Letters: NICE right to recommend acupuncture in guidance

I work in a rheumatology department part-time and am used to NICE guidelines prohibiting newer, excellent drugs such as abatacept and very stringent criteria for the treatment of osteoporosis, spending as little money as possible.

I was therefore impressed to read that new guidelines recommend acupuncture for treating back pain as well as manipulation and exercise (GP, 5 June).

As the Chinese have found, it is very cost-effective and, with a skilled acupuncturist, most patients can improve in four treatments, not 10 as suggested.

As a single-handed GP (and acupuncturist for 20 years), my PACT prescribing costs were about 70 per cent below the local average for musculoskeletal pain and 35 per cent overall, due to the use of acupuncture.

Audits show that analgesic use normally drops by over 50 per cent, even in severe pain. Many acupuncture trials show a superiority of true acupuncture over sham, especially if experienced acupuncturists are used.

For example, in a meta-analysis of randomised control trials for knee pain, the majority showed an improvement over sham, according to WOMAC (Western Ontario and McMaster Universities) scoring. The best results occurred when traditional points were used.

Dr Rosemary Alexander, west Hendon, north London

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