Acupuncture for pain no better than placebo and not without harm

Mar 24, 2011

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 for 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."

Researchers carefully identified and critically examined systematic reviews of acupuncture studies for pain relief and case reviews reporting adverse effects. Reviews were defined as systematic if they included an explicit Methods section describing the search strategy and inclusion/exclusion criteria. Systematic reviews had to focus on the effectiveness of any type of acupuncture for pain. Of the 266 articles found, 56 were categorized as acceptable systematic reviews.

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.

In an accompanying commentary, Harriet Hall, MD, states her position forcefully: "Importantly, when a treatment is truly effective, studies tend to produce more convincing results as time passes and the weight of evidence accumulates. When a treatment is extensively studied for decades and the evidence continues to be inconsistent, it becomes more and more likely that the treatment is not truly effective. This appears to be the case for acupuncture. In fact, taken as a whole, the published (and scientifically rigorous) evidence leads to the conclusion that acupuncture is no more effective than placebo."

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More information: The article is "Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews" by E. Ernst, Myeong Soo Lee and Tae-Young Choi (DOI: 10.1016/j.pain.2010.11.004). The accompanying commentary is "Acupuncture's claims punctured: Not proven effective for pain, not harmless" by Harriet Hall, MD (DOI: 10.1016/j.pain.2011.01.039). Both appear in PAIN, Volume 152, Issue 4 (April 2011)

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User comments : 11

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xznofile
5 / 5 (1) Mar 24, 2011
because it wasn't stated, I assume the evidence of equality with a placebo is statistical.

Sorry, I call bull on selective collection of evidence.
RobertKarlStonjek
5 / 5 (2) Mar 25, 2011
Placebos are effective...soup made from ground up unicorn horn is particularly effective and has a tasty chicken noodly flavour...
Nairb
3 / 5 (2) Mar 25, 2011
One of the problems with testing acupuncture is that it is concidered an art my those who practice it following the traditional methods. If 20 people show up with lower back pain, they will get 20 different treatments. Giving them all the same treatment will mean some may get worse, and many will not notice any improvement.

This means that traditional acupuncture does not lend itself to double blind studies. That is not to say that it is necessarily effective, just that it does not lend itself to rigourous investigation.

What is needed, is a reliable way to equal the playing field in terms of messages that therapists give to clients, so that the same messages can be given to both groups of subjects, even when the therapists in the test group knows they are using traditional acupuncture. This may be difficult as messages a far more than just spoken words.
PinkElephant
3.7 / 5 (3) Mar 26, 2011
If 20 people show up with lower back pain, they will get 20 different treatments.
And yet, apparently all this "art" is no more effective than sham acupuncture.
Ron_Alford
3 / 5 (2) Mar 26, 2011
Too bad they didn't compare to the harm from drugs or surgery. There are plenty of studies pointing out the harm from those two modalities.
Dummy
1.8 / 5 (5) Mar 28, 2011
I am a licensed acupuncturist. Ignorance is rampant here. Not stupidity, ignorance. Oriental Medicine is a different system than western medicine the 2 are apples and oranges. Different treatments for low back pain has nothing to do with "art". There are different syndromes that need to be diagnosed, and treated in different ways. It is not 'willy nilly, anything goes'...

See? It's not that hard, people. You scientific types are so unbelievably arrogant.

I was the first post on this article, I come back and the post is gone... hmmm... bias here? I wonder how long this post will last.

Lastly and unrelated, scientists think if it cannot be measured and quantified, it does not exist. Really?

Do you love you mother?

Prove it. (Buying flowers on mothers day is not proof).

There are realities in this creation that transcend the temporal world. Deal with it.

In my career, I have treated literally thousands of patients for all conditions with great success.
PaulieMac
not rated yet Mar 28, 2011
Placebos are effective...soup made from ground up unicorn horn is particularly effective and has a tasty chicken noodly flavour...


Invisible Pink Unicorn is particularly efficacious...
PaulieMac
5 / 5 (3) Mar 28, 2011
Oriental Medicine is a different system than western medicine the 2 are apples and oranges


But the essentials are the same, right? A patient is suffering some disorder, a practitioner diagnoses and treats the symptoms and/or the source of the disorder, and the patient ends up 'more well'. That's the crux of it, yes?

And an actual, effective treatment should be greater in effectiveness than could be achieved by exploiting the placebo effect?

And the thing about healthcare is - it *is* measurable. Disregarding your mystical ramblings about the 'realities in this "creation"(?) that transcend the temporal world', a patient is either more or less 'well', or unchanged, after a treatment. That can be measured, analysed. And that's what these people have done. Do you have a problem with the effectiveness of what *you* sell being questioned?

PaulieMac
5 / 5 (2) Mar 28, 2011

Lastly and unrelated, scientists think if it cannot be measured and quantified, it does not exist. Really?


Yes, really. You use 'love' as an example; a bad one. Emotion can actually be measured, via detectable chemical and electrical signatures in our brains.

So, give another example - one that works - of something that exists with being measurable or quantifiable. Just one will do ;-)


There are realities in this creation that transcend the temporal world. Deal with it.


lol. Prove it. Or do you just 'feel it' so it must be true?
Deesky
3.5 / 5 (8) Mar 28, 2011
@Dummy
I am a licensed acupuncturist. Ignorance is rampant here. Not stupidity, ignorance. Oriental Medicine is a different system than western medicine the 2 are apples and oranges.

You scientific types are so unbelievably arrogant.

scientists think if it cannot be measured and quantified, it does not exist. Really?

There are realities in this creation that transcend the temporal world. Deal with it.

Dummy by name, dummy by nature.
Dummy
1 / 5 (1) Mar 29, 2011
LOL...

Nice try.

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