Is Acupuncture Nothing More Than a ‘Theatrical Placebo’?

TCM did acupuncture a disservice by suggesting that there was such a thing as an acupuncture ‘point’, a concept which has been taken too literally in western medicine and its obsession with proving efficacy.

If, as rational intelligent beings we can all agree that there is no such thing as a physically or otherwise definable acupuncture point, then we can stop trying to prove that missing the point i.e sham acupuncture, has any better or worse clinical effect.

With this understanding we can stop comparing like with like in an effort to prove efficacy. Surely the suggestion that inserting a needle into the tissues, regardless of where, is likely to have a physiological effect over and above placebo? These proposed mechanisms have been well described in the scientific acupuncture literature, with further evidence of specific physiological effects emerging regularly.

Of course we can’t ignore the placebo effect as it permeates everything we do in medicine and physiotherapy in particular. As with just about every other form of medical intervention, it is likely that acupuncture everts both specific and nonspecific effects although probably not in equal proportions.

The challenge of course is to devise an acupuncture placebo which exerts no specific effects, perhaps impossible? Until then perhaps we should be concerning ourselves with the question of does acupuncture work, i.e. is it effective?

The answer from large scale studies is an overwhelming yes when you compare acupuncture (both verum and sham) with no treatment or standard guideline based treatment for a number of conditions including low back pain, migraine, OA knee etc.

There may be small, in some cases statistically significant differences in favour of verum acupuncture for some more peripheral nocioceptive type conditions which is likely to be due to differences in pathophysiology and how this is influenced by acupuncture. It’s these small margins which have lead to claims that we are dealing only with an elaborate placebo and may indicate a failure to interpret the literature correctly.

I have been using acupuncture to complement my physiotherapy practise for over 10 years. As a clinician I don’t need reams of literature to convince me that acupuncture has made a significant difference to hundreds of people’s lives over the years. As a technique it has allowed breakthroughs that would not have been possible had I listened to the naysayers and abandoned its use early on in my career.

 

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