From time to time, practitioners of acupuncture ask whether it is desirable for patients to do their own treatment. This suggestion sometimes elicits cries of horror, mainly from traditionalists who regard acupuncture as an esoteric affair requiring years of study before it can be practised adequately. This does not apply to my view of acupuncture, so the question is mainly one of safety. Considering that diabetic patients give themselves insulin injections daily or more frequently, and other classes of patients are also taught to inject themselves, I find it hard to understand why an intelligent patient can’t be taught to insert a plain needle fairly superficially, perhaps only once a month. At any rate, I, in common with other acupuncture practitioners at our hospital and elsewhere, have taught a good number of patients to do their own acupuncture, and in many years no problems have arisen.
There are two main sets of circumstances in which self-acupuncture may be appropriate. Some patients have difficulty in attending for treatment regularly for one reason or another. Other patients suffer from disorders that respond quite well to acupuncture but only for short periods, sometimes for just a week or two. When I first started practising acupuncture I thought that if one gave such patients more frequent or even daily treatment for a time, perhaps as inpatients, there would then be a carry-over for some months after the intensive course. However, this never worked; the duration of any remission appears to be pretty well fixed for each patient, and this pattern of response is nearly always apparent after about six treatments or fewer. In such cases self- acupuncture seems like a good option.
Naturally, certain precautions have to be taken. Not every patient is happy about the idea of self-treatment, although a perhaps surprisingly large number are; if patients are reluctant it is sometimes possible to find a family member or a friend to do the treatment. The disorder for which the patient is being treated must have been shown to respond adequately in this instance. The patient (or other person who is to do the treatment) must be of reasonable intelligence. Finally, it is of course essential that the site to be needled is anatomically safe and easily
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accessible. In practice, I have most frequently used LR3 in this way, although other sites have been the target on occasion; for example, some patients with ulcerative colitis have been taught to do their own treatment by needling the lower abdomen, which is perfectly safe provided there is adequate subcutaneous tissue in this region. For self- acupuncture, patients are taught to use short (15 mm) needles, so as to reduce still further the risk of anatomical damage.
Having decided, after discussion with the patient, that this is the best plan to follow, I then make a slightly longer than usual appointment for the instruction to be given. The patient will already be familiar with the procedure, having had acupuncture several times previously, but on this occasion I repeat the treatment on one side, explaining what I am doing, and then the patient needles the opposite side under my supervision. If all goes well, as it nearly always does, the patient is told how to obtain a supply of needles. (The hospital pharmacy used to sell them for our patients.) The patient then goes home and carries out the treatment as prescribed for a few weeks. The frequency of needling varies according to the individual case; it might be as often as once a week, or it might be less frequent or might even be done on an occasional ‘as required’ basis. The patient is then seen again, and provided all is going well a further appointment is made for a few months ahead. After that it is often possible to discharge the patient.
It’s important to make sure that there are suitable arrangements for disposing of used needles. When I first started teaching patients to treat themselves I used to tell them to put the needles in a tin or a jar with a top and bring them back to us for disposal. Nowadays some local authorities have arrangements in place for diabetics to dispose of used needles, or alternatively the local GP centre may be willing to take the needles.
Patients are told that they are able to telephone for advice at any time, although in practice they hardly ever feel the need to do this. They are also told not to change the site of needling without advice from us and to let us know if the symptoms change or the acupuncture ceases to be effective. I think it is essential to give them a leaflet (see below) summarizing all the points they have been told about. This leaflet mentions all the possible complications that might occur, including bleeding, infection, and broken needles, although it is emphasized that, apart from slight bleeding, these things are very unlikely to happen.
Experience with self-acupuncture has been good. Patients generally find it to be effective, although in some cases they report that it is not as effective as when they have acupuncture in the clinic, and they therefore like to come in for an occasional ‘top-up’. This suggests either that they do the acupuncture less skilfully than we or, alternatively and more probably, that there is an element of placebo in the response in these cases and that having acupuncture in the clinic is more effective for that reason.