A meta-analysis study of acupuncture recently released in The Archives of Internal Medicine found that acupuncture was more effective in reducing various types of chronic pain than usual care and should be considered a reasonable treatment option.
Study Design and Results
Researchers conducted a systematic review of randomized controlled trials of acupuncture for chronic pain to determine its effect compared to sham acupuncture and no acupuncture (usual care). While there are a large number of studies related to acupuncture for chronic pain, many were “of questionable interpretability and value” and were therefore excluded from this analysis.
After review, the scientists settled on 29 high-quality trials, which included a total of 17,922 individual patients and covered four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain.
The results were given in “standard deviation” scores, which I personally find incredibly confusing. Thankfully, though, they also gave two additional and more understandable interpretations of those scores.
1. If the baseline pain score on a 0 to 100 pain scale is 60, the pain score following treatment would be:
30 in patients receiving true acupuncture.
35 in patients receiving sham acupuncture.
43 in patients receiving usual care.
2. If the results were defined in terms of a pain reduction of 50% or more, the percentage of participants who experienced that reduction would be approximately:
50% of patients receiving true acupuncture.
42.5% of patients receiving sham acupuncture.
30% of patients receiving usual care.
The researchers concluded, “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.”
Like many complementary or alternative therapies, acupuncture is very difficult––in fact, impossible––to study using what is considered to be the gold standard of methods for conducting clinical trials: randomized, double-blinded and placebo controlled. For example, there is no way to make an acupuncture study double-blinded. Although the patients might not know whether they are receiving true or sham acupuncture, the therapists have to know which procedure they are performing. There's just no way around that.
Because a number of studies report a fairly high success rate for sham acupuncture––often close to that for true acupuncture––critics claim acupuncture is nothing more than a placebo effect and has no real value. I've discussed several of these studies with my own acupuncturist and he points out that although the sham acupuncture techniques used don't actually insert the needles or at least don't insert them as deeply as in true acupuncture, they still usually provide some stimulation of various points on the body. Since even mild stimulation of acupuncture points can have a positive effect, as demonstrated by acupressure where no needles are involved, it's very possible that the people receiving sham acupuncture are getting benefits from the techniques being used.
I was glad to see that the authors of this study pointed out the significant differences between true and sham acupuncture in the trials they analyzed and presented those differences as evidence that acupuncture offers more than just a placebo effect.
I was also pleased to see that they found acupuncture to be a “reasonable referral option” for doctors to consider with their chronic pain patients. It doesn't have negative side effects like most medications and can often be quite helpful in relieving pain.
I've personally used acupuncture for several years––on a regular schedule at first and now on an as-needed basis. It's been very effective for me in relieving pain in a variety of areas. I definitely believe there is much more to acupuncture than just a placebo effect, but even if it is simply a placebo effect, I don't care as long as it takes away my pain.
Vickers AJ, et al. “Acupuncture for chronic pain: Individual patient data meta-analysis” Arch Intern Med. 2012 September 10. [Epub ahead of print].
Published On: September 19, 2012