The Evidence for Acupuncture

Acupuncture is an effective medical therapy.  I know this for many reasons.  I use acupuncture in practice to help a number of afflictions. We all know acupuncture has been around for a long time and that is has been controversial in modern medicine for not standing up to scientific rigour.  But like many other modalities that eventually get adopted into the mainstream medical realm, so too is acupuncture taking that place, as an effective, and now well studied therapy. Surgeons are recommending it post surgery, physiotherapists use it readily for musculoskeletal problems, psychiatrists recommend it for depression, and reproductive endocrinologists tell their patients to try it to get pregnant.  To bolster it’s use in modern medicine, we now have 5 Reviews (Cochrane Reviews and other Meta-Analyses) proving its worthiness.

What’s been the problem with studying acupuncture so far?  Before 2010, Systematic Reviews for acupuncture had liberal eligibility criteria – meaning they included RCTs with flaws, bias, and other factors reflecting low quality of study.  The conclusion of these reviews was then that no conclusions can be made since the studies were of poor design.  Inconclusive might as well be a four-letter-word in science.  It’s not good enough to use when defending the use of any therapy.  But now we have a few Reviews that have only included high-quality RCTs. The one I am most excited about is a Review done by the Archives of Internal Medicine in 2012 called Acupuncture for Chronic Pain: Individual Patient Data Meta-Analysis by Andrew J. Vickers et al.

The authors wanted to avoid any studies that have previously been done that didn’t stand up to significant scientific scrutiny in the studies and would fail rigorous tests of their methodology, keeping only what are considered high-quality RCTs.  Other criteria they mandated for inclusion in the Review were that the trials compared acupuncture against either no acupuncture or what’s called sham acupuncture (the placing of needles in the wrong spots or only superficial placement of the needles or a needle that doesn’t penetrate the skin but retracts back into the handle or laser pointer acupuncture).  They looked at studies treating neck pain, shoulder pain, osteoarthritis or chronic headache where the problem existed for longer than one month and the treatment lasted longer than one month.  They also ensured the studies provided adequate allocation concealment and asked all the study principle investigators to submit their raw data so they could confirm data accuracy.  In total the Review covered just under 30 high-quality studies with a test population of just under 18,000 people.  Just to be that much more unbiased, they even took out the two studies of very high-quality that showed a very significant benefit of acupuncture vs the control because their results were so far beyond the average of all the other studies that also showed acupuncture was effective.

After all that painstaking Reviewing Andrew and co. concluded that they found statistically significant differences between both acupuncture vs sham and no-acupuncture for ALL pain types studied calling it “of major importance for clinical practice.”  Thanks to their Review (and 4 others) we can say with greater certainty that acupuncture works.  They report clear and robust differences in favour of acupuncture and that patients and practitioners are valid for considering acupuncture clinically relevant.  Now we just have to better understand how acupuncture works and whether we can find robust evidence to show that it does for otherwise-not-so-physical concerns like mood disorders and fertility.

Study Reference: Vickers, A. et al.  Acupuncture for Chronic Pain. Individual Patient Data Meta-Analyses. Arch Intern Med. 2012; 172(19): 1444-1453.

4 Other Reviews that reach similar conclusions

Manheimer E, ChengK, Linde K, et al. Acupuncture for peripheral joint osteoarthritis. Cochrane Database Syst Rev. 2010;(1):CD001977.

Eastern and Western Acupuncture >