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 (黄帝内经), 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.
No comments:
Post a Comment