Na.2

l . H o V B r a d l e yP ( 1 9 9 2 )A c u p l n c f u r et o r r e ss t a n t e m p o r o '
mandib! rf loint pain dysfunctionsyndrome.Aclpun.tufe
in Medicine. 1o(2):53's
T h o m p s o nR ( 1 9 9 0 ) A d e n t a e l e c t l v et o C h n a r 9 ' r 0
A.upun.turc in Medi.ine. 812):70-1
3 . B.jrgum JensenL, TallSrenA, noest T, B.jrglumlensen s
(1977) EJfect ol ac!puncturc on myo8enc headache
Scandinarian
lournal Dntal Res.85:45670
l e n k j n s M { 1 9 9 0 ) T r l S e m i n anl e ! r a l S i a :W h a t d o e s t h e
paticntneed? ,A.uplr.ture in Medicile.8(2):65 7
r er t r S e m i n anl e u f a8 i a :
5 . C r a l ' tI ( r 9 8 8 ) E l c c t r o a c u p ! n c t uf o
A tn \reafrevlew A.lpun.turc in Medi.ine. 511):35-6
Loh L, Nathan PW Schott CD, Zilkha Kl (1984)
Acupuncture vefsus medlcal treatmentlor migraine and
ai Neurcb\v,
musce iension headaches. /o!d
Nedr.rd[qerr .rnd P(l.hirtrJ. 4- ] I I 7
| . rrFn o rr, ,l | ..,n
, , . . - - p l s - . 1 " 6 L n , a nJ - J
Acta Nedro.:hir.(Wisn).59:279
by acupuncL!re.

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in
Sessions
Funding
of Acupuncture
CeneralPractice
CharlesWalker
Thispaper is basedon a prcsentation
at the BMASAutumn Meetingin Londonin Octobet 1991
to continuethe schemeuntil mid-April
when lwas due to go on extended
course
studyleaveon an acupuncture
in China.A iurthertl2,250 was to be
madeavailableon my returnin August
to continue the service until April
within the first 10
1996.Additionally,
monthsI had gainedtl,065 in private
feesand t75 in lecturefees.

Sufimary
A genetal practice acupuncture
service was set up with financial
support from both the local Family
Health Services Authotity and the
Regional Health Authotity. Refeffals
were taken from within the group
pnctice and other local practicesin a
bid to rcduce the referral ftte to
hospital clinics. This appearsto have
been successful.

conditions trcated
Ovef the first 12 months, 492
conditions were treated in a total of
Key words
390 patients(Iable /), involving1,890
Acupuncture,Audit, Funding,Ceneral
The ALthor in his surgery
practlce,Musculo-skeletal pain.
treatments; 67.9%
ol
treated
(Phat by krnd pe,nhsid ot Pul.e)
The
conditionswere musculo-skeletal.
averagenumber ot treatrnentsper patient was 4.B;
tntroduction
coursern 53% of patientsreceivedonly one or tlvo treatment
Aftef attendinga BMASbasicacupuncture
an acupuncture
serviceat
January1994I introduced
our three partner Medical Centre,serving5000
patienisin Merseyside.
Initially,this was an unpaid
service,but in March 1994 I appliedto the North
West Re8ional Health Authority (NWRHA) for
waitinglist initiative money to reduce hospital
refenals,primarily to orthopaedic,rheumatology
clinics.
and physiotherapy
A figure of I15 per 15 minute treatmentwas
suggested.In responseto a requestfor a detailed
breakdownof treatmentcosts includingmy own
Number
ol lrealmen|s
time, my nurse'stime/ heatinS,liShting,stationefy,
needles,moxa etc., expensesin the reSion of {29
FiEurc 1. Frcquency ol acupunclurc treatment.
per treatment were identified. My personal
expenditure
on coursesand equipmentwasf2,675. sesston5.
using
Continuousauditof patientsymptomatolo8y
a visual scoring systernduring the course of Res.rrts
treatment, provided data to support the bid for Clinic time was availablefor 36 treatmentsper
funding. A supportive Family Health Services week; 390 patients were treated over a 52 week
local newspaper period,with a total of 1,890 individualtreatment
Authority(FHSA)and an interested
gave further momentum and advertisementto a sessions(Frgure/).
serviceprovidedwithin the NationalHealthService A score card was used to assessthe benefit
Thiswas markedfrom
obtainedfollowingtreatment.
in an areaof high unemployment.
On 4ih July,NWRHA, jointly with Wirral Health 0 to 10 in centimetres(Fiqurc2) and patientswere
priorto each
FHSA,offeredprospectivefunding of f8,900 as a 12 askedto completea cardanonymously
includinBthe first.lt was not seen
month, once only, schemebased upon f15 per treatment
session,
treatment and equivalent to 593 treatments.The by the doctor treating,who merely asked if the
service was to be available to both practice and patient's symptoms were static, better or worse,
patientsalike.This was well reported beforedecidingwhetherto usethe sameselectionof
non-practice
The
in the nationalgeneralpracticenewspapers.
--------".-->
deterorating
schemecommencedin Augustand 157 treatments
1 0
1
2
3
4
5
6
7
I
9
0
\ e r eB r \ e 1i n l h e f i r s r5 i \ w e e l ' u o n h - 1 2 , . j 5 5Br y.
aAD
30th lanuary 1995, 18,100 had been utilised, G O O D < - _ - - _ ' - _ _ - ' - i m p r o v i n s
providing 163 patients with a total of 540
used ta asses benefit.
Wifral Healthprovideda furtherf2,000 Figure 2. Scorc cad
treatmentsAcupuncturcin Medicine

