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Category Archives: Other Conditions & Research
A significant amount of research is based on randomised controlled trials. This means that a patient group has been divided randomly into two or more arms. One arm was given the treatment being tested, and the other was given a supposedly inactive placebo; the latter constitutes the “control”. This trial design was originally developed to test new drugs. The placebo tablet can be a pill made from something inactive and unrecognisable to patients.
However, for more complex interventions like acupuncture, surgery or psychology, controls which are both inert and credible to patients, are harder to devise. Sometimes in trials, acupuncture appears only a little more effective than the sham placebo procedure used as a control. The latter may be where for example, patients unbeknown to them, have “irrelevant” acupuncture points needled.
These results are mirrored in placebo-controlled trials of surgery. In a systematic review (1) published in the respected British Medical Journal –
74% of the trials found improvements in patients in the placebo arm, and
51% of the trials found no difference between surgery and placebo.
In acupuncture trials, one explanation is likely to be that the sham procedures used by researchers are not actually inert. Thus when you compare real with sham treatment, the effects are closer than they would otherwise be. A more useful trial would compare one therapy against another, for effectiveness, safety and cost-effectiveness, because that would answer the question in the average GP’s mind when they are wondering how to help a patient with back pain say. “Should it be physiotherapy, acupuncture or exercise therapy?” No controls are then needed, and therapists in these trials can treat as they actually practise, rather than following a protocol devised by researchers. Otherwise we are trialling acupuncture say, not as it is actually practised.
With this in mind, I hope you will feel more informed when you see the research below, and any medical research in the news.
The University of York’s Department of Health Sciences has appointed a Professor of Acupuncture Research: Hugh MacPherson’s work includes conducting clinical trials and systematic reviews to evaluate the effectiveness and cost-effectiveness of acupuncture for a variety of conditions. He has also conducted neuroimaging studies designed to explore the potential mechanisms of acupuncture.
Acupuncture research has provided several useful spin-offs for modern western medicine. These include advances in neuroimaging, an improved understanding of chronic pain, better clinical trial designs, and the TENS machine (2). Finally, patients naturally enough, are often curious to know how acupuncture works. For a scholarly review by two respected authors, of what we know about acupuncture in general in the twenty-first century, take a look at Acupuncture and the Emerging Evidence Base.
(1) Use of placebo controls in the evaluation of surgery: systematic review. British Medical Journal, 21 May 2014.
(2) Unanticipated Insights into Biomedicine from the Study of Acupuncture. Journal of Alternative & Complementary Medicine, 2016.
A French pilot study suggests that preoperative acupuncture administered to the ear, reduces the dose of drugs needed to achieve subsequent general anaesthesia. A total of 32 patients aged 18 to 65 awaiting elective digestive or gynaecological surgery, were allocated to receive either acupuncture or no acupuncture as a control group. Needles were retained for 20 minutes before administering conventional anaesthetics. The required dose was 18% lower in the acupuncture group. The study authors believe acupuncture may exert its effects in this case via the vagus nerve and parasympathetic nervous system.
(Effect of Auricular Acupuncture on Propofol Induction Dose: Could Vagus Nerve and Parasympathetic Stimulation Replace Intravenous Co-Induction Agents? Medical Acupuncture, 15 April 2019.)
Acupuncture combined with amiodarone, a standard anti-arrhythmic drug, seems more effective at preventing the recurrence of atrial fibrillation after ablation, than does the drug alone. A Chinese team randomised 85 patients into acupuncture and control groups. Both groups used the drug from day one after the ablation, but additionally the acupuncture group received daily needling for seven days afterwards.
After three months, the rate of atrial fibrillation recurrence in the acupuncture group was 12%, compared with 33% in the control group. Serum inflammatory markers were elevated in both groups after ablation but the acupuncture group displayed significantly lower levels.
(Effect of acupuncture at Neiguan point combined with amiodarone therapy on early recurrence after pulmonary vein electrical isolation in patients with persistent atrial fibrillation. Journal of Cardiovascular Electrophysiology, 24 March 2019.)
American authors have surveyed complementary treatments including acupuncture for psoriasis. They studied 44 randomised controlled trials, 13 uncontrolled trials and 3 meta-analyses. One meta-analysis of 13 randomised controlled trials examined the association of acupuncture with improvement in psoriasis, and showed significant improvement with acupuncture compared with placebo.
Other helpful approaches were fish oil, curcumin, dietary modification, meditation and Chinese herbs.
(Complementary & Alternative Medicine Therapies for Psoriasis: A Systematic Review. Journal of the American Medical Association Dermatology, November 2018.)
A review by American clinicians of acupuncture in cancer care, shows it is associated with improvements across a range of symptoms patients typically encounter. They studied records on 375 patients, mean age 56, presenting for acupuncture treatment over one year at an outpatient integrative medicine clinic. The worst symptoms at baseline were poor sleep, fatigue, impaired wellbeing and pain.
After the initial acupuncture session, statistically significant improvements were noted across all symptoms. The highest mean reduction occurred for hot flushes, followed by fatigue, numbness/tingling and nausea. Clinically significant reductions were observed in both physical and psychological symptom scores, including those for anxiety, appetite, depression, dry mouth, shortness of breath and wellbeing. Response rates were highest for symptoms of spiritual pain (59%), dry mouth (58%) and nausea (57%).
The study authors point out that a 2017 National Cancer Institute paper identified as a future direction the need to advance the evidence-based integration of acupuncture into conventional cancer care settings.
(Outpatient acupuncture effects on patient self-reported symptoms in oncology care: a retrospective analysis. Journal of Cancer, 8 September 2018.)