Acupuncture Research - Pain
In an article titled "Acupuncture for Pain", published in American Family Physician (a peer reviewed journal of the American Academy of Family Physicians), in 2009, a number of limitations of current research on acupuncture were discussed, including:
1. An incomplete understanding of the physiological effects of acupuncture -
Though a comprehensive understanding, developed over centuries of clinical use, exists within the system of Chinese medicine (thus allowing it to be used safely and effectively), a complete modern biomedical understanding has yet to emerge.
In my (Aguilar) opinion, this understanding will likely develop as the biomedical sciences, themselves, grow and evolve.
2. Ineffective blinding of trial participants -
In clinical research, where the goal is to link, as closely as possible, the effects of intervention (treatment) with the outcome, limiting the influence of other factors on that outcome is important (i.e. you wouldn't want to use both acupuncture and medications simultaneously, as you couldn't be sure which led to the end result).
A huge potential influence on the outcome is the patient's conscious awareness of receiving treatment (hence, the use of "placebos", where the patient receives a form of treatment that appears, to the patient, to be actual treatment). "Blinding" refers, as is suggested, to the efforts used to prevent the participant or caregiver from knowing what treatment they are receiving (or giving).
The easiest example is in trials of medications where some participants are given little pills that are actually the medication being tested, while other participants are given little pills that are completely inert, like sugar pills. As the participants don't know whether they received the actual drug or not, that awareness is removed as a potential influence on the outcome. (There's a very real effect caused by the mere belief that professional treatment was given.)
Things are not so easy in acupuncture trials, for obvious reason. If acupuncture needles are stuck in you, you're pretty sure you're receiving acupuncture. Thus, you are not "blinded" to whether you are receiving the actual treatment. This is a problem in trying to demonstrate, through strict clinical research, whether acupuncture has an actual effect (an example argument it isn't could be "maybe it's the caring, attention, and physical touch of the acupuncturist that causes the effectiveness, and not the actual insertion of needles").
3. Difficulty in finding appropriate placebos for use in acupuncture trials -
Related to number two, above, it is difficult to find a treatment that is similar to acupuncture (so the patient believes they are receiving an actual acupuncture treatment), but that is definitively not acupuncture. (See the post on IBS). Many attempts have been made, such as inserting needles in areas of the body that are not actual acupuncture points. (Makes sense, right? Unfortunately, it makes for a very poor placebo - see the aforementioned IBS post.)
4. The use of standardized treatments in clinical trials, instead of treatments tailored to the individual patient, as is standard care in actual, clinical practice -
This is a huge complaint made by practicing acupuncturists. Our medicine is heavily weighted towards providing treatments that are unique to each individual patient. We love that about acupuncture and Oriental medicine!
Unfortunately, that approach does not meld well with the modern research paradigm. For research purposes, acupuncture has to be isolated as a distinct, clearly definable practice, so that it can be tested. If "it" changes with every treatment (i.e. different treatments for every patient), it makes researching "it" very difficult. (What is "it" if it keeps changing?)
This is a huge problem in validating or "proving" the effectiveness of acupuncture in modern clinical trials. More on this later...
According to the author of this particular article, as of 2009, controlled trials, regarding acupuncture, have been published on:
- lumbar pain,
- shoulder pain, and
- neck pain, as well as
- temporomandibular joint pain, plus
- other pain syndromes
According to evidence thus far collected, acupuncture is "most likely to benefit" patients suffering from:
- low back pain,
- neck pain,
- chronic idiopathic or tension headache,
- migraine, and
- knee osteoarthritis.
And "promising data" exists for:
- shoulder pain,
- temporomandibular joint pain, and
- postoperative pain.
It's important to note, here - after all, the whole purpose of my posting this information is not to show evidence that acupuncture works, but, instead, help identify where there is evidence that acupuncture works, based on modern research (based on Western scientific paradigms) - there are serious difficulties and limitations in studying acupuncture in the way that researchers insist on studying it (as was discussed above).
Acupuncture has been effectively treating the full gamut of illnesses for thousands of years (keep in mind, the theories and modalities, like acupuncture, constituting "Oriental medicine" have acted as the sole system of health care for the Chinese people up until the last century - it has seen a lot).
The article being discussed here is a decent snapshot of the current research-based evidence behind acupuncture (along with all the posts about research appearing on this blog).
It's exciting to see a matured system of medicine slowly being recognized and understood by one that is young and rapidly developing.
Keep on checking in to see what other interesting stuff I find!
Kelly, R. (2009). Acupuncture for pain. American Family Physician, 80(5), 481-4. Retrieved from www.ncbi.nlm.nih.gov/pubmed/19725489
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