Acupuncture

Hi All,

A new Cochrane Review on acupuncture. It’s probably all placebo effect.

[size=130]Acupuncture remains a moot point[/size]

ACUPUNCTURE can help banish headaches and migraines, research has found. But fake acupuncture — that is, sticking random pins in people without regard to traditional “energy flows” and “pressure points” — works just about as well.

The results suggest that the technique may work only because people believe in it …

Scott 8)

Either that, or, “[a]nother theory is that any pinprick triggers the release of pain-numbing endorphins”.
Personally I believe either in the above or the placebo effect. This whole yin/yang and energy flow is just a bunch of mumbo jumbo as far as I’m concerned. :slight_smile:

I just finished a 3-month trial with an oriental medicine practitioner. She used chinese herbs and acupuncture in my treatment plan. I think she is great and can help a lot of people. Unfortunately, she wasn’t able to help me very much with my oddball symptoms. I don’t believe in the yin/yang and energy flow mumbo jumbo either. But, I do believe chinese medicine can be effective for biological reasons.

The one thing I can say for certain, if it is done correctly, is that acupuncture can provide temporary relief from headache pain. Headaches are not a primary symptom for me, but I do go through periods where I will have a mild to moderate headaches every day. Once, I went to see her while this was going on. She focused most of the needles on my head. I asked her to put needles in the pressure points in my eyebrows. I think that was the trick. It hurt like hell when they went in, but I didn’t have another headache for almost an entire month after that.

Bottom line, I don’t recommend acupuncture for vertigo and the other non-headache symptoms of migraine. But it may help with headaches. For me, I think it may have made a small difference temporarily, but not enough to warrant the cost.

This whole yin/yang and energy flow is just a bunch of mumbo jumbo as far as I’m concerned.

I totally agree. There’s no evidence to support any of it. Astrology and homeopathy is all the same woo in my book as well.

I have used acupuncture recently combined with a certain head massage and herbs. The herbs made me feel worse so ditched that (surprise, surprise) but I think it was the massage of the occipital muscles over a four solid days that fixed me up so much. The area was full of muscle spasms. And perhaps the needles all over my head released some pain-numbing endorphins.

Scott 8)

acupunkture relaxes muscles and body. I dont think it matters that much where you put the needles, but I used it a bit when I had inflammation in my underarms. It helped, because it made blood flow much better to my arms and hands.

It has effect(s) Im sure, but not to the extent some would say. For migraines Id think it would do as much or maybe even less than a good massage.

Neurologist Steve Novella gave an analysis today of the acupuncture debate and the study described above with regards to migraine. He makes many very good points and this guy is totally grounded in science-based medicine like no other. I still don’t know if acupuncture really does a damn thing but the few times I’ve tried it, I sometimes got benefit from it while other times it did nothing. And even then I couldn’t be certain if it was the needles doing anything at all or just the great relaxing massage and the doctor’s insistence that he could “heal” me. He was very persuasive too which probably loaded me up with placebo effect.

Full blog post here for those interested: theness.com/neurologicablog/?p=532

Novella writes the following:

— Begin quote from ____

Let’s look at the 2009 Cochrane review of acupuncture for migraine headache. The lead reviewer is Karl Lunde whose affiliation is given as Centre for Complementary Medicine Research, Department of Internal Medicine II, Technische Universitaet Muenchen. The authors of the review broke the eligible trials into three types - acupuncture compared to no intervention, acupuncture compared to standard treatment, and “true” acupuncture compared to “sham” acupuncture.

The results are not difficult to guess. The first two groups showed a benefit from acupuncture. Of course they did - these were unblinded studies. It is already well-established that most symptomatic interventions, acupuncture included, will have a perceived placebo effect, most notably for pain symptoms.

The only comparison any science-based practitioner should care about are the blinded comparisons between true and sham acupuncture, for which the reviewers found: “Fourteen trials compared a ‘true’ acupuncture intervention with a variety of sham interventions. Pooled analyses did not show a statistically significant superiority for true acupuncture for any outcome in any of the time windows, but the results of single trials varied considerably.”

Right - no effect when looked at together, with lots of variability in individual trials. This is exactly the pattern we see for treatments that have no real physiological effect.

