Your doctor has referred you to the Acupuncture Clinic for specialist treatment of your symptom(s).

Please make sure you have someone to collect you afterwards as you should not drive home after your treatment.

This leaflet gives you information about acupuncture before your informed consent to treatment. Please read this carefully. Ask if there is anything you do not understand. Before going ahead with acupuncture the person giving you the treatment will discuss the expected benefits and risks with you.

Acupuncture is a form of treatment where fine needles are put into the body at specific points. It is one of the oldest forms of medicine and has been used for possibly as long as 5000 years. There are two main forms: traditional Chinese acupuncture and Western medical acupuncture. The traditional Chinese belief is that we have energy or qi ( pronounced chee) which circulates round the body, through channels. When disease affects the body, it also affects the flow of energy through these channels and the balance of energy - Yin & Yang. The aim of traditional acupuncture is to restore the normal flow of energy and thus health.

Over the last 50 years we have begun to understand how acupuncture might work in a Western scientific way. Western medical acupuncture uses current knowledge of anatomy, physiology and pathology, and the principles of evidence based medicine. Western medical acupuncture is principally used by conventional healthcare practitioners, and is commonly used to treat pain (White et al 2008). In a palliative care setting, it can also be used to treat nausea and vomiting, breathlessness, dry mouth, hiccups, and sweats (Filshie and Rubens, 2011).

The acupuncture you receive from the palliative care team will mostly be a Western approach, incorporating some traditional points as required.

There is research showing that acupuncture affects most of the body's systems:

• the nervous system
• muscles
• hormone secretion
• circulation
• the immune system, as well as
• respiratory, digestive and urinary systems

In the first session, we will put in only a few needles briefly to assess your response. You often don't feel the needles going through the skin as they are very fine. Once they reach the acupuncture point there may be a heavy numb feeling which is sometimes uncomfortable. This feeling will usually continue after the needle has been removed.

You may feel stiff after the treatment then feel better the next day. You may be sleepy, which is why it is best not to drive home. Occasionally, people can feel so drowsy that they fall asleep during the treatment. This is fine.

You will be asked to keep a symptom diary, so that when you come back to clinic we can see what difference acupuncture has made, and alter the treatment if needed. You may be seen for up to six treatments, and it can take more than one treatment for an effect to be seen.

Occasionally, it may be appropriate to send you home with very small needles left in place for you to be able to give yourself acupuncture in between treatments. We would discuss this with you in more depth if it is felt that this might be good for your particular symptoms.

Is it safe?

Acupuncture is generally safe when practised by trained professionals using pre-sterilised disposable needles. Side effects are rare. To reduce these you will be asked a number of questions about your health.

Does acupuncture have side effects?

You will need to be aware of the following:

• A small number of patients feel drowsy after treatment. The release of endorphins (the body's natural pain killers) can make you sleepy afterwards. If affected, you are advised not to drive after treatment.
• There may be a small amount of bleeding or bruising after acupuncture. Especially if you have blood
  clotting problems or are taking anticoagulant medicines like warfarin.
• You may feel some pain during treatment. Often there is some stiffness after acupuncture, the risk of this being permanent is less than 1 in 10,000.
• Fainting can occur. Although this is rare, precautions are taken.
• Occasionally the symptom may be made worse temporarily after treatment. This is usually a sign that the symptom will respond well to acupuncture over time.
• There is a very small risk of damage to nerves - less than 1 in 100,000.
• If the acupuncture needle is put in too deeply over the lung it may be punctured. Although this is rare, precautions are taken. As practitioners have been trained in anatomy we hope to avoid this.

If there are any other risks particular to you, your acupuncturist will discuss these with you.

Following discussion you will be given a consent form to read and to sign before treatment. This will ask you some questions about your general health. These are important to allow your acupuncturist to decide whether acupuncture is suitable for you.

Please tell your acupuncturist if you feel unwell on the day of treatment in any way.

Will it hurt?

This is the most common concern of patients. When put in, the fine needles cause a sensation, which should be a temporary discomfort at most. You may also have short-lived feelings of heat or tingling.

You may feel your symptoms during the treatment. If you do, please discuss these with your acupuncturist.

Important notes

• Please eat something within four hours of coming for acupuncture treatment
• Acupuncture is safe and almost painless
• Single use sterile, disposable needles are always used
• You have the right to refuse treatment at any time
• There is no hurry to leave the treatment area
• You may wish to make use of the treatment session for rest and relaxation