Acupuncture for Pain No Better Than Placebo -- And Not Without Harm, Study Finds

[salvorhardin]

Although acupuncture is commonly used for pain control, doubts about its effectiveness and safety remain. Investigators from the Universities of Exeter & Plymouth (Exeter, UK) and the Korea Institute of Oriental Medicine (Daejeon, South Korea) critically evaluated systematic reviews of acupuncture as a treatment of pain in order to explore this question. Reporting in the April 2011 issue of PAIN®, they conclude that numerous systematic reviews have generated little truly convincing evidence that acupuncture is effective in reducing pain, and serious adverse effects continue to be reported.

"Many systematic reviews of acupuncture for pain management are available, yet they only support few indications, and contradictions abound," commented lead investigator Professor Edzard Ernst, MD, PhD, Laing Chair in Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, UK. "Acupuncture remains associated with serious adverse effects. One might argue that, in view of the popularity of acupuncture, the number of serious adverse effects is minute. We would counter, however, that even one avoidable adverse event is one too many. The key to making progress would be to train all acupuncturists to a high level of competency."

...

The authors observe that recent results from high-quality randomized controlled trials have shown that various forms of acupuncture, including so-called "sham acupuncture," during which no needles actually penetrate the skin, are equally effective for chronic low back pain, and more effective than standard care. In these and other studies, the effects were attributed to such factors as therapist conviction, patient enthusiasm or the acupuncturist's communication style.

If even sham acupuncture is as good as or better than standard care, then what is the harm? The answer lies in the adverse effect case studies. These studies were grouped into three categories: Infection (38 cases), trauma (42 cases) and other adverse effects (13 cases). Many of these adverse side effects are not intrinsic to acupuncture, but rather result from malpractice of acupuncturists. The most frequently reported complications included pneumothorax, (penetration of the thorax) and bacterial and viral infections. Five patients died after their treatment.
Link: http://www.sciencedaily.com/releases/2011/03/110324104147.htm

[LiberalEsto]

1. Since I had acupuncture for my lower back

about 5 years ago, I haven't needed the cortisone shots that I used to get 2 or 3 times a year.

It also helped me lose 23 pounds and keep most of it off for 5 years.

[cleanhippie]

4. Glad to hear you had sucess with it. Do you think it was the accupuncture?

Or could it simply be the placebo effect?

I know that at the end of the day, you think you have less pain and thats all that matters.

[LiberalEsto]

7. It was definitely the acupuncture

If I could afford it (currently unemployed) I'd go back to get treatment for an arthritic ankle and various other things, but it's too expensive.

[Wilms]

2. Acupuncture for pain management is often performed by MD's, not TCM doctors.

Medical acupuncturists don't study Traditional Chinese Medicine (TCM). They are the last people I'd trust to prescribe treatment.

Further, the article states:

Many of these adverse side effects are not intrinsic to acupuncture, but rather result from malpractice of acupuncturists.

If you want acupuncture, I'd seek out a TCM doctor, not a needle wielding MD.

Consider...

As a medical doctor who attended and passed a "medical acupuncture" course, I know what that training entails. When I completed it, I had seen 70 videotapes, all given by one MD instructor. I had been to 5 days of lecture, and needled 3 people, all of them other MD's attending the course. I had not treated one patient on my own. I did not know how to make a Chinese Medical diagnosis, develop a treatment plan, analyze pulse, evaluate tongue. Furthermore, I had no idea of what acupuncture & Chinese herbs could actually do, and therefore I didn't know when to send patients to a licensed acupuncturist. I don't believe that MD's with 300 hours of "medical acupuncture" training can safely and competently practice acupuncture.

http://www.flyingcraneacupuncture.com/LAvsMD.html

Some more commentary here:

In fact, it is in the nature of Medical Acupuncture to offer a less comprehensive course of acupuncture study to their trainees. Some states offer a minimum of ONLY 100 hours of acupuncture study while licensed acupuncturists (L.Ac.) have over 3,000 hours.

If you have received acupuncture by an MD, DC, or someone not fully trained like an L.Ac. and have not benefited from the treatment, you should consider going to a licensed acupuncturist (L.Ac.) to experience the full potential that acupuncture has to offer.

http://www.medicalacupuncturefacts.com/2008/11/14/medical-acupuncture-what-is-it/

[Vinnie From Indy]

3. Not all MD's are as incompetent as your broad brush paints

I know an MD that is an expert at acupuncture and I would put him up against anyone.

[Wilms]

5. I don't doubt your experience. But I'd tend toward, as a general rule, TCM for acupuncture.

DU often has 'broad brush' posts decrying acupuncture. I took the opportunity to make readers aware of an important distinction.

To back-up and expand on your comment, however, I'd add the following. The OP is talking about pain management. And often the underlying cause is stressful activity, rather than an underlying biological syndrome. I have little doubt an MD with a nice touch and good aim could yield the results you report.

[Celebration]

6. I don't really understand "systemic reviews"

From a scientific point of view, how do you combine all studies.......acupuncture for knee pain is probably completely different from acupuncture for head pain. Apples? Oranges?