Now again - imagine a pharmaceutical company going to the FDA with this evidence for their new anti-migraine drug. The unblinded trials show a benefit over doing nothing or standard care. But the blinded placebo-controlled trials show no effect. The FDA would tell them to take a hike.

This, by the way, is an excellent example of the difference between evidence-based medicine and science-based medicine. SBM considers prior-plausibility, which is low for acupuncture, and also has a greater respect for the vagaries and limitations of clinical trials. EBM, at least as practiced by Cochrane, in my opinion and that of others, puts too much faith in clinical trials.

But even according to Cochrane’s own criteria, this conclusion is not justified. The principles of EBM state that better quality evidence trumps lower quality evidence. With regard to acupuncture and migraine, the best evidence is all negative, while weaker evidence is mixed if overall positive. The best evidence (blinded controlled trials) says that there is no effect from acupuncture for migraine. That should have therefore been the conclusion of reviewers.

— End quote

He also says this about complimentary and alternative medicine (CAM) which I think is right on the mark:

— Begin quote from ____

First [the question] treats “alternative medicine” as if it were one entity. The questioner claims that “alternative medicine works,” but this is a meaningless statement. Which CAM modalities work for which indications? Each modality has to be considered in its own right. This is precisely why the category of CAM itself is counterproductive and unscientific. It exists only to promote modalities which are not supported by science and evidence, because if they were they would not be “alternative” medicine, they would be medicine.

— End quote

Novella remarks, however, that “There is therefore no reason to think that acupuncture has any specific role to play in migraine therapy”. I don’t agree with this statement. As long as a person realises it isn’t going to cure the condition and is not sold false hopes or ripped off, I can’t see what’s wrong with dropping 50 bucks every now and then if someone comes out of the session feeling more relaxed and maybe even migraine-free for a few days. Any therapy that promotes relaxation can’t hurt when it comes to migraine. Personally, I’ll be skipping the pins from now on and stay with the massage.

Scott :slight_smile:

Maybe acupuncture is relaxing because you’re lying flat on a bed for an hour. You can do that at home for free!

I give massage the big thumbs up - they’ve usually got some pleasantly fragrant oils or candles burning, soft lighting, hauntingly beautiful music (or whale clicks or Gregorian chants) in the background and it feels great. Throw in a bottle of wine and it sounds like a romantic date really… :slight_smile:

Victoria

I think it gives some relief whether it is tension relief, muscle relief, or relaxation. No scientific evidence but I think it does help me. My doctor recommends it but says there is no scientific evidence but a lot people get relief. It is an add-on to medication, like diet and excercise is in my opinion.

Like everything else (natural healing, etc), this may not work in OUR case (MAV), but can for other problems. I’m just saying we shouldn’t poo-poo everything (meaning the other comments above too about energy flow) that isn’t scientifically grounded (and keep in mind, I am a proponent of scientifically grounded research so I can say this!) :wink:

Hi Bonnie,

Definitely don’t want to poo-poo everything. However, I think we need to discuss all of this stuff occasionally so we know what the story is with all of these treatments as best we can. I came into MAV not knowing anything 6 years ago, and consequently wasted far too much money on junk therapies. I just stupidly never did any investigation back then and got sucked into months of chiropractic (cost me over a thousand bucks), then about 4 rounds of homeopathy @ $80 a pop (I must have had rocks in my head to do that one), and then the icing on the cake was the Migraine Program last year. If only I had known this was migraine in 2004 (and even before that). That knowledge alone plus some education on woo therapies would have saved me a king’s ransom.

Scott :slight_smile:

Hi Scott,

I hear ya. :smiley: I just wanted to make clear just because something doesn’t work in our case, it doesn’t mean it won’t work for another. It’s easy to just group them all together and say nothing that is scientifically-proven is bunk. One can believe in herbal and Asian remedies while understandning that they may not work in our case.

Cheers, Bonnie

Hey Bonnie,

I totally understand what you’re saying here and that’s cool. For me though, as I’ve researched more deeply into complementary and alternative meds (CAM) over the last 6 months, the more I think there’s not much in it. I really think the whole movement has mastered the use of language to make us think it is effective. The CAM industry generates billions of dollars a year as a result. However, I believe there are some herbs that really do have an effect. Unfortunately my experience is that when there is an effect it’s messy (St John’s Wort for example). But you have a point with, say, other health issues like IBS for example. Using probiotics or Slippery Elm probably helps relieve the acute symptoms until it blows over. I think migraine is a very different animal though and requires the big guns to deal with it. I really like the way Steve Novella says it: if one of these CAM treatments was really truly effective, scientists would have extracted the active molecule(s) by now and it would no longer be considered “alternative” medicine but just medicine.

