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. (It soon became apparent that big yellow pills appeared to be a more powerful placebo than small white ones….)

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.

Acupuncture Safe & Effective in Intensive Care Units

Acupuncture Safe & Effective in Intensive Care Units. Acupuncture is safe and effective in intensive care units (ICUs), and is associated with positive outcomes including reduced length of stay and lower risk of mortality. University authors in Taiwan undertook a systematic review of 31 studies involving over 2900 critically ill patients who had received acupuncture during their ICU stay.

No serious adverse events were associated with acupuncture. A meta-analysis of minor adverse events showed no significant differences between acupuncture and control groups. Acupuncture was associated with a reduced risk of adverse reactions. Patients receiving acupuncture spent less time in the ICU, equivalent to 1.45 days per patient, and had lower mortality rates than those receiving routine ICU care.

(Is acupuncture safe in the ICU? A systematic review & meta-analysis. Frontiers in Medicine, 24 August 2023.)

Acupuncture Improves Work Performance

Japanese research suggests acupuncture improves work performanceJapanese university researchers have shown that acupuncture improves work performance when companies are prepared to spend money on treatment to benefit employees’ health problems. In a four week multi-centre trial, 203 participants, median age 46, who were aware that their performance was impaired by health concerns, were randomly assigned to one of two groups. The intervention group was provided with financial support to enable them to receive acupuncture, whilst the control group just followed workplace-recommended measures to address their impaired effectiveness.

In the intervention group, the most common issues were neck disorders, back disorders, followed by depression, anxiety and irritability. On average, participants received one therapy session during the four week observation period.

At the end of the trial, there was a statistically significant improvement in job performance by the intervention group compared with the control group. This improved performance was equivalent to a cost saving for the company of £76 per worker per month.

(Managing office worker presenteeism by providing financial aid for acupuncture therapy: a pragmatic multicenter randomized comparative study. Industrial Health, May 2023.)

Ear Acupuncture helps Dry Mouth in the Elderly

Acupuncture Exeter: ear acupuncture helps dry mouth in the elderly. Research from Taipei Medical University in Taiwan shows that auricular (ear) acupuncture can improve dry mouth symptoms in older adults. A total of 75 such adults were randomised to receive eight weeks of either true ear acupuncture or sham ear acupuncture. After eight weeks of treatment, the true acupuncture group reported significantly improved dry mouth, ease of speaking, swallowing, amount of saliva, dry throat and thirst, compared with the control group. They also demonstrated higher objective saliva flow than the control group.

(Efficacy of auricular acupuncture in improving dry mouth among an institutionalised older population: A randomised controlled study. Journal of Clinical Nursing, 3 February 2023.)

Acupuncture Treatment of High Blood Pressure in the Elderly

Acupuncture treatment of high blood pressure in the elderly. Hospital and university researchers in Taiwan have found that acupuncture treatment of high blood pressure in the elderly, alongside usual medication, delivers a host of other benefits. Seventy patients aged 65 and above, with hypertension and impaired mobility, receiving home care, were randomly allocated to have either standard antihypertensive drugs, or acupuncture alongside standard drugs. Acupuncture was given twice a week for 12 consecutive weeks. Patients were taking between one and three antihypertensive drugs.

At the end of the treatment period, the patients receiving the combination therapy had lower physical pain levels, improved physical and mental health, a greater ability to undertake daily living activities, and lower systolic blood pressure. The drug-only group showed no significant changes.

(Assessment of quality of life & activities of daily living among elderly patients with hypertension & impaired physical mobility in home health care by antihypertensive drugs plus acupuncture: A CONSORT-compliant, randomized controlled trial. Medicine (Baltimore), 18 March 2022.)