Saturday, September 15, 2012

USA - Acupuncture May Offer Real But Modest Help For Chronic Pain

An analysis of patient data from 29 randomized controlled trials suggests that acupuncture may be better than no acupuncture or sham acupuncture for the treatment of some chronic pain.

First recorded in the Yellow Emperor’s Inner Canon (黄帝内), an ancient Chinese medical text written more than two millennia ago, acupuncture is the practice of inserting and stimulating needles at specific points on the body to treat ailments such as chronic pain.

A team of researchers led by Dr. Andrew J. Vickers of Memorial Sloan-Kettering Cancer Center, New York used data from previously published randomized controlled trials (RCTs) to determine the efficacy of acupuncture for some chronic pain conditions.

The study, published in the Archives of Internal Medicine, involved a total sample size of 17,922 patients from the United States, United Kingdom, Germany, Spain, and Sweden.

We found acupuncture to be superior to both no-acupuncture control and sham acupuncture for the treatment of chronic pain,” said the authors.

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.”

Sham acupuncture in the trials included needles inserted superficially, devices with needles that retracted into the handle rather than penetrating the skin, and non-needle approaches such as deactivated electrical stimulation or detuned laser, according to the study.

The authors report that patients receiving acupuncture had less pain compared to sham controls for back and neck pain, osteoarthritis, and chronic headaches, respectively. Likewise, patients receiving acupuncture also had less pain compared to no-acupuncture controls.

Our results from individual patient data meta-analyses of nearly 18,000 randomized patients in high-quality RCTs provide the most robust evidence to date that acupuncture is a reasonable referral option for patients with chronic pain,” the authors conclude.

In a separate commentary, Dr. Andrew L. Avins of Kaiser-Permanente, Northern California Division of Research, Oakland, writes of the “ambiguous” relationship between conventional allopathic medical care and complementary and alternative medicine (CAM).

At the end of the day, our patients seek our help to feel better and lead longer and more enjoyable lives. It’s ideal to understand the mechanism of action, which carries the potential for developing more and better interventions. But the ultimate questions is: does this intervention work (or, more completely, do its benefits outweigh its risks and justify its costs)?” Avins wrote.

At least in the case of acupuncture, Vickers et al have provided some robust evidence that acupuncture seems to provide modest benefits over usual care for patients with diverse sources of chronic pain. 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,” he wrote.

Source: JAMA.

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