Guidelines

In most countries there are no formal, generally-agreed, guidelines to cover the specific details of how to diagnose and treat particular groups of patients. Different styles, schools and individuals have different ideas and there is little evidence to favour one above another. The BAcC have produced Standards of Practice for Acupuncture, which lay down the bases of good practice in general terms. The BAcC Codes of Safe Practice provide more detailed guidance in this area. These are available on the codes page of the BAcC website.

Evidence-based TCM clinical practice guidelines have been developed recently in China for some conditions, though their implementation amongst acupuncture practitioners appears to be poor (Zhou L, Chen Y, Liu J, Liu ZL,  Gao Y.  Evaluating the implementation of evidenced-based TCM clinical practice guidelines for cerebral infarction. European Journal of Integrative Medicine, 6 (2) (2014), pp. 147–155).

A clinical guideline on acupuncture for cancer care (Filshie J and Hester J. Guidelines for providing acupuncture treatment for cancer patients - a peer-reviewed sample policy document. Acupuncture in Medicine 2006;24(4): 172-182) is aimed particularly at medical acupuncturists. It covers the responsibilities and competencies of the practitioner, what patients are suitable, contraindications and cautions, the acupuncture treatment and audit. Apart from issues related to safe practice the acupuncture treatment recommendations are largely confined to the number/frequency of sessions (again, there is no guidance on how to select points or stimulate them)


There is an acupuncture section in the complementary therapy guidelines produced by the Foundation for Integrated Health, for cancer care (Tavares M, 2003, ‘National Guidelines for the Use of Complementary Therapies in Supportive and Palliative Care’) and for mental health (National Guidelines on Integrated Mental Health, 2009). [The Foundation no longer exists: ARRC has copies of the whole of the first document and the acupuncture chapter for the second, which was never published]. These are not clinical guidelines: they summarise evidence and were aimed particularly at those who might commission acupuncture services,


Acupuncture features in some of the evidence-based orthodox medical guidelines produced by:

  • disease-specific national and international bodies, e.g. British Association for the Study of Headache (BASH) www.bash.org.uk; Osteoarthritis Research Society International
  • cross-disease organizations such as The British Pain Society www.britishpainsociety.org
  • national guideline bodies, such as NICE (National Institute for Health and Care Excellence) www.nice.org.uk, SIGN (Scottish Intercollegiate Guidelines Network) www.sign.ac.uk
  • other organizations that provide evidence-based care pathways for patients with a particular illness, e.g. Map of Medicine www.mapofmedicine.com

 

There is as yet no comprehensive list of all the acupuncture guideline appearances, which, globally, may amount to a large number.

Guideline recommendations are usually underpinned by extensive evidence reviews, though for CAM therapies these may be out of date, perfunctory and poorly informed.

Acupuncture is recommended by NICE for low back pain, tension headache and migraine, and cancer pain. Acupressure for pregnancy sickness features in the guideline on antenatal care. For SIGN, it is endorsed for headache, and in the draft guideline on chronic pain. Acupuncture appears in a number of the Map of Medicine pathways. Guideline recommendation is a mark of official approval and hence political as well as scientific factors come into play. A summary of CAM therapies appearance in some of the major UK guidelines can be found here: Lorenc A, Leach J, Robinson N. Clinical guidelines in the UK: do they mention Complementary and Alternative Medicine (CAM) – are CAM professional bodies aware? European Journal of Integrative Medicine, 6 (2) (2014), pp. 164–175

Most of the major guidelines are available in full on the relevant websites.