Acupuncture Effective Pain Relief?

[livius drusus]

Annals of Internal Medicine recently published a couple of studies on the effectiveness of acupuncture as pain relief. I've only read some press articles and the patient summaries (not that I'd necessarily understand the full study even if I did have access to it), but according to them, it seemed to have some positive effect in the treatment of osteoarthritis of the knee (http://www.annals.org/cgi/content/summary/141/12/901) -- particularly over a longer term course -- and no more than the placebo in the treatment of chronic neck pain (http://www.annals.org/cgi/content/summary/141/12/911).

Both studies seem very small to me and I've seen no references to anyone duplicating the study. Do any of our local science types have any comment?

[livius drusus]

Some mainstream sources on the story:
Reuters (http://www.reuters.com/newsArticle.jhtml?type=healthNews&storyID=7144055)
The Times (http://www.timesonline.co.uk/article/0,,3-1411000,00.html)
CBS News (http://www.cbsnews.com/stories/2004/12/20/health/main662112.shtml)
Annals video (WMP) (http://www.dssimon.com/vnr/acp2fe.wmv[/url)

[wildernesse]

I think pain relief is one of those things in which it doesn't really matter whether there is a placebo effect or not--because for the most part, pain is just a symptom of a problem. However, it looks like the study in your first link also associated greater function with real acupuncture, and that is an interesting thing. Although greater function may just be a result of feeling less pain in the joint, I guess.

I like alternative therapies, but that's just because I dislike doctors and pre-med students.

[Socratoad]

What wildernesse said.

[ceptimus]

I've always considered acupunture to be bullshit. It's cleverer than most other forms of quackery in that it is very difficult to perform a scientific trial of its effectiveness. Patients tend to notice whether needles are stuck in them or not, so blind trials are difficult. Double blind trials, where the practicioner doesn't know whether or not the patient is receiving treatment, are, as far as I can see, impossible.

[Dingfod]

Perhaps it is just redirection, kind of like stomping on my foot to make my finger quit hurting.

[livius drusus]

I think pain relief is one of those things in which it doesn't really matter whether there is a placebo effect or not--because for the most part, pain is just a symptom of a problem. However, it looks like the study in your first link also associated greater function with real acupuncture, and that is an interesting thing. Although greater function may just be a result of feeling less pain in the joint, I guess.

That is notable, particularly since the patients on the 8 week program had an improvement in function but not in pain. So given that, it seems that less pain is not what led to greater function, at least in the initial phases.

[livius drusus]

I've always considered acupunture to be bullshit. It's cleverer than most other forms of quackery in that it is very difficult to perform a scientific trial of its effectiveness. Patients tend to notice whether needles are stuck in them or not, so blind trials are difficult.

The osteoarthritis study resolved that problem:

Sham acupuncture involved using a special device to place fake needles on the 9 areas of the body where the patients who received true acupuncture got real needles. The fake needles did not pierce the skin, but they created a needle-like feeling, and the device that held the needles in place made it look like they had been inserted.

Double blind trials, where the practicioner doesn't know whether or not the patient is receiving treatment, are, as far as I can see, impossible.

Agreed, but that doesn't automatically make the results of blind trials nonsense, does it?

[ceptimus]

They're not automatic nonsense, but they're highly suspect. The whole reason that double blind trials are undertaken in the first place is that there is plenty of evidence to suggest that a doctor who knows she is only giving placebo treatment does not produce the necessary confidence in the patients.

To do a single blind trial on acupuncture that means anything, you either need acupuncturists who are ambivalent as to the efficacy of their art, or acupuncturists who are world class actors. Both varieties are probably in short supply.

[livius drusus]

Well, all the summaries refer to is "the researchers" so I unless someone has access to the full study, I can't say whether they're acupuncturists or osteopaths who learned the technique on purpose for the study or what. :shrug:

[Ymir's blood]

Maybe you could find someone to randomly stick needles in people? :muahaha:

[viscousmemories]

Maybe you could find someone to randomly stick needles in people? :muahaha:
:mememe:

[livius drusus]

Here (http://www.annals.org/cgi/eletters/141/12/901) are some reader responses to the published OA study pointing out methodological flaws.

[Roland98]

I file acupuncture under the "maybe" category. I mean, they're freaking sticking needles into your body, which certainly can stimulate a whole host of biological responses, including (but certainly not limited to) endorphin release. So I'm not surprised that some physiological response to acupuncture is seen, including diminshed sense of pain. What I don't buy it for is when they try to sell acupuncture as a "magic bullet" for whatever ails you, from herpes to depression.

Anyhoo, from the actual study:

The results of our study extend those of our previous trial (19) and demonstrate that true traditional Chinese acupuncture is safe and effective for reducing pain and improving physical function in patients with symptomatic knee osteoarthritis who have moderate or greater pain despite background therapy with analgesic or anti-inflammatory therapy.