112

Nov 1995 Vol l3 No.2

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BYACUPUNCTURE
CONDITIONSTREATED
6
6

osteoarthritis
16

E.Cadiov$cular
calfcnmpvpain
venousinvrestless
leSs

9
1

whiplash
11
7
4
2
52

fieumatoid arthritis

37
10
I
4A

injury
Lawet IeB
medialcompaftrnentstrain

37

injury

3
1
5a

2
2

F.Drug withdnwavdietinq
ciearette
cessation
weightreduction
drugwithd.awaJ

2
I

to

G. Dematological
itch eczema
jaundice

H, Respiratory

l
2
I

'14

4
29

A. ENr

20
rheumatoidarthritis
c a r p a r t u n n esry n o r o m e
muscularpain (2 presnanr)

sinusitis(2 pregnant)
rhinitiYnasalcongestion

12
10
8
3
3
l
l
46

2
32
5

labyrinthitis
pharynSitis

tension(l prcgnanl)

31
2A

t5
tl
3
1
io
9
8
3
2

5
5
3

l
1
1
5

K CNs
Bell'spalsy
tic (epileptic)
pon herpeticne!raligia
trigeminalne!ralgia

2
l
I
l
5

L. Ophthalnologial
2
I
J

23
82

potntsor nor.
Due to an error,some patientsd;d not completea
card before their first session.A number of them
later did this retrospectively,but 64, who had had
only one treatmentsession,remain witfr no score
card. A standard, ungraduated,1ocm visual

DsB. ol impovement(%)
Figurc 3 . Degree af inprovenent

Nov 1995 Val 13 No.2

in patients obaining

benefit.

analoguescorewas not used as it was thought that

this would need more explanationand there was no
for this.
time available
Cards were analysedcomparingthe first and last
42B primary
scores:326scorecardsencompassed
conditions (F/gufeJ)j 68.5o/01337)improved; 7.5%
(37) remained the same; 7.5% (37) showed no
progression;3.57o(17) deteriorated;13.0% (64) had
is unknown.
no scorecard,thustheir proSression
Of the 492 primary conditions treated, 337
(68.5%) showed some improvementon the score
cards and 357oof the improvementSroup (24"k ot
the total treated)showeda benefitgreaterthan 50%
in symptomcontrol. Side effectsnoticed were: one
faint, three cases of light headedness, one
haematoma(1cm diameter)and occasionalbruises
The NWRHA funding was intended to reduce
hospital referrals,thus any treatmentthat a patient
would have received had acupuncture not been

