Putting together a number of studies about acupuncture, authors concluded that acupuncture “Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.”
The study, which you can see here, is not new information, but a new way of looking at a lot of other studies and getting the conclusion that they want. When examining data the best studies are those where the subject does not know what treatment they are getting – blinded; and those who are providing the treatment do not know which treatment they are giving (double-blinded). This is difficult with acupuncture. Pain, that has no specific diagnosis, and that has no treatment that can be compared, is difficult to rate, evaluate, and determine – e.g. – pain that we could measure would be pain from post surgery where acupuncture could be compared to narcotics. There is a reason this study has never been reported – it fell flat on its face. The rumors of Chinese physicians performing surgery under acupuncture have never been confirmed, it is an urban-legend, and has never been reproduced. This study instead used patients who suffer from “chronic pain,” which is difficult to treat.
What was worse about the metaanalysis was they included studies that compared an ineffective method to acupuncture. A patient who has chronic pain that is not being relieved by any method, or poorly relieved, is compared against an intervention (again, no one is blinded) and against what is considered to be the statistical placebo (in chronic pain, interventions have a placebo effect, which means if you do something for them that has no known benefit- like giving sugar pills – they will have a positive response, and that response is known as placebo. Acupuncture, an intervention for which there is no known mechanism identified, must distinguish itself against the placebo effect, and overcome the bias of the researcher who knows they are providing a treatment, as well as the bias of the patient who knows they are getting an intervention beyond a pill.
They state the difference is statistically significant – sadly, there is no criteria for evaluation of this. There is not a non-bias observer asking the person later, it is the person performing the intervention asking the question of the patient. In this paper they show a difference between sham acupuncture and placebo as 5%.
In spite of a paper pulling together as many reports as they can in the best possible light there remain significant and real issues with a treatment that is ill defined as to mechanism, that cannot compare with acute pain, and that fails in every analysis of the basic data.
In summary: if acupuncture would work in chronic pain, why wouldn’t it work in acute post surgery pain? That is real, determined, and has effects that are measured against narcotics. The study presented is with chronic pain- ill defined, filled with practitioner and patient bias, as well as placebo effect. Using health care dollars for a procedure that does not show efficacy beyond placebo is a waste of our limited resources.
Dr. Terry Simpson
Dr. Terry Simpson received his undergraduate and graduate degrees from the University of Chicago where he spent several years in the Kovler Viral Oncology laboratories doing genetic engineering. He found he liked people more than petri dishes, and went to medical school. Dr. Simpson, a weight loss surgeon is an advocate of culinary medicine. The first surgeon to become certified in Culinary Medicine, he believes teaching people to improve their health through their food and in their kitchen. On the other side of the world, he has been a leading advocate of changing health care to make it more "relationship based," and his efforts awarded his team the Malcolm Baldrige award for healthcare in 2011 for the NUKA system of care in Alaska and in 2013 Dr Simpson won the National Indian Health Board Area Impact Award. A frequent contributor to media outlets discussing health related topics and advances in medicine, he is also a proud dad, husband, author, cook, and surgeon “in that order.” For media inquiries, please visit www.terrysimpson.com.