The following article was published by our friends at Guelph Community Acupuncture in Ontario, Canada on their website.
We're taking the opportunity to re-post Stef & Lisa's writing here in order to open this common clinical topic up. No one can tell you about the pain or illness you experience. Likewise, no one can tell you if you are feeling better. However, this post offers examples of changes that typically show through that are good signs of a shift in the right direction, even if you're not where you'd ultimately like to be, quite yet.
We hope it's useful to you.
- MAS Staff
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How to Tell That Acupuncture Is Working Even Though You’re Still in Pain
We see many people in intense, long-term chronic pain. Some of these people get immediate and dramatic relief, but it's much more common for regular treatment to slowly chip away at an issues that are chronic. (That's why we do our best to make acupuncture as accessible as possible; it may not work if you can't get enough treatment.) And sometimes progress is less straightforward. How do you tell if acupuncture is working even though you're still in pain? Here are some questions to ask yourself:
Am I taking less pain meds?
It is surprisingly common for someone to arrive for their second visit, say there's no improvement, that the pain is just as bad ... and then, when we ask about medication it turns out they forgot or didn't need to take it. We get that it may feel the same in your body, but that's still progress!
Has the pain changed?
Sometimes acupuncture shrinks the area of the pain before it changes the intensity of the pain. Was the original pain covering a postcard-sized area? Did it shrink to the size of an egg after you started treatment? That's progress, even if that egg-sized area is still very painful. Likewise, if the pain was very intense all day every day and now you are getting small windows of only milder pain, that's progress as well.
Am I able to walk further/do more physical activity?
Chronic pain can make our lives a lot smaller, can make going out to the car a struggle or doing the dishes a seemingly impossible task. We frequently see people doing more in their lives, sometimes before we even see the pain itself decrease.
On a related note: did you feel so good after your treatment that you overdid it and re-injured yourself?
We get it, you were in pain for so long and now there's so many errands and things to do around the house, nevermind the other things you've been waiting to do for so long. It's common for people to get really excited when they feel better, overdo it, and then have the pain set in again. If that happened, and you're feeling worse now, we wouldn't necessarily call that "progress" ... but it is a sign that the acupuncture helped. Try to take it easy after the next treatment!
Are you sleeping better or longer?
Chronic pain often interferes with sleep. If you're still in just as much pain during the day, but your sleep is better, then the acupuncture is most likely helping. Keep at it, and hopefully you'll experience daytime relief too.
Is your mood and focus better?
Chronic pain demands a lot of our brains' "bandwidth". Another great thing about acupuncture is that it can help clear up mental fog, forgetfulness, anxiety, or a low mood. It may be, especially at the beginning of treatment, that your mood or focus improves before your pain does.
Our staff in Manchester and Merrimack field their share of acupuncture-related questions on any given day, as you might imagine. Many questions about acupuncture school have been posed to us throughout the years. We thought we'd give an attempt at a semi-comprehensive answer in writing for those who are curious. Just like we have attempted to do in the little Q & A book, 'Why Did You Put That Needle There?', we promise to be casual and direct with our answers here.
Let's offer up general information about acupuncture training programs and acupuncture licensing, in order to set the table. Specific questions follow, down below.
Requirements for accredited school of acupuncture training programs are set forth by a regulatory body who oversees secondary education for acupuncture and Chinese medicine in the United States. This body is called ACAOM (Accreditation Commission for Acupuncture & Oriental Medicine)
All acupuncture training programs take place within accredited schools of learning, or schools that are in the process of gaining accreditation.
Programs are 3 to 4 years in length.
Prerequisites for most acupuncture training programs include, anatomy and physiology, general and abnormal psychology and biology, among others.
Most acupuncture training programs require completion of at least two years of baccalaureate level classes. The state of NH, it may be worth mentioning, requires a full bachelor's degree, in addition to the Master's in Acupuncture and passing of the Boards (more on that below).
All acupuncture training programs consist of two main parts: classroom learning and clinical observation/practice.
Upon graduation from an accredited program, students earn a 'Masters' in acupuncture and Oriental medicine.
Like the Bar exam for lawyers or the Boards for doctors, acupuncturists must pass a comprehensive multi-day examination upon graduation. This exam is proctored by the NCCAOM. Once the exam is passed, the graduate is free to apply for licensure in whichever state one hopes to practice within.
Licensing for acupuncture is legislated state to state. Requirements can differ widely between states. The title given to licensed acupuncturists can also differ state to state. For example, those licensed to practice acupuncture in Florida or Rhode Island are given the designation of 'Dr. of Acupuncture'. Most states who licensed acupuncturists offer the designation of 'Licensed acupuncturist' (L.Ac.). This is the case in New Hampshire.