113

Acupunctu re i n Medic ire

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by mysell
availablewas noted.'fhiswas determined
and followed my former routines,used prior to
starlingacupunctllre.
In the periodfrom August1994 to lanuary1995,
whilethe NWRHAschemewas running,l63patiefts
were treated, inclLrding21 referralsfrom other
lhcy had 540 tfeaimntsessionsHospital
Dractices;
referralwas avoidedin 79 casesalable2)t medication
84
in the remaininS
would havebeenLlsed
R E F E R R AATVSO I DE DT H R O U G HT H EU S EO T
ACUPUNCTURT
40
1.1
t0
5
2
ENT

Discussion
_l-he
is idea forthe Llse
generalpracticecnvironment
of acupunctufe, as preliminary screening oi
conditions for fLlrther investigationof westeln
medicaltreatmentcan a ready have iaken place/
reierral
thLrsobviatingthe needfor secondary
Paticntscan thefeforereceivelreatmentlocallyin
"Minimalstimulatian"
clinic surroundings.
sLritable

give a cheap,quick,effectivetrealment
techniques
with little disruptionto Eeneralclinic time This
incrcaseslreatmentoptions to both doctor and
pa(ient.The minirnalstirnulationtechniquethat I
used initiallyon a I palients,involvedtaking one
needle per paticnt (except if C8.30 was being
needled,when lused an additional,longerneedLe)
and inserting it serially at multiple points l
stimulatedal each poinLfor a maximumoi lOsec
(de ql) was reported,
bcfore
unlil needlingsensation
o.(:asions
I
pointrare
C)n
mo\,ingon to the next
which
at
15Hz;
for 20min
usedelectroacLtpuncture
waslhe on y time needleswereleft in fof morethan
as standard,
1osec.I offeredsix,weeklytreatrnents
il
louf
sessions
after
was dlscontinued
but treatment
The
cnd
had been experienced.
no imDrovement
fof thoservho had improvedwas
pointof treatment
variable.I would carry on for rnorethan the six
if the patientielt symptomscontlnuedto
sessions
jmprove,although in some casestleatmentwas
o i j ( o n r r u c dL p ,r u s eo i t n r ' . u . l . i l . .
conclusion
sidecffectsand
in drug expenditure,
The redcrcLion
and
in timesol linancialconstraint,
hospitalreferrals
y
private
seclor
the openinil up of an essential
havebeen
servicein an areaof high unemployment
welcorteo.
Cha es WalkerMRCP
CavendishMedical Cenlre
211ParkRoadNorth,Bikcnhead(UK)LlI BllU

A Reviewof the Useof AcuPuncture

in GeneralPractice
mainlymusculo-skeletal.
ln Septemberand October 1994 I was able to
attendthe Naniinil Colle8eof TraditionaChinese
Medicine as a "Forei]n Sluclent".I spent the time
- . u f . , L p . l ' , l rr p i 1
o b - F r \ i n gt l ^ e l , o : l i ud
hosDital
alinicsand attendinglectureson tradilional
Chinesemedicine(TCM).I 6ad no wish to learnto
needlepatientsin the TCM manneras I was alleady
nt tP*and' F
b\ B'
lneta\pm,nt \ o-,l"inad
"minimal"
confident of the outcome usin],
t. lhc ,lue'tiatu'.,trc \^tth ct i F C l ' n Bl h l b c n " h l
brie{lyat
In this,onc needleis inserted
laste(lmorc than 5 days. lnilially 50'n' ol pattents acupuncturepoints.
know
about
Chinese
The
oi
were saeptical about acupunctLtre, but alter a limitednLrr.ber
and
meridians
single poinl needling, using
treatmenl91lo haalbecone enthusiasts
"Eitraordinary" points, but not many doctors in
as patients
Chinaactuallyusesinglepointsroutinely,
Key words
needle
pleier,
mLllti
the traditional
seemto expecl,or
Aauputicture,Audit, GeneraIPractice
jnsertion
extra
time
and
technique,wilh extended
eLectrotherapy.
wilh ..oxa,cuppingor
stimulation
lntroduction
(ln
retufn
to generalpracticelbegan lo neeclle
20
more
than
practitiofer
for
genera
a
I havcbeen
range of
vears.In June 199'1I attendeda courseon the Tnanvmore paiientsfor a much wider
of
nunrber
;'New"Acupuncture
taughtby Dr Fclix Mann and problemsthan beforeand incorporated.a
points
into my reperlolre
quick!y began to 8et some interestingresults, the Exlraordinary
foI acupLrncture,
aside
specifically
not
set
time
p
r
o
b
I
do
e
m
s
,
c
l
i
n
i
c
a
l
l
i
e
d
o
l
l
i
m
i
t
e
d
i n i t i a l l yi n a

