...it is 2016 and acupuncture is still a taboo

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It's 2016 and acupuncture is still a taboo :(
“At best, acupuncture is a waste of valuable time — and now so is the debate about it.”
— PainScience: Does Acupuncture Work for Pain?

People ask me, is there any evidence for acupuncture, so I put together a blog post - Acupuncture: Is there any evidence? The goal is this post was to stimulate meaningful conversation, but the conversation rarely progressed past people linking to this blog post from The Painscience website to ‘prove’ to me that acupuncture doesn’t work. As someone who is naturally curious, I took the time to read this article and what stuck out to me was the assertion that acupuncture is a waste of time. 

I put this post together because it is 2016 and acupuncture is still a taboo topic, it would be refreshing to see a conversations that reflects the way my peers and I practice acupuncture. For those that are interested, I have provided some insight to help clear up common misconceptions and about acupuncture.

1. Misconceptions about medical acupuncture

“If new evidence emerges that shows that it isn’t what we all hoped it would be, then it must change”
— PainScience: Does Acupuncture Work for Pain?

People hear about medical acupuncture and do not have an understanding of what it means. Medical acupuncture is a reconceptualization of acupuncture, that was pioneered by Felix Mann, it provides clinicians and researchers with an acupuncture paradigm based on neurophysiology. 

Medical acupuncture views acupuncture as a form of peripheral nerve stimulation. Needle insertion is based on an understanding of anatomy and neurophysiology and acknowledges the fact that, regardless of where the needle is inserted (skin, fascia, muscles, tendons, periosteum, joint capsules etc.), there will be a number of physiological responses across different areas of the nervous system, this includes, but is not limited to: peripheral receptors, dorsal horn of the spinal cord, and sensorimotor cortical areas. 

If readers would like to stay up to date, or are looking for resources related to medical acupuncture, I would recommend the following researchers and thought leaders as a starting point:

“Preferential sites for acupuncture stimulation are associated with areas rich in specialized sensory receptors such as muscle spindles, Golgi tendon organs, ligament receptors, Paciniform and Ruffini’s receptors (joint capsules), deep pressure endings (within muscle belly), and free nerve endings (muscle and fascia).”
— Alejandro Elorriaga Claraco

2. Misconceptions about placebo acupuncture

A placebo control only works if it’s biologically inert and not providing any of the same physiological effects as the treatment itself. Nonetheless, the most common 'placebo' approach is inserting an acupuncture needle into the 'wrong' point. What I suggest is that before jumping the the conclusion that acupuncture is 'no better than a placebo' people look beyond the headlines, to see what placebo control was used and more often than not it still involves the insertion of acupuncture needles into the body. 

Here is an example of a large randomized control trial that compares acupuncture to acupuncture... :O

This study concludes that acupuncture performed no better than a sham, but the sham was...acupuncture. When sham acupuncture is providing the same physiological effect as verum acupuncture I have a hard time agreeing that this is a good enough comparative. 

German Acupuncture Trials (Gerac) For Chronic Low Back Pain
Sham acupuncture

3. Misconceptions about the scientific literature

Working at a university, a common complaint I hear "My neck hurts, and I get headaches from long hours spent in class and on homework". So naturally I would look into the literature to see if acupuncture something that will help my patients with their aches and pain. If you do not read past the headlines or have access to PubMed, you may be left with the impression that acupuncture that is no more than a placebo. The reality is that there is a growing scientific literature that concludes that acupuncture should be considered as treatment option for patients willing to undergo this treatment. Here is a sample of that literature:

Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain. (2015). Annals of Internal Medicine.
* In this study 517 patients were recruited and pain was assessed using the Northwick Park Questionnaire (NPQ). At the 12-month mark, patients who received acupuncture had a to significant reductions in neck pain and associated disability compared with usual care.

Acupuncture for Chronic Pain. (2012). Arch Intern Med Archives of Internal Medicine.
* This was a large meta-analysis found pain scores improved through acupuncture by 0.23 standard deviation (SD) for neck pain and back pain. In this paper researchers looked at all accumulated randomized controlled trials in examining how acupuncture fared in treating people with chronic pain. “Not only did acupuncture work better than no acupuncture control groups, there were significant differences between acupuncture and sham acupuncture.”  (This would suggest that not all benefits are placebo)

Acupuncture for Chronic Pain. (2014). JAMA.
* For chronic headaches, a large meta-analysis found an improvement of 0.15 SD in pain scores with acupuncture when compared with sham acupuncture and 0.42 SD in patients receiving no acupuncture

Acupuncture for patients with chronic neck pain. (2006). Pain
* This was a large study of 14,161 patients, that concludes that treatment with acupuncture added to routine care in patients with chronic neck pain was associated with improvements in neck pain and disability compared to treatment with routine care alone.

...and what does The Cochrane Collaborative say about acupuncture for neck pain?

The Cochrane Reviews are considered by many to be the gold standard when it comes to research because they tend to be more rigorous, transparent, independent, and up-to-date than other reviews. Using the Cochrane reviews as a benchmark for clinical evidence there seems to be compelling evidence that when acupuncture is used as part of an evidence based treatment it can be effective for a number of neck related conditions including: tension type headaches, neck pain and migraines.

“Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.”
— The Cochrane Review: Acupuncture for migraine prophylaxis

Acupuncture for the prevention of tension-type headache.
2016. Cochrane Database of Systematic Reviews.

Acupuncture for neck disorders. 
2016. Cochrane Database of Systematic Reviews.

Acupuncture for migraine prophylaxis. 
2009. Cochrane Database of Systematic Reviews.

A new hope

Moving forward, it would be refreshing to see the conversation progress beyond "Acupuncture is a placebo because...these blog posts say so", for this to happen there are still a number of common misconceptions about acupuncture that should be addressed, namely:

  • Medical acupuncture is not an oxymoron, it is a treatment approach rooted in science.
  • Placebo acupuncture is often a misnomer, that still involves the insertion of acupuncture needles.
  • There is a growing body of scientific literature that supports the use of acupuncture.

The RMT Education Project
"Starting The Conversation"