Licenses will normally expire in two years and require multiple hours of continuing education in order to keep up to date. Some states, including New Hampshire, also require continued affiliation with NCCAOM.
Okay, now on to specific questions.
Where are the acupuncture training programs located?
Answer: Schools of acupuncture and Oriental medicine exist around the country. The closest to New Hampshire at this point is the New England School of Acupuncture which is now part of the Massachusetts College of Pharmacy & Health Studies program located in Worcester, Massachusetts. Others in the Northeast are located in New York State. Many more still operate in various states outside of New England.
How much do the programs cost?
Answer: A whole lot of money at this point. Costs for these programs have risen dramatically over the last 20 years mirroring the increase in cost for higher education in general. One can expect to spend at least $80-$100,000 for a complete 3-4 year program.
Take note, prospects for work after graduation remaining limited for licensed acupuncturists. We will say more on this topic below.
Are there any programs you would recommend?
Answer: MAS has a close affiliation with an accredited school of acupuncture training called POCA Tech, which is located in Portland, Oregon. POCA Tech (pocatech.org) is the training program for POCA, The People's Organization of Community Acupuncture – a community acupuncture support organization we helped found. A strong piece of the program is dedicated to teaching the socio-economic factors that inform the philosophical bedrock for clinics like MAS. The POCA Tech program also maintains a fundamental promise to its students to provide comprehensive training at a fraction of the cost that other acupuncture training programs do. The cost for the POCA Tech 3-4 year training is currently $25,000.
All in all, we do recommend training at POCATech.
So what happens after graduation and licensing is complete? Where would one find jobs as a licensed acupuncturist?
Answer: This is a great question that has been shrouded in mystery for far too long within the acupuncture profession and world of Chinese medical education. It is a poorly kept secret within the acupuncture profession that many recently-graduated students of acupuncture are completely out of the business within as little as five years of graduation. The reasons for this are multi-faceted, but big pieces involve the following, from our point of view:
1) The majority of available work for acupuncturists involves becoming self-employed and running one's own practice. As you may imagine, managing the birth of a small business while navigating the obligations of considerable student loans can be a difficult road. We can tell you from personal experiences that finding financial stabilization as small business owners is a challenge.
2) Positions that are available to licensed acupuncturists that make us legitimate W-2 employees (vs. independent contractors) are limited in number. Thankfully, a large percentage of these positions are currently being offered through community acupuncture clinics like MAS. Scant others are available in a few, but a slowly growing number of health care institutions around the country. The Veterans Administration and select hospital programs, among them.
The reality of the newly graduated licensed acupuncturist is a field of limited opportunities. One does not simply open the want ads to look for work as a licensed acupuncturist!
Now, having offered this information and our honest opinions on the state of education and potential employment for licensed acupuncturists, we would also like to encourage anyone interested in pursuing education for acupuncture and Chinese medicine to do so. We would only like for you to have your eyes wide open while you do.
The world of work using acupuncture and Chinese medicine is humbling, quite deep and wide, endlessly fascinating and satisfying.
Anyone who has gotten the call to study should seriously consider the vocation. And, three cheers for more people getting access to acupuncture!
Please feel free to speak with any of our acupuncturists as part of your initial investigation, if you are inclined. We'd be happy to continue this honest exchange of information.
- Andy Wegman and the MAS Staff
For a bit more information on the greater topic of acupuncture education, please consider the following websites:
http://www.ccaom.org/faqs.asp
https://www.pocatech.org/
If you are still interested in practicing acupuncture, but not quite sure you are ready to devote 4 years of your life, there is another option to consider. In the state of New Hampshire any individual including peer counselors, recovery coaches, and other health professionals can be trained as "Acupuncture Detoxification Specialists (ADS)" under RSA 328 Section G9a.
An ADS is trained to safely administer a standardized 5-point ear acupuncture protocol known as the 5NP. This simple, safe and effective protocol helps address physical and emotional symptoms related to toxic stress, drug and alcohol detox, chronic pain, anxiety, PTSD, depression, trauma, shock and addiction recovery. Training is roughly 70 hours. For more information please visit this very website.
Similar to how CBD has very recently captured the collective imagination, Dry Needling (DN) has made a dent in the collective cultural awareness over the past few years, mostly via adoption into physical therapy and chiropractic practices.
Nowadays, the staff at MAS is asked fairly frequently about dry needling, so we've put together a small amount of information about it from our collective perspective. We offer this as experienced licensed acupuncturists, who've both employed and received dry needling, and from our experience from speaking to dozens of people who've also received DN, mainly outside of MAS.