Summafv
Tltis is i practice aLtalilreviewinE the oulcome of
treatnent over a t\/o nonth periacl A
acupLt!1(Iure
questionnairewas used tct determine the ben-'fit
abtainerlby patientsfollowinp,acupttnctureanclalso
to hvesf4ate any changc in atlilude towards the
ft, Jttn-ntbuu+ht dbru! bt -h. p cnd c\p'' ien e

Acupuncturei n Medi.i ne

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but offer it duringthe normalcourseof a consulta- 3a.Haveyou changedyourmind?

(6%)
Therearenow:Sceptics:
10
tion. As the local Brapevinebeginsto wofk, rnore
Enthusiasts:
15B (91%)
patientsare specifically
coming lvith a requestfof
d , L p u 1 ,l u t e I ' e d l m e n l , w h i l p o h e r s r e m a i n 4.Was the conditionacute or chronic (recentor
surprised but pleased that I can treat them
longterm)?(Novemberfiguresexcludedbecause
immediately.
of the misunderstanding
of the words "acute"and
I make no chargeto NHS registeredpatientsin the
practice,and get no reimbursement
from the FHSA,
Recent:44 (52%)
but I am gettinga lot of experienceand am gratetul
Long-tefm:41 l41o/o)
for all those patientswho let me treat them. In
addition I treat non-registeredpatientsfrorn other 5. was the conditionimprovedor not?
lmproved:i67 (85%)
practices
{or a nominalfee.I needle
at theirrequest,
Not improved:26 (13%)
over100 patientseachmonth.
6. lf the conditionwas improved,wasthat complete
Method
or partial?
I record all acupuncture treatment on patients'
complere:50 (25%)
cornputerrecords.Using "Batch Reporfs"lrom these
Pattial.124 (63'k)
records,in ianuaryand February1995I wroteto all
figures
add
up
to
more than the original
lThese
patientstreatedin Novemberand December1994
totalsfor irnprovementas some patientshad more
I
inviting completionof a simple questionnaire.
thanone condition)
decided against incllrding stamped addressed
can you sayby how much?
envelopes,
but reliedon the personalinterestof the 7. If paftialimprovement,
<25Y":25 113Y")
patientsto respond,as many did by post or hand
25-50%:51 126%)
delivery.sufficientnumbersrepliedfor qualitative
>75%:48 (24%)
analysis.
A lessonlearnedfrom the first batch of replies
how longdid it last?
B.lf therewas improvement,
question4. InitiallyI had asked
mademe re-phrase
1
6
7
r
e
p
l
i
e
s
<
:1 d a y : 1 5 ( 9 ' l " )
whether a condition was '2cute or chronic", but
1 5 days:46 (28olo)
quicklylearnedthat patientsdidn't understand
these
>5 days:96 (57%)
terms:at least2 patientsthoughtthat chronicmeant
while othersleft the 9.lf improvement,how did the acupuncture
maliBnantor life-threatening,
comparewith other more orthodoxtreatments?
question unanswered-I therefore substitlted the
(1"/.J
137 replies:
Worse:2
words "recentor long term".
Same:22 (16010)
AlthoughI could reviewonly thosepatientswho
B e t t e r : 1 1 3( 8 2 % )
thpr{.\ Frpa ferr o,, a-ion'
had a,, eptedlrearme']r.
when, although it was offered, it was refused:a 10.Wastherea worseninB
of symptomsbeforeany
couple of times becausepatients"didn't believe in
benefitwas felt?
it", and on one baffling occasion because the
I 7'l replies:Yes:16
l9%)
patientclaimed, "lt's againstmy religion."!
N o : 15 5 ( 9 1 % )
The replies
Not all figuresadd up to 100%. In somequestions
patients failed to Eive clear answers of lelt
PercentaSe
figures
unanswered
someof the sections.
whole number.
havebeensimplifiedto the nearest
No. of questionnaires
sentout: November'94= 136
'94= 115
December
=
No. of repliesreceivedback: Total 197 (78%)

for
1l.woLrld you be preparedto use acupuncture
otherconditions?
182 replies:
Yes:178 (9A%)
No:4
t2%)
12. Please
add anyof yourown comments:

Discussion
The most strikingresultsshow an overwhelming
shift in attitude from an initial, even, balance
1.Was this the first time that you had had between "scepilc" and "enthuslasts",to the vast
(91ok).
rnajorityof patientsbecomin|-"enthusiasts"
acupuncture?
Bearingin mind the chronicityof someof the clinical
Yes:156 (79'l")
problems,therewas a good outcomein a siSnificant
No:36 (18'l")
number of patients.The challengelies in trying to
2.lf no, was previoustreatment"traditionaJ"or
rcducethe "not improved"groupand alsoin extending
"minirnal"(thatis, usinBonly a few needles,
and
the lenSthoftirne for which benefitwasachieved.
not leavingthem in for long)?
:
ireatedsuccessfully
included
Conditions
36 replies:
Traditional:25 1691")
painful shoulders, knees, backs, elbows, necks,
Minimal:B (22%)
ankles,hands, plantar fasciitis; emotional distress
"sceptic"
initially? and insomnia; irritable bowel syndrome; nausea
3. Wereyou a
or an "enthusiast"
and vomiting;hiccouEh;toothache;asthma;sinusitis
Therewere:Sceptics:87 (50%)
and catarrh(acupuncturehas becomemy prefered
Enthusiasti:86 (50%)
Nov 1995 Vol 13 Na.2

115

Acupuncturc in Medicine

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option for chranic rhinitis); dysnenorrheoa ancl ireeJyaccepted.My impressionis that a patient's
prcmensttLtaltension; cystitis and uinary inconti- state of mjnd actually has little ef{ect on the
nence; parst-viral fatigue; acute iniuries (t'ar . u l ,o m pu I p d l m e r l 1 r h . r l h - \ F , o m e l o p r p . r
are a little sceptjcalat the outsetto
analBesia);miBraine and other lleadache; piles; pat'entswho
"reallybelievein it"!
those
w6o
weight reductianand cessationof smokinS.
was deviscdwhile my use of
The questionnaire
Someconditionsdid not respond:
neh,,so I was pleasedLo
was
stillfairly
(thou7h
acupuncture
impression
was
ot'
my
1 catarrh;I lliccou1h
of
opinion from scepticto
the
significant
shift
perhaps
see
psychalogical
which
component
a najor
on... Ore.r .irg c\cn d
crtl^uri".t
pdr
joint
rnur
m)
(rutcone);
sone
4 headaches;
influcnced
E.l
time, but to see if I
audit
takes
considerable
simple
1
wfist,
2
problems includittg 3 backs, I shoulder,
signiticantly
over the
improved
my
outcomes
have
knees,1 tae and 1 tenniselbow.
past
year
exercise,
thou:lh
over
I
intend
to
repeat
the
requ'res
a
The list,mainlyof functionalconditions,
December
1995.
I
do
not
olten
rnonth,
in
only
one
the
flexiblc approachto treatrnentre8it es:
Sreat
for patientsunderaboutten years
to use acupuncture
r.ajority wil need only one or two lreatments
people
seemLorespondvery well. ln
of
age.
Older
period
iei.
For
more
of re
obtain an extended
questionnaires
I shallbe more specificabout
future
or
chronic conditions like stress incontinencc,
quest'on
was an error:the group517
there
age.
In
weekly
prophylaxis of rniBraine, I find that
on
the
ori8inal questionnaire.
75%
was
omitted
LJest
over4 or 6 weeksscemto brinBthe
treatm-onts
patients
noticjngthis, but it
repofted
None
of
the
play
with
it by ear in discussion
result.My patients
in
the results.
Thiswill
introduced
an
error
will
have
precise,
hencethe challenge
me. lt is difficultto be
in
the
1995
audit.
be
corrected
shifting
becauseof the constantly
of acupuncture,
to the questionfor otherr.odiiications
variablesof the "dose"given,the individualpatient Suggestions
welcome.
naire
would
be
physician.
I
very
a..
responseand the role of lhe
on
gratefulfor Dr FclixMann'soriginalobseNations
the phenonrenon ol "Superreactors" and his Conclusion
wanringthat sornepatientsgel worsebeforeEetting The use of acupuncturein my routine Seneral
better.This has hclpedcurb my initialtendencyto pra,ti, e has ludpo : beneli,id oplinn jr m.rn\
situationswhich would otherwise be clinically
ovef needlesomepatients,
I will continueto use it tor an
In the early slagcs oi Saining experienceI tiresometo rnanage.
problems.
range
of
persuade
reluctant expanding
foundmyselftryingto
sometimes
paticntsto accepttrealmcnt.I now ofler it if 1feel it
SarahWatkinsMB BSMRCCP
would be appropriatc,but no longerspendtirne
EuropaHouse,WeJlSreet
I teel
lrying to sweettalk patientsinto acceptance.
lluzzard,
Beds(UK) LU7 7DD
Leighton
which, if freelyoffered,shouldbe
lhis is something

