BMJ report questions pain relief of acupuncture

The Australian Science Media Centre has rounded up scientific opinion on the British Medical Journal paper questioning the effectiveness of acupuncture based on pain trials of 3000 people:

Access the research on the BMJ website. Contact the SMC if you would like to track down comment from local acupuncture experts.

RAPID ROUNDUP: Pain relieving effects of acupuncture are limited (BMJ) – Experts respond

UK researchers have found the pain relieving effects of acupuncture compared with placebo are small and seem to lack any clinical relevance, questioning both the traditional foundation of acupuncture and the prevailing theory that acupuncture has an important effect on pain in general. The study reviewed clinical trials of acupuncture treatment for pain that included acupuncture, placebo acupuncture, or no acupuncture and found only a small analgesic effect of acupuncture that the authors say seemed to lack clinical relevance and could not be clearly distinguished from bias.

Professor Marc Cohen is Professor of Complementary Medicine at RMIT University in Melbourne. He has a medical degree and a PhD in traditional Chinese medicine and is an expert advisor to the Therapeutic Goods Administration’