Cheers … Scott :slight_smile:

Absolutely. The scams out there are too numerous to count! MIgraine and MAV are totally a different animal as you say, Scott, no doubt. Funny you mention IBS, as that is a great example of how herbal medicines can help. I have found great success with peppermint/fennel/ginger caplets and tea for my stomach and digestive problems. Just depends on what your issue is I suppose. I also believe that acupuncture, meditation, T’ai Chi, massage, and other related areas have usefulness and validity as herbal use. This does NOT mean, however, that I think they will “cure” someone; they are supplementary.

A new and large study, just published (discussed in Time magazine), comparing true acupuncture, sham acupuncture, and “fake” or placebo acupuncture (using tooth picks that do not penetrate the skin) in chronic back pain. The results - no difference between the groups. Previous studies show that the precise placement of needles has no effect. A good example of the placebo effect across the board.

http://www.time.com/time/health/article/0,8599,1897636,00.html?cnn=yes

“After eight weeks, twice the number of patients getting any type of acupuncture — whether it was customized, standard or sham — reported improvements in their ability to function, such as walking or going up and down steps without pain, compared with those sticking with traditional care.”

Scott 8)

Went that route in 2006. It would stick (pun intended) for a day or so…then…back to reality.

Acupuncture/acupressure has been scientifically proven to work in some cases. For example, it has been proven in studies that pressure on the Pericardium (P6) point in the wrist prevents (or at least eases) nausea and vomiting. I have got a lot of benefit from the nausea caused by my migraine by wearing those travel sickness wrist bands you get from the chemist.

Becky

Hi Becky,

Let’s look at the 3 most recent well-designed, double-blinded, randomised controlled trials (the best scientific evidence available). The first one published in the Lancet in 2006 involved 960 people who were given 10 treatments each over 26 weeks for migraine. There were 3 groups: real acupuncture, sham or fake acupuncture, and standard treatment.

The authors concluded, “Treatment outcomes for migraine do not differ between patients treated with sham acupuncture, verum acupuncture, or standard therapy”. Sham and real acupuncture did not differ!

In 2008, this one appeared in the Clinical Journal of Pain: 37 patients given 16 sessions over a period of 3 months. There was a real and sham acupuncture group. The conclusion was this: “Individualised treatment based on traditional Chinese medicine plays a role in preventing migraine attacks. Nevertheless, sham acupuncture had similar effects”. There was no difference between sham and real acupuncture in this study. The authors in this study, however, tried to spin the results by saying that the sham acupuncture was also effective. This is ridiculous because you cannot conclude that your placebo treatment also worked - no difference between treatment and control means no effect.

And then there was the recent one that was published in Archives of Internal Medicine which involved 638 adults who received 10 treatments over 7 weeks. There were 3 groups randomised to individualised acupuncture, standardised acupuncture, simulated acupuncture, or usual care. They concluded, “Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits. These findings raise questions about acupuncture’s purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide physiologically important stimulation or represent placebo or nonspecific effects”.

There was no difference between the groups. Twirling toothpicks on their backs gave the same result yet they question acupuncture’s mechanism of action when they should be questioning if acupuncture works at all. Dr. Karen Sherman came much closer to the truth when she said this, “Maybe the context in which people get the treatment has effects that are more important than the mechanically induced effects”. In other words, an induced placebo effect.

Most all studies showing a benefit from acupuncture are unblinded. As neurologist Steve Novella reports, “It is well-established that most symptomatic interventions, acupuncture included, will have a perceived placebo effect, most notably for pain symptoms.”

But, as I’ve said before, if a person doesn’t mind coughing up $90/week for each session and feels better from it than go for it. Just don’t let them tell you that they can cure you if you keep coming for months on end or that your chakras are out of balance.

Scott :slight_smile:

Hey there -

I have to agree with Becky here. When I was pregnant those bracelets saved my life, whether real or imagined. They saved me on a cruise and with my history of motion sickness, I have to doubt that a placebo effect was at work here. I was sure that they would not help me as a matter of fact and was carrying pockets full of pills anticipating failure of the bracelets.

