New NICE guidelines have recently been published, with new information regarding acupuncture. In this article we discuss what the new guidelines mean for services returning to offering acupuncture, and acupuncture as part of wider care.
2021 NICE Guidelines for Acupuncture
New NICE chronic pain guidelines were released on April 7th 2021. The new NICE guidelines state that acupuncture is now recommended for patients with chronic pain. But, how do services return to offering acupuncture as part of an integrated package of care?
In this article, we draw upon our experience of listening to clinicians and service managers for over 15 years, coupled with research and teaching of acupuncture related topics for the last 10 years.
Previous NICE Guidelines for Acupuncture
Over the last decade, acupuncture has taken an interesting journey, particularly within the NHS. Driven by improving quality in the evidence base, NICE guidelines in 2009 for lower back pain, and more recently NICE guidelines for migraine & headaches, advocated the use of acupuncture for chronic pain.
Whilst the former grabbed the headlines, both of these documents were responsible for encouraging greater access to acupuncture across any service that provided care for lower back pain or headaches.
Next, the OA NICE guidelines, followed shortly by the 2016 LBP guidelines, insisted that acupuncture should not be used for chronic pain. The various guidelines caused much debate, particularly over lower back pain guidelines, given inconsistent recommendations.
And despite stronger evidence to support the use of acupuncture, coupled with updated headache NICE guidelines continuing to recommend acupuncture, many services took the decision to stop offering acupuncture as part of their service for any condition.
How Do Services Return to Offering Acupuncture?
We need to begin by establishing boundaries as acupuncture is a great holistic treatment, however cannot cure everything. Other interventions should be considered first, and/or in conjunction with acupuncture. Clinicians are sometimes unaware of the limitations of acupuncture, and overlook simple solutions for clinical pain such as exercise. Further to this, each service has its own restrictions; physical space, in-house skills, finance, population that they serve, staff culture. All of which means that not every service will, nor should, be identical.
Through our experience in helping to implement change, we have found the most important first step in establishing boundaries is to understand the team. Specifically identify:
- Where individuals see opportunities to enhance staff work / life balance
- Where individuals see opportunities to enhance morale
- Where individuals see opportunities to enhance service user experience
If you instead frame questions around barriers, whatever the outcome of the discussion, it will not be perceived as a positive change. It will only be considered as less negative (there is a difference). So, keep it positive!
Furthermore, a sure-fire way to come up against resistance and/or to fail to make changes, is by not bringing the team with you. When failing to understand that your team is your priority, services also fail.
Acupuncture as Part of a Wider Package of Care
Once you have the blueprint for your service, what does acupuncture for chronic pain look like?
Acupuncture is never a standalone intervention. Not only can you introduce acupuncture before or after exercise or patient education, you can also use it during exercise or patient education. In fact, this is where you will likely see the best results.
We can use acupuncture before exercise to provide confidence and pain relief so that activities can be carried out. We can also use acupuncture after exercise to reduce the amount of pain a patient may experience following a challenging intervention. The use of acupuncture during exercise is fairly straight forward, but needle placement is key to safe application.
Where you are delivering education, acupuncture is best administered during the discussion. For some cohorts, group education classes are hugely popular, and there are specific acupuncture protocols that can be used without needing everyone to lie down on a bed. It also doesn’t take too much of an imagination to realise the cost savings associated with a group-acupuncture approach.
What is more, we can harness the principles of pain education through using acupuncture. There is considerable overlap in the mechanisms of acupuncture pain relief and pain education. It also helps to build trust in the clinician (because the patient experiences a physical and visceral response to being needled). Establishing and maintaining the patient – therapist relationship is a big deal, and acupuncture can help cement this quickly.
Sure, there are safety and practical considerations to take into account, but these are covered in any training package we deliver through Breeze Academy. In fact, safety and pragmatics are our main focus when teaching acupuncture. It’s all well and good having a good handle of what the ideal needling scenario would look like, but if that doesn’t fit in with time restraints and co-morbidities, then acupuncture will fail.
Effective Acupuncture for Chronic Pain
Exercise can be done well, or not so well. Education can be done well, or not so well. Acupuncture...you get the idea!
So, what does effective acupuncture for chronic pain look like? There are a few broad principles:
- Dosage: the ideal acupuncture dosage is between 25 & 40 minutes with around 10 needles insitu.
- Frequency: acupuncture should be performed twice a week for the first couple of weeks, then spread out gradually.
- Deqi is almost always desired. Likewise the needling of distal points. - Accurate location and depth of needle insertion
- Acupoint selection should be tailored to the person being needled, although there are a couple of protocols that can be used as a baseline approach across chronic pain populations.
For some cohorts, group acupuncture is perfect, and very easy to set up and administer.
Acupuncture Courses with Breeze Academy
We exist to help people, help people. We want to collaborate with health professionals who are committed to offering exceptional quality services, and we can help you do this through our training packages. Our acupuncture courses are consistently rated 5 stars, and we have over 10 years’ experience teaching in higher education and researching in acupuncture related topics.
Our acupuncture training programmes are delivered to maximise productive learning without having to train over several weekends. We not only travel the globe, but we can also run bespoke courses at your clinic, so that the pragmatics and application fit perfectly into your service.
On our Foundation acupuncture courses (for needling beginners) and refresher courses (for those who need to update their skills), we ensure that clinicians are safe, confident and effective.