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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.
‘Does acupuncture help with COPD?’ was the question asked by authors of a collaborative systematic review by universities in Barcelona and Beijing. Their analysis of data from 28 randomised trials showed that acupuncture added into patients’ usual treatment, improved difficulty breathing, quality of life, lung function and capacity for exercise, all when compared to sham treatment. The authors conclude that acupuncture might be beneficial for COPD, although the quality of trials was low and they would like to see further, well-designed studies undertaken.
(Filiform needle acupuncture for copd: A systematic review & meta-analysis. Complementary Therapies in Medicine, December 2019.)
Researchers in the Department of Respiratory Medicine at a Japanese hospital, studying acupuncture for COPD (chronic obstructive pulmonary disease), have shown treatment is associated with improved exercise performance parameters. In the trial, 16 patients with COPD received acupuncture once a week for 12 weeks, in addition to any usual medication. The effects of treatment were evaluated at baseline and at 12, 16, and 24 weeks.
During the trial period, significant improvements were found. There were increases in peak oxygen uptake and minute ventilation during exercise tests. By 12 weeks, exercise endurance time was significantly increased, and oxygen uptake upon finishing the exercise session was significantly lower compared to baseline. There were also improvements in patients’ perceived exertion scores. The researchers conclude these findings indicate that acupuncture may be a new intervention for COPD, in addition to conventional maintenance therapies.
(Clinical Effects of Acupuncture on the Pathophysiological Mechanism of Chronic Obstructive Pulmonary Disease During Exercise. International Journal of Chronic Obstructive Pulmonary Disease, 5 December 2019.)
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.)