First, they claim this is "true traditional Chinese acupuncture." But let's look at the methods a bit:

Acupuncturists applied electrical stimulation (Micro-850, Texas Medical, Waxahachie, Texas) at knee points Xiyan, at low frequency (8 Hz), and square biphasic pulses (0.5-ms pulse width) for 20 minutes.

Huh? Thousands of years ago these "true traditional Chinese acupuncturists" had a Texas Medical Micro-850 electrical stimulation machine??

Of note is the fact that the sham acupuncture group didn't get this stimulation either. There's a big red flag in my book.

ETA: liv's link mentions this too.

The control group received no electrical stimulation, while the traditional group received twenty minutes of electrical current. This bizarre design totally negates any substance to the claim that the study was controlled. And of course patients did not know which group they were in: they were naïve to acupuncture, so were just guessing that what they were getting was acupuncture or not!

Moving on...

We used a credible sham acupuncture group to control for the potential placebo effect in our trial. In addition, we included the recommended nonpharmacologic treatment (education) as a second control group (3). While the participants in the true acupuncture group were more likely to correctly guess their treatment, this masking procedure was reasonably successful in blinding participants in the sham control group since most participants believed that they were receiving true acupuncture (or were unsure) throughout the study. However, participants' differential awareness of group membership may have contributed to the positive results found. These between-group masking differences may have reflected the differential pain and function improvements due to the treatments themselves. In other words, because real acupuncture was benefiting its recipients, they, in turn, assumed that they were receiving real rather than sham treatment. We cannot be sure, however, what, if any, effects participants' guesses on group membership had on the overall trial results.

I'd say the bolded part explains a decent amount of their results. First note that the success rate in the "real" acupuncture group compared to the controls were not all that much different, and by 26 weeks they'd lost fully 25% of the group in the real and sham acupuncture groups, and 43% of the education group. This also is a red flag--you've lost a quarter of 2 groups, and nearly half of the third. Why?

ETA: in liv's link, one reviewer touches on this:

A few obvious problems relate to the fact that the subjects were not isolated from one another, the fact that the true acupuncture group did so well on guessing their treatment, and the considerable (embarrassing ???) attrition that occurred over the 6-month study for all involved groups. Were the ones who left the study more intelligent subjects, who lost confidence in the therapy and therapists?

Overall, I think the study is intriguing and again I wouldn't be surprised that there's some benefit to acupuncture for treatment of conditions such as osteoarthritis. But I don't think this study has done a great job convincing skeptics of the benefits of acupuncture.

[LadyShea]

I did some research into acupuncture as it is frequently used in IVF. The studies are available are small, but somewhat positive...at least the results seem to be slightly above placebo. Not enough for me to say "Acupuncture works!", but enough to say "There is enough here to warrant further investigation". I simply cannot discount it out of hand.

Side note: My IVF program did a multi-state study using sham needles on a control group (to test for placebo) and real needles on the rest, and their results are in peer review now, and hopefully will be published this year. I know my doctor was skeptical, and if asked will only say "The results are inconclusive, but it might help with relaxation" whereas the director of another location (same program) was very excited and told people their findings were significantly positive. Weird.

[Roland98]

I did some research into acupuncture as it is frequently used in IVF. The studies are available are small, but somewhat positive...at least the results seem to be slightly above placebo. Not enough for me to say "Acupuncture works!", but enough to say "There is enough here to warrant further investigation". I simply cannot discount it out of hand.

And again, with something like this, it's hard to say whether it is the acupuncture per se (meaning the actual technique and manipulation of needles in particular areas of the body) or just the physiological response that occurs from being stabbed with a bunch of needles that could cause a response.

Side note: My IVF program did a multi-state study using sham needles on a control group (to test for placebo) and real needles on the rest, and their results are in peer review now, and hopefully will be published this year. I know my doctor was skeptical, and if asked will only say "The results are inconclusive, but it might help with relaxation" whereas the director of another location (same program) was very excited and told people their findings were significantly positive. Weird.

Well, they could both be right. The results could be "significantly positive" (meaning that they reached statistical significance), but if they are only barely so and the findings haven't been repeated by other investigators, I'd agree with your doctor and say that it's inconclusive. I'd never advocate for anything like that based on only one trial, and I'd be wary of a doctor who did.

[Ymir's blood]

Maybe you could find someone to randomly stick needles in people? :muahaha:
:mememe:
/me gives viscousmemories some sharp needles.

/me runs :runaway:

[viscousmemories]

:drevil:

[livius drusus]

Thank you for your critique, Roland. That was exactly what I was hoping for. By any chance, could you feel my mental vibes calling out to you, drawing you inexorably towards this subject? ;)

[Roland98]

Thank you for your critique, Roland. That was exactly what I was hoping for. By any chance, could you feel my mental vibes calling out to you, drawing you inexorably towards this subject? ;)

Indubitably. ;)