Our definition: Dry needling involves repeated needling directly into knotted muscle fibers, each time causing a twitch in said knot, for the purpose of ultimately coaxing it to become exhausted and release.
A few things we'd like to get out of the way, up front.
First things, first: dry needling is an acupuncture technique, called 'trigger point' needling in different circles. The term 'dry' was apparently attached to the technique when adopted by medical professionals to distinguish it from a prevailing needling technique performed with a hollow hypodermic that would be used to inject various substances into the flesh.
First things, second: At MAS, we want lots of people to get acupuncture. In light of this, we support people getting acupuncture in all forms - including dry needling - as readily and affordably as is possible for them.
...and third: We have not and likely will not offer dry needle/trigger point needling at MAS. There are several reasons for this, one of which is we normally don't find the technique any more effective than the distal-needling we primarily employ. Also, more than any particular technique, receiving treatment as often as is appropriate clinically, is the factor most closely related to feeling better in our experience.
You may have heard Maslow's Law of the Instrument: if the only tool you have is a hammer, you'll see the world like a nail. DN reminds us of this notion. Repeatedly and directly needling into a muscle knot is one way of approaching helping to resolve the knot via acupuncture needle, but it certainly isn't the only one.
Alternately, one could choose to stimulate strategically connected acupuncture points further away from the muscle knot. These can be effectively employed like the light switch on the wall controls the lights on the ceiling. In addition, this approach will eliminate the likelihood of the great soreness after a treatment as compared to the DN approach. It's also our preference to do so as a tremendously more gentle means to an end.
Just like the piano is a tool that can played in many ways, the acupuncture needle can be employed in distinctive ways as well. You wouldn't expect all pianists to tickle keys in the style of Fats Domino, right? In the same way, MAS acupuncturists aren't limited to a heavy-handed direct-needling techniques either. While these can be effective, no doubt, they simply aren't always going to be the best choice across a broad array of clinic situations, from our perspective.
A few other thoughts to share...
Dry needling is normally felt much more intensely than most other acupuncture techniques. So if you've had DN done in past and are thinking, "that's what acupuncture feels like", hold that thought. You may surprised at how softer different approaches can feel, while providing good results.
To the folks who have been left to wonder if they can receive acupuncture at MAS when they've had DN alongside at their PTs office, Yes, please come on in and grab acupuncture treatments. As we normally aren't directly needling locally (ie. where the target pain is located), treatments at MAS will not further test the area needled with DN. Just the opposite, in fact, where a reduction in inflammation via movement of blood and body fluids aims to ease local soreness and pain.
Not all approaches will hit the spot for every person. If distal acupuncture techniques haven't done the trick after a course of treatment, DN may be a good choice. Some folks do well with a more passive approach, others more direct. For our part, we never want to see you stuck on a hamster wheel, just spinning in place. Any referral that we feel would be of benefit for you in your goals, we are most happy to make. This happens regularly at MAS, where we are grateful for many outstanding providers of many stripes, in and around southern NH.
It's a long-held truism in the realm of Chinese medicine, that Springtime is a favorable time of year to include natural sour-flavored foods to one's plate in small amounts at each meal.
The thinking here is it's an advantage to do so for the parts of our system that are involved in clearing the heavier residues of the winter diet and assisting getting things moving anew upward and outward.
Read more about recommendations the Chinese medical classics make for us down below.
Aside from citrus juices like lemons and grapefruit, a number of natural sour-flavored foods can be found among those that are fermented. Fermented foods are produced or preserved by the action of microorganisms.
Think pickles or sauerkraut or kimchi as common examples.
Adding to the case for fermented foods in the Springtime, or any time of year for that matter, is information like this that comes out of modern research. This research from the National Institute of Health suggests fermented foods have the measurable effect of aiding the beneficial bacteria in the lower digestive system, but also improves our ability to perform various mental processes such as memory recall, orientation to the outside world, learning and furthering language skills.
At MAS, we know that acupuncture only works when people have access to it. As part of the People's Organization of Community Acupuncture (POCA) our mission is to make acupuncture affordable and accessible to as many people as possible.
That is why we are happy to know New Hampshire now offers tiered-licensing for providers of acupuncture. Lay practitioners such as recovery coaches, peer counselors, and other health professionals can now be certified as Acupuncture Detoxification Specialists, providing a very helpful and specific ear acupuncture point combination.
Last week, the Governor's Recovery Task Force voted unanimously to support this expansion of access to ear acupuncture. You can read more about it here.