Acupuncturefor the Treatmentof

Painin GeneralPractice
Musculo-skeletal
lohn B Hynes
Summary
An au(lit of 28 patientstreate(lwiLhacupuncturefor
ntusculo-skeleLtlpain, of whom visual analoSue
scorcs were analyseclfor 2a, showed a ntarked
decreasein pain follor\litigtrcatment.Need/esused
in treatmentcosl /ess than 50p pet session,but
consultationswete doubled in len]th to 2omin.

To audit the eflectivenessand efficiency of

skeletal
acupuncturejn the treatmentof muscuJo
pain in my generalpractice,I asked patientsto
complelevisualanaloguescores(VAS),I checked
needlesusedand timed
the numberof acupunctlrre
the consultations.

Method
patientsdrawnfor this studywerethoseseenIn
The
Key words
with
When patientspresented
Musculo
foutine
consullation.
Practice,
Acuputlcturc, Audit, Ceneral
pain
the
options
I
discussed
musculo-skeletal
pain,
scores.
Visualanalogue
skeletal
non steroldal
availableto them such as analSesia,
"wait and
physiotherapy,
drugs,
anti-inflarnmaiory
lntrcduction
DuringexaminationI would
lbeBan treatingmy lleneralpracticepatientswjth see" or acupuncture.
treatments
availableand if requested
reiterate
the
lhe
British
Medical
acupunctlrreafter attending
perform
there and then.
acupuncture
(BMAS)
would
course
in
October
Society
basic
AcLrpuncture
quile
a few options
a
there
afe
However,
as
CP
1wo
weel<end
course
1994.This was an intensive,
pain,so Idid
for
treating
musculo-skeletal
available
practical,
hands
on
demonstTations.
on
concentraling
Acupun.turc in Medicine

