The Problems with Acupuncture

Acupuncture works for many pain conditions; this is a fact, not opinion.1

There a significant amount of research evidence to support a neurobiological basis for acupuncture.2 

These neurobiological effects are specifically related to the insertion of acupuncture needles. However, where the needles are inserted may be less important for certain patients and conditions. For example, a sensitive patient with a condition such as migraine, a disorder of the central nervous system, may respond as well to needles inserted away from the site of pain and while avoiding any ‘acupuncture points'.3

points model 

Science has shown there is no such thing as an ‘acupuncture point’. So if and acupuncture point does not exist, an acupuncture point cannot be ‘missed’ to perform a ‘dummy’ or placebo treatment. So how does one test for efficacy using the standard randomised controlled trial? How do you create a credible placebo treatment? The fact is that you cannot, even when using non penetrating needles.4 There will always be specific physiological effects in addition to the placebo effects, regardless of where the needle is inserted, even with little stimulation.

 As regulated healthcare professionals, we function within the paradigm of evidence-based medicine. The randomised controlled trial was designed to test drugs, not physical therapies, including acupuncture. Yet far too much emphasis is placed on flawed research methodology, devised by those who have little understanding of acupuncture mechanisms, to determine if acupuncture is worth using in clinical practice.

These days, I tend to ignore sham-controlled acupuncture RCT’s in favour of more pragmatic studies of clinical effectiveness, i.e. does acupuncture work better than no treatment or other forms of treatment? Studies of clinical effectiveness usually always favour the group that received acupuncture.

What concerns and saddens me is how many suitable patients are denied acupuncture as a potentially highly effective treatment for pain management, by their GP’s and consultants. This occurs mainly due to ignorance, politics, cultural bias and perhaps financial incentive. It is also much easier to dismiss something you don’t understand as ‘hocus pocus’.

Nonetheless, I feel very fortunate, as a regulated chartered physiotherapist, to have the knowledge and skills to help those suffering from pain conditions for which medical acupuncture is effective. I use medical acupuncture, including dry needling, as part of a combined physiotherapy approach which also includes manual therapy and therapeutic exercise. A clinical audit would suggest this approach is highly effective and I have been able to help hundreds of clients every year with acupuncture.

In good health,

Simon


References:

1. Vickers AJ, Cronin AM, Maschino AC, Lewith G, MacPherson H, Foster NE, Sherman KJ, Witt CM, Linde K, Acupuncture Trialists' Collaboration FT. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of internal medicine. 2012 Oct 22;172(19):1444-53.


2. Zhao ZQ. Neural mechanism underlying acupuncture analgesia. Progress in neurobiology. 2008 Aug 1;85(4):355-75.
Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews. 2016(6).

 

3. Linde K, Allais G, Brinkhaus B, Fei Y, Mehring M, Vertosick EA, Vickers A, White AR. Acupuncture for the prevention of episodic migraine. Cochrane Database of Systematic Reviews. 2016(6).


4. Lund I, Lundeberg T. Are minimal, superficial or sham acupuncture procedures acceptable as inert placebo controls?. Acupuncture in Medicine. 2006 Mar;24(1):13-5.

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