pain 9.pai.11123 Louis J. Sheehan, Esquire

Acupuncture, the ancient Chinese practice of sticking needles into a patient at specific points to relieve pain and treat other conditions, seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body, a new analysis shows. Louis J. Sheehan, Esquire

Researchers in Denmark came to this conclusion, which they report in the Feb. 7 British Medical Journal, after analyzing 13 studies in which people received real acupuncture, sham acupuncture or standard pain treatments such as drugs. http://Louis1J1Sheehan1Esquire.us

The studies enrolled 3,025 people in all. In each, the participants were randomly assigned to get one of the three therapies. Decreases in pain, if any, were recorded using standard pain scales.

On average, people getting acupuncture or sham acupuncture — in which needles are stuck into body areas not targeted by acupuncturists — sensed a clear decrease in pain, whereas those getting standard care sensed considerably less improvement. http://Louis1J1Sheehan1Esquire.us People getting real acupuncture reported a little more pain relief than those getting the sham needle sticks, but this slight difference was insignificant from a clinical perspective, says study coauthor Asbjørn Hróbjartsson, a physician and epidemiologist at Rigshospitalet in Copenhagen.

The value of acupuncture in this meta-analysis might have been diluted somewhat by the study design, says physician Adrian White of the University of Plymouth in England. http://Louis1J1Sheehan1Esquire.usFor example, some of the studies in this analysis centered on sore backs and knee pain from osteoarthritis, areas in which acupuncture has a positive track record, he says. But the overall value of acupuncture for pain might have been lessened by the inclusion of studies of people with headaches, a group in which acupuncture hasn’t performed well, he says.

Of course, he concedes, “this was done because acupuncturists argue they can treat any kind of condition.”

Acupuncture purports to hit key spots along channels called meridians that run throughout the body. But the narrow difference in the findings of sham needle sticks and real acupuncture raises the question of how acupuncture works.

The placebo effect, in which patients get some benefit from a fake treatment because they assume it is real, probably plays a role in acupuncture and may explain some of the sham acupuncture benefit, says Andrea Furlan, a physician and pain researcher at the University of Toronto and the Institute for Work & Health, also in Toronto. But the placebo effect is unlikely to account for all the pain reduction, she says. “There might be physiological changes” brought on as needle sticks affect the nervous system, she says.

The experience of undergoing the ritual of acupuncture also influences the therapy’s effectiveness, she says. “Belief is a big part of this,” says Furlan, a trained acupuncturist who no longer practices.

Only a few decades ago, most Western doctors had little regard for acupuncture. Now, that viewpoint is more mixed. Insurance companies in some countries even reimburse for its costs — for certain health problems.

“Complimentary or alternative therapies often provoke a division into believers and nonbelievers,” says Hróbjartsson. “That is also the case with acupuncture, though in acupuncture, in my view, a strict division is too simplistic. There are moderate skeptics and moderate believers.”

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Comments 4

* Carroll Cristie, I should have come back to the page sooner. I think one must conclude that if there is no difference between sham and experimental treatment, but both are different than the "standard" control, that there is a confounding factor. It would be more fruitful to investigate the nature of the apparently beneficial therapeutic environment, interaction, or conditioned response in order to understand it, study it, and if appropriate later incorporate it into other treatment with scientific evidence of efficacy. If we can identify the other factors that can contribute to a beneficial response then we can take advantage of them in providing improved care to our patients. We must also hold all of our treatments up to the same standards. If a treatment is not better than placebo it should not be offered. This should apply equally to pharmaceuticals, and other treatments, conventional or not.
There are varieties of known and well studied causes of conditioned responses, such as salivating in Pavlov's dogs which are not caused by the inciting factor (the bell ringing) but rather, are caused by the conditioning of the dog. (And one wouldn't conclude that the correct response to the dog's hunger would be bell ringing instead of feeding). This type of conditioning explains the physiologic response to stimuli such as packaging, pill color, the interaction with the caregiver, and probably the results of this study. Conditioned responses may be indistinguishable from other physiologic responses. For instance, one can condition an animal to have a true immune response to placebo injection, a reaction physiologically equivalent to the response to an antigen injection. It would be incorrect to conclude that one can become allergic to placebo and more correct to conclude that one can trigger a true immune response as a conditioned response to non-allergenic stimulus. It is exactly this bias and confounding effect that a placebo is designed to control for, and it is the reason that a placebo-controlled study is less bias prone than a "no treatment" or "standard treatment" control group study.
Steven Zeitzew Steven Zeitzew
Apr. 2, 2009 at 11:04am
* In reply to both Sven G and Bone Doc's comments, the article also states: "...whereas those getting standard care sensed considerably less improvement." Does this mean people should see standard pharmacological treatment for what "it really is"?
Many drugs which are currently used in hospital care do not have a clear mechanism of action. Not understanding these mechanisms nor having solid proofs does not negate a particular therapy.
Carroll Christie Carroll Christie
Feb. 8, 2009 at 7:17am
* The reason these experiments are designed to compare acupuncture with sham acupuncture is to control for confounding factors (the scientific justification of using a placebo group). The fact that there is no difference between acupuncture and sham acupuncture is scientific evidence that there is no therapeutic effect of acupuncture whatsoever and that acupuncture is equivalent to the placebo (sham acupuncture) in this experiment. This experimental result is therefore evidence that there is no therapeutic effect from acupuncture and that the observed effects are due to confounding factors. One must therefore conclude that there is not sufficient evidence of efficacy with acupuncture to justify the known risks of that treatment.

When you stated, "Acupuncture purports to hit key spots along channels called meridians that run throughout the body" you neglected to note that there is no scientific evidence whatsoever that these channels or meridians even exist. This study does not raise "the question of how acupuncture works", it is evidence that acupuncture does not work.
Steven Zeitzew Bone Doc Louis J. Sheehan, Esquire
Feb. 4, 2009 at 3:39pm
* I predicted this (acupuncture is just barely more efficient than sticking needles randomly as an anesthetic), in that causing a lot of little pain will release endorphins and thereby soothe pain systemically. This really is nothing new, but hopefully coming from a reputable source people will finally see acupuncture for what it is. :)

Good show!