116

Nov /995 Yol 7.:iNo.-2

Downloaded from aim.bmj.com on February 13, 2013 - Published by group.bmj.com

Discussion
This
was quite a small qualitativesiudy. Howevet
PAIN
IMPROVEMENT
IN MUSCULO-SKITETAT
given the limitations,the results proved very
TOLLOWINCACUPUNCTURE
satisfyinS.Of the patients who remained in the
study,71% showeda markeddecreasein pain, with
an averagereductionof 52.57oas measuredby VAS.
Six patients,21"h ol the initial 8roup, did not return
9
2
7
for
their follow up appointmentafter the initial
9
3
6
There are various possible reasonsfor
treatment.
7
10
3
Neck& headache
3
the
acupuncture
may havebeenfully effective
this:
9
1
8
after the one treatmentjit may have given no relief
7
2
5
3 days
2.5
8.5
6
Neck & shoulder
the pain itselfmay have
6
or causedexacerbation;
s
3.5
8.5
7
Neck & shoulder
beenself limitinSanywayithe patientsmay not have
9
2
7
likedthe acupuncture
or found it uncomfortable;
or,
t0
4
6
as in my practiceall the CPs run personallists,
7
2
5
10 Headachdtension
patientsmay havereturnedto their own CP instead.
7.5
I
6.5
ll
Shoulder
Pain can be very difficult to measureobjectively;
5
1
4
l2
N e c k& s h o u l d e r
however,
the VAS, adequatelyexplainedinitially
9
3
6
treatment,should havebeen
and
at
each
subsequent
5
3
2
l4
Shoulder
pain
means
measurement.
a
reliable
of
9
2.5
6.s
of
15-20
minuteswere requiredfor
Consultations
5
t
2
treatment.
I did not find this personally
5
2
3
acupuncture
7
t0
3
18 Shoulder
althoughsomeCPs may
disruptive
to my surgeries,
8
2
6
needlescost
find it a problem.Modernacupuncture
8
1
7
20 Neck
approximately7p each, which comparesvery
anti inflam
favourably
with the costof non steroidal
lvasa 52.5%redlctionin painasmeas!rcdby VAs.
Overallthere
matorydruBs.Thus,each treatmentsessioncost less
not overstressthe acupuncture,but found none the than 50p for equipment,but was doublethe cost in
lessthat a significantmajoritywere quite keento try doctortime.
time,but
Successin alleviatinBpain, especiallychronic
it. UsuallyI havea ten minuteconsultation
musculo
skeletalconditions,and a strongpositive
this
extended
to
twenty
minutes.
with acupuncture
feed
back
from gratefulpatients,which I thoroughly
I
have
not
found
that
this
has
caused
However
enjoyed,
has maintained my enthusiasmfor
my
disruptionto
surgeries.
continuing
the useof acupuncture
wheresuitablein
a
history
of
the
musculoDuringthe consultation,
pain
routine
consultations,
was
to
identify
its
caLrse
and
skeletal
taken
duration.The patientswere then askedto Sradethe
usinB
levelof paintheywerecurrentlyexperiencinS,
lohn B HynesMB LRCP&SINUI
pain
Registrar,
Exeter
VocationalTrainingScheme
10
being
the
worst
CP
a VASwith 0 bein8no
and
pain they could imagine.Acupuncturetreatment
Addrcssfor correspondence
was at recognised acupuncture points and
points,
ConventRoad,Ballinrobe
were
found
in
myofascial
trigger
wherethese
quadratus
CountyMayo, lreland
trapezius,rhomboid, erector spinae,
4-7
needles
were
lumborumor multifidimuscles;
u . e d f o r l 0 m i n u l e . .P a l i e n l sw e ' e S i r e n d r
BMAS (1994) Ihe Iheory and Practiceof Acupundurc.
informationleaflet on acupuncture(7), supple- 1. Brirish
MedicalAcupuncturcSociety
mented by verbal explanation,and were requested
to feturn in three days for a secondacupuncture
treatment. The VAS was used to assesstherr
B.M.A.S.INTRODUCTORY
visits.
response
on thisand subsequent
Results
There were 28 patients initially treated with
in this study;only 22 of them returned
acupuncture
for follow up treatmentand 2 of these had to be
excluded from the study, as one had a dramatic
phobia to needlesand the oiher had ankylosing
with wildly fluctuatingpain levelswhich
spondylitis
made assessment
difficult.The resultsof the 20
patientsfinaily includedin the studyare shown In
Iable /. They had a total of 43 treatments:3 patients
had one treatmenteach, 1'l patientshad 2, and 6
patientshad 3.
Nov 1995 vol 13 No.2

't17

February
9-1'lthand Ma
OXFORD
May 17-191h
and June
BIRMINGHAM
Septemberand Octo
SLOUGH
November1-3rdand
Detaits trcrn the BMAS
Tel:01925730727 Fax: 01

AcLpDn.turc tn Medione

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Facial pain: a review of 200 cases treated

with acupuncture
Nazim Merchant
Acupunct Med 1995 13: 110-111

doi: 10.1136/aim.13.2.110

Updated information and services can be found at:

http://aim.bmj.com/content/13/2/110

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