Medical Acupuncture Does Not Work Simply Because People Expect It Will

I have previously written about the role of expectation and suggestion in the use of Medical Acupuncture (MA) and how this may positively influence local pain relief.

This is a subject I have always been interested in. In clinical practice such non specific effects no doubt play a very significant role in treatment outcomes, no matter what technique you are using.

As such when I came across a study by Sherman KJ, et al (2010) considering expectations and preferences as predictors of MA outcomes in low back pain, I was quick to take a read.

The study involved 638 low back pain sufferers who had never had MA as a treatment in other words ‘Acupuncture naive’. They underwent a 7 week course of treatment using MA, and the findings were as follows:

  • Those with high pre-treatment expectations of MA showed greater expectations of improvement in general and showed greater preference for MA
  • Those with high pre-treatment expectations were more likely to have heard that MA was a very effective treatment and to have a moderately positive impression of MA
  • However, those with such favourable beliefs towards MA did not predict improvement in back related function or pain at the end of the 7 weeks of treatment, nor after 1 year follow up
  • After the participants had received one session of MA, revised expectations were associated with an improvement in pain but not function at the end of the treatment period
  • After the participants had received 5 sessions, revised expectations were predictive of improvements in pain and function at 8 and 52 weeks
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Self Needling....Ever Tried It?

Firstly I need to introduce you to Dr. Max Forrester, past president and treasurer of the BMAS and proponent of self-acupuncture as way to allow patients to be treated more regularly and overcome accessibility issues. He presented a lecture and demonstration on this interesting topic at the BMAS Spring conference, 2013.

Dr. Forrester defines the approach as follows: “Self or home acupuncture (SHA) is acupuncture performed by a patient or patients acupuncture partner, following assessment and appropriate training by their attending regulated healthcare professional.”

There is a historical description, the first relating to SHA, by Ten Rhyne who witnessed a man “driving needles into his own abdomen in several locations and regaining his health as a result.” Sounds extreme but apparently effective.

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Dry Needling vs Medical Acupuncture - What’s The Difference?

This is a question that came up recently in a brief Twitter discussion. So thought I would take a stab at a more complete explanation.

Medical acupuncture (MA) is a western approach to the use of acupuncture based on an evidence based, more scientific understanding of the use of needles.

Given advances in understanding what happens at a neurophysiological level when we insert a needle, MA seeks to utilise these effects in different ways to promote healing and recovery from illness and injury. This is is a simplified explanation but I am sure you get the idea. For an excellent read on the definition of MA, take a look at this paper published in Acupuncture in Medicine.

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Re-accreditation Success

Well 5 years have gone by and it was time to submit my application to the British Medical Acupuncture Society for reaccreditation.

So whats this all about?

As an accredited member who has been awarded the Diploma in Medical Acupuncture, I am required to submit evidence to the Competency, Accreditation and Examination Board of the Society to demonstrate that I have been keeping up to date with developments in Medical Acupuncture, effectively proof on continuing education.

As a Physiotherapist who has a particular interest in the use of needling as part of an integrated physiotherapy approach, its was not difficult to meet the criteria. If you’re interested, take a look at the re-accreditation guidelines here.

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Does Acupuncture Promote Anti-inflammatory And Mechanotransduction Mechanisms Promoting Tendon Healing?

This article by de Almeida et al, 2013 reminds us that previous studies have shown acupuncture to increase the synthesis and reorganisation of collagen molecules in rat tendons after injury. Clinical studies have also shown that acupuncture improves pain and functional activity in patients with tendinopathy. This may be due to acupuncture having been shown to modulate both anti-inflammatory and mechanotransduction molecular pathways resulting in an increase in type 1 collagen synthesis.

The authors present a hypothesis that acupuncture increases synthesis and subsequent reorganisation of type I collagen during tendon healing by concomitant modulation of the Toll-like receptor-nuclear factor-κB AI pathway, the mitogen-activated protein kinases pathway and the Rho/Rac-F-actin MT pathway. All sounds a bit complicated for my clinical brain, so lets move on.

In practice the authors state that increased collagen synthesis and reorganisation requires the use of at least one acupuncture point that is anatomically ‘connected’ with the site of the injury because of the local tenoblast mechanotransduction mechanism. This may support the use of more local needling when treating tendon injuries which I have discussed in a previous blog.

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