I turned to acupuncture twice in my life with very serious problems and had very serious results. One was with my infertility and the other was addressing my husband’s Ulcerative Colitis. I started with acupuncture and herbs (perhaps it was the herbs) and I got pregnant right away. Now I miscarried that pregnancy but got pregnant right away soon after. My husband, who had been plagued for YEARS with horrible bouts of Ulcerative Colitis flare ups, and I mean HORRIBLE, has never been bothered as significantly again. He did change his life style which was a major contributor most likely to his condition and I know Scott, from our conversations, you believe this to be probably the main reason for his healing. However, sometimes I just can’t “science” everything to death. I believe in things beyond our understanding - science doesn’t allow for this. So while acupuncture hasn’t solved my migraines, I don’t believe it to be worthless regardless of research.

I understand the reason for sharing this information. I think all of us have spent a lot of money on “cures” that just really aren’t cures. Acupuncture can be one of those promised cures that most likely isn’t going to cure our MAV. I’ve been actively trying acupuncture since this all began and I still have it. So it obviously isn’t a cure for me. My point for writing this is that I do believe in mystery and scientific data doesn’t allow for that.

Hope this makes sense… It’s early in the morning here and my thoughts are like square blocks - no flow going yet.

Best -

Molly

I agree with you Molly on the accupuncture… there is some research on it. Why else would the average age in China be like 150… :smiley:

My wife used Accupuncture as well and we are having twins… I use it 2 times a week and it does help me along with my medication… I think there are a ton of scams and hoaxes out there. Accupiuncture does not cure what we have but if it gives us some relief I am not against it.

Dr Newman also is not against it. He actually refers an accupncturist for Migraines for children that have Migraines. He does not want 10 year old on a trial of medications…

I know the medication is what helps me but accupuncture is an extra like a massage, steam room , etc… But like Scott said it can be expensive so dont look for a cure

Hey Molly,

My point for writing this is that I do believe in mystery and scientific data doesn’t allow for that.

Wow, that’s just so not true. Science absolutely allows for mystery. I can’t believe you said that! In fact, I would argue that science takes us to and reveals the REAL and TRUE mysteries in this world and has revealed things we would have had no idea about otherwise. The list is staggering … the more that is discovered, the more mysterious and wonderful it gets. If we just look at the things discovered about the cosmos alone through science, it boggles the mind. Imagine if we didn’'t have science to learn about the universe? There would be no Hubble telescope for example. That telescope alone has completely rewritten the textbooks about the universe over the last 20 years. There’s been enough real mystery discovered there alone to sink a ship! What a bore it would be without such great scientific accomplishments. We’d still be in awe of astrology and astrologers telling us all kinds of nonsense about what the stars and universe were all about in their superstitious opinions. We’d be walking around still thinking the earth was flat, that the sun rotated around us, and that the gods were angry whenever there was an eclipse. No thanks. To me there’s no mystery or excitement in irrational made up stuff like that with no basis in reality. The real stuff makes it pale by comparison. And if that’s what “sciencing” everything to death :lol: means, then bring it on I say. It’s too much fun to ignore.

Hey I’m not saying not to use acupuncture if you feel it helps whatever it is you’re wanting to sort out. Even it if it is just one big fat placebo, I’d be willing to pay 30 or 40 bucks for 3 days of placebo relief from a headache. Using the sort of tests discussed in the posts above isn’t necessarily science so to speak. It’s just a smart and logical way to tease out what the hell is really going on and is a clever way to remove bias and placebo effect to get at the truth.

Cheers … Scott :slight_smile:

EDIT: I hope you don’t think I hate acupuncture. Not at all. You know me … I just go nuts when they start telling me it’s working on energy flows or chakras. Next time I hear that I’m going to ask the Chinese doctor to explain why twirling toothpicks on the skin accomplished the exact same thing.


EDIT II. This is off-topic but to add to my Hubble example I wanted to show you a BIG dose of real mystery thanks to science. Just take a look at some of these sensational pictures snapped by Hubble:

And for an even bigger mystery that scientists still can’t get their heads around check out this video presentation on Dark Matter. It was discovered by Hubble and accounts for some 22% of the universe. We can’t even see it!