Do you prescribe acupuncture?

I don't prescribe it per se, but I refer patients for a physiotherapist assessment with the expectation that acupuncture will be offered to them. I can't refer directly via the NHS provision in my area, and it's variable across the UK. It's available in a limited way and is usually accessed via chronic pain clinics or some physiotherapists.

What for?

The only recommendation we've got at the moment is to refer patients with lower back pain. There are certainly some pain clinics that use it for all other forms of chronic pain. That said, many of my patients ask my advice because they're contemplating trying a course of acupuncture privately for other problems.

Would colleagues prescribe more readily than yourself?

A lot of doctors think it's worth giving acupuncture a go for any sort of chronic pain but the evidence base isn't there for anything outside of pain management. You'll find GPs who practise acupuncture themselves, for all manner of things, but conversely a lot of GPs are more wary than I am of referring patients for accupuncture.

Have you always prescribed it?

No, it was not available a decade ago. Certainly over the past 10 years there's been more use of acupuncture for lower back pain. It's been available for seven or eight years in my area, I think, but only in a limited way. Because it's a grey area in medicine, provision is ad hoc across the UK. The Nice guidelines have given more support for people who want to get acupuncture but more patients are turned away than I would like.

Do you think it has an effect beyond placebo?

Yes, I do believe there is a benefit beyond that of the placebo effect. I have seen positive effects in some of my patients which support the findings of clinical trials that Nice used in making its recommendation. Not in everybody, however. Some people respond and some do not respond, and it is important people know that before they start.

Is there anything wrong with prescribing it merely as a placebo?

If all you will achieve is the placebo effect, then it's a very expensive way of getting it. We have to be fair to all patients, so to offer expensive treatments that don't have benefit is not a fair use of NHS resources. However, you can't tell for an individual patient whether it's placebo effect or a genuine effect. Homeopathic treatments are usually a placebo and I don't prescribe them, even though some people think they are beneficial.