Acupuncture therapy remains a prickly matter

By Piriya Mahendra, medwireNews Reporter

Acupuncture may actually be effective for treating some types of chronic pain, a systematic review in the Archives of Internal Medicine shows.

Andrew Vickers (Memorial Sloan-Kettering Cancer Center, New York, USA) and colleagues found that acupuncture was more effective for treating back and neck pain, osteoarthritis, and chronic headache than no acupuncture at all or sham acupuncture.

"Although the data indicate that acupuncture is more than a placebo, the differences between true and sham acupuncture are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to therapeutic effects," the team says.

The systematic review of 29 randomized controlled trials involving 17,922 patients showed that acupuncture was superior to both sham (needles inserted superficially, retracting nonpenetrating needles, and nonneedle approaches) and no-acupuncture control. No-acupuncture control involved advising patients to avoid acupuncture, attention control, eg, group education sessions, and guideline care in which patients were given advice about specific drugs and doses.

After excluding an outlying set of randomized controlled trials that strongly favored acupuncture, the effect sizes remained significant across all pain conditions.

Specifically, patients who received acupuncture experienced less pain, at pain scores that were 0.23, 0.16, and 0.15 standard deviations lower than those of sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively.

In addition, patients who received acupuncture had pain scores that were 0.55, 0.57, and 0.42 standard deviations lower than those of no-acupuncture controls for back and neck pain, osteoarthritis, and chronic headache, respectively.

The authors note that there was no significant evidence that publication bias affected their results.

They add that their analysis provides "the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain."

Editorialist Andrew Avins (Kaiser-Permanente, Oakland, California, USA) says there is no reason for clinicians to feel that acupuncture should not be used over more conventional therapies just because it may have placebo-based mechanisms, when it may have a clinical benefit.

"If we called that mechanism 'the placebo effect,' how does that change its clinical benefit?" he asks. "Should the lack of biological plausibility lead us to reject compassion and empathy as a means to help improve our patients' heath?"

He concludes: "Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing."

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