Still Skeptical About Acupuncture

A recent meta-analysis in the Archives of Internal Medicine seems to back up the claims that acupuncture has benefits for chronic pain.

Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis
Andrew J. Vickers, et al.

Conclusions: 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.

I do not have access to the full article, so I must put some trust on someone who has more information than I do, in this case, Alok Jha, science correspondent for The Guardian UK. His information comes from Edzard Ernst.

Edzard Ernst, emeritus professor of complementary medicine at the University of Exeter, said the study “impressively and clearly” showed that the effects of acupuncture were mostly due to placebo. “The differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies. Several investigations have shown that the verbal or non-verbal communication between the patient and the therapist is more important than the actual needling. If such factors would be accounted for, the effect of acupuncture on chronic pain might disappear completely.”

Ernst added that a potential problem with the trials in the meta-analysis was that, in all cases, the therapist knew whether he or she was administering real or sham acupuncture. “Arguably, it is next to impossible to completely keep this information from the patient. In other words, a trial is either both patient and therapist-blind, or not blind at all. Acupuncturists tend to tell us that therapist blinding is impossible, but this is clearly not true. I fear that, once we manage to eliminate this bias from acupuncture studies, we might find that the effects of acupuncture exclusively are a placebo response.”

As Ernst point out, there are number of possibilities why acupuncture may appear to be of benefit. They all boil down to the placebo effect. In simple terms, the placebo effect is positive effects of the patient believing they are being treated when they are not. For acupuncture, the treatment is most likely the communication between patient and therapist and not the needles.

Hua Shou. Expression of the fourteen meridians. (Tokyo, 1716) from Wikipedia

From what I have been able to glean from reading different articles around the web, the authors made no mention of which specific acupuncture points were used in each of the studies. Different practitioners use different points for their needles to achieve their goals. Since the meridians are based entirely on belief and not on any scientific determination, the points are based entirely upon anecdotal evidence. Would needles in the ‘wrong’ points affect the results.

This leads to another aspect of the analysis. One might refer to it as an application of Occam’s Razor. It is obvious from the authors’ comments that most of the difference found is due to the placebo effect or at least the patient/therapist interactions. There is currently no reasonable explanation for the mechanism of action of acupuncture. Therefore, it is reasonable to suppose that the placement of the needles is the reason behind the pain relief.

As I said, I do not have access to the complete article, so I await analysis from those who can more critically evaluate the paper. Until then, I remain skeptical.


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One Response to Still Skeptical About Acupuncture

  1. Pingback: More on the Acupuncture Paper | PEI Curmudgeon's Blog

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