The fact that sham acupuncture can be just as effective as acupuncture I see as a big plus. Think about it. Suppose sham acupuncture was 100% effective for all pain, and *real* acupuncture was 100% effective for all pain. Would you *really* avoid getting acupuncture because it wasn't better than a placebo? If so, I would say you were a fool.

[laconicsax]

8. K&R

[GoneOffShore]

9. Did acupuncture for back pain - didn't work - Marijuana & nsaid's did.

[HuckleB]

10. Acupuncture Revisited

http://www.sciencebasedmedicine.org/?p=11765

"Believers in acupuncture claim it is supported by plenty of published scientific evidence. Critics disagree. Thousands of acupuncture studies have been done over the last several decades, with conflicting results. Even systematic reviews have disagreed with each other. The time had come to re-visit the entire body of acupuncture research and try to make sense out of it all. The indefatigable CAM researcher Edzard Ernst stepped up to the plate. He and his colleagues in Korea and Exeter did an exhaustive study that was published in the April 2011 issue of the medical journal Pain: “Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews.” It is accompanied by an editorial commentary written by yours truly: “Acupuncture’s claims punctured: Not proven effective for pain, not harmless.” (The editorial is reproduced in full below.)

Ernst et al. systematically reviewed all the systematic reviews of acupuncture published in the last 10 years: 57 systematic reviews met the criteria they set for inclusion in their analysis. They found a mix of negative, positive, and inconclusive results. There were only four conditions for which more than one systematic review reached the same conclusions, and only one of the four was positive (neck pain). They explain how inconsistencies, biases, conflicting conclusions, and recent high quality studies throw doubt on even the most positive reviews.

They also demolished the “acupuncture is harmless” myth by reporting 95 published cases of serious adverse effects including infection, pneumothorax, and 5 deaths. Some but not all of these might have been avoided by better training in anatomy and infection control.

Their analysis does not prove that acupuncture doesn’t work (negatives are hard to prove) but it unquestionably sheds serious doubt on the claim that it does work. Overall the evidence is inconsistent, and the results tend to be negative among those studies judged to be of the highest quality. Where the results are positive, the reported benefits can be explained by the surrounding ritual, the beliefs and expectations of patient and practitioner, and other nonspecific effects of treatment. There is no evidence to support the vitalistic concept of qi or the prescientific mythology of acupuncture points and meridians; it doesn’t seem to matter where you put the needles or whether the skin is pierced. More modern science-based explanations like increased endorphin production are not convincing, since placebo pills can produce the same effects.

..."

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This OP should have received dozens of recommendations. Instead it was unrecced down, without the slightest justification. This analysis is profound, and it is clearly a mistake to ignore it.

[laconicsax]

12. +1

[salvorhardin]

11. I wonder if the fact that the study's lead researcher is a trained acupuncturist means anything?

He's trained in other complementary techniques as well.

Professor Ernst qualified as a physician in Germany in 1978 where he also completed his MD and PhD theses. He has received training in acupuncture, autogenic training, herbalism, homoeopathy, massage therapy and spinal manipulation. He was Professor in Physical Medicine and Rehabilitation (PMR) at Hannover Medical School and Head of the PMR Department at the University of Vienna. In 1993 he established the Chair in Complementary Medicine at the University of Exeter. He is founder/Editor-in-Chief of two medical journals (Perfusion and FACT). He has published more than 40 books and in excess of 1000 articles in the peer-reviewed medical literature and has been given visiting professorships in Canada and the US. His work has been awarded with 13 scientific prizes. In 1999 he took British nationality. His unit’s research is funded from two endowments by the late Sir Maurice Laing, by research grants and fellowships (not, however, by ‘Big Pharma’ as sometimes speculated).
Source: http://sites.pcmd.ac.uk/compmed/ernst.htm

We're not talking about some cynical CAM skeptic here. He's had training in multiple CAM modalities, and held a CAM chair at a major university.

I should think these facts should give some people pause to reexamine the evidence.

[Name removed]

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[Lorien]

14. I used to think that acupuncture was a bunch of BS, but my cat proved me wrong

I've tried it several times myself and felt no benefit from it. But when my old tuxedo cat Miro was dying of an aggressive cancer it drastically extended his life and eased his pain. My vet practices both conventional and Chinese medicine, so when he ran out of conventional treatments he turned to the older Chinese cures. My old cat Miro became too sick to eat or walk comfortably three times, and each time I took him to the vet to have him euthanized the vet said "let's try some acupuncture first". They would turn Miro into a kitty pin cushion and he would start to purr with his tongue sticking out (his sign that he was blissed out). After the treatments he was like a whole new cat; full of energy, normal appetite, and he walked comfortably and seemed like his old self. He was originally expected to live only another 2-3 months, but the acupuncture gave him nearly an additional year of life.

[CanSocDem]

15. Nice story.

Personally, I believe in whatever works. But in my dealings with my own cat, I'm starting to believe that she will go along with whatever I think. We've stopped going to the vet......

.

[HuckleB]

16. Correlation is not causation.

http://www.sciencebasedmedicine.org/?p=519

[Name removed]

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