Acupuncture Research

Acupuncture research is regularly published in journals worldwideA 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 or surgery, 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 surgery trials found improvements in patients in the placebo arm;
51% of surgery 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 of the two are closer than they would otherwise be, so it is easy to simplistically conclude that acupuncture is not significantly better than sham. Another contributing factor is that the acupuncture given in trials can be sub-optimal, and not what a professional acupuncturist would actually do in clinical practice.

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 indeed any medical research in the news. If you would like to read more about the quality of research evidence and how different designs of study relate to each other, I would refer you to the British Acupuncture Council’s description of the evidence pyramid. In addition, Evidence Based Acupuncture attempts to summarise the current state of knowledge, using the language of modern science.

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).

(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.

Ear Acupuncture helps Diabetic Foot

Acupuncture in Exeter: ear acupuncture helps diabetic foot. Researchers at the University of Alfenas Nursing School in Brazil, have found that ear acupuncture helps diabetic foot, as measured by improved vascular parameters after a course of treatment. A total of 44 patients with type 2 diabetes were randomly assigned to receive either five sessions of auricular (ear) acupuncture, or to a no-treatment control group.

Patients receiving acupuncture were observed to have significantly increased lower limb blood circulation and raised plantar temperature, compared with the control group.

(The effects of auricular acupuncture on vascular parameters on the risk factors for diabetic foot: A randomized clinical trial. Complementary Therapies in Clinical Practice, August 2021.)

Acupuncture is One of the Safest Medical Treatments

A team of authors from university hospitals in Munich and Beijing, has concluded that acupuncture is one of the safest medical treatments available. In a systematic review, they surveyed data from 21 studies, covering nearly 13 million acupuncture treatments.

Meta-analyses indicated one minor adverse event in 9.3% of patients during a series of treatments. Serious adverse events were rare, with estimates of 1.01 per 10 000 patients and 8 million treatments. Those requiring any medical treatment were uncommon, and estimated at 1.14 per 1000 patients. Half of the adverse events reported, involved bleeding, pain or inflammation at the needling site.

The authors conclude that acupuncture can be considered among the safer treatments in medicine. Serious adverse events are rare, and the most common minor ones are very mild.   

(Acupuncture-related adverse events: systematic review & meta-analyses of prospective clinical studies. BMJ Open, 6 September 2021.)

Acupuncture for Mild Cognitive Impairment

Acupuncture Exeter: acupuncture for mild cognitive impairment. Researchers at DongShin University in Korea, have assessed the effectiveness of acupuncture for mild cognitive impairment (MCI), and found promising results. A total of 32 patients aged 55 to 85, and with MCI, were randomly assigned to one of four acupuncture treatment arms: a core group of acupuncture points for 30 minutes; core points for 20 minutes; core points plus an additional point; electrical stimulation of core points. Sessions were given three times a week for eight weeks.

All four treatment arms were associated with beneficial effects on cognitive function, with the greatest effect coming from the core group of points when used for 30 minutes. The team recommends more rigorous clinical studies with a large sample size to validate these results.

(Factors contributing to cognitive improvement effects of acupuncture in patients with mild cognitive impairment: a pilot randomized controlled trial. Trials, 12 May 2021.)

Acupressure After Gall Bladder Removal Reduces Pain & Speeds Recovery

Acupressure after gall bladder removal reduces pain & speeds recovery. University researchers in Turkey have found that acupressure after gall bladder removal, reduces pain and speeds recovery. A total of 65 patients undergoing laparoscopic gall bladder removal, were randomly assigned to receive either acupressure at four designated points, or light-touch contact as a control. Acupressure was given for 12 minutes at 0, 4 and 8 hours following surgery.

Acupressure was associated with significantly reduced post-operative pain, increased intestinal sounds, and shortened time to first defecation after surgery. The authors conclude that acupressure can be a recommended nursing intervention following laparoscopic cholecystectomy, to reduce acute pain and shorten the time to defecation.

(The effect on gastrointestinal system functions, pain and anxiety of acupressure applied following laparoscopic cholecystectomy operation: A randomised, placebo-controlled study. Complementary Therapies in Clinical Practice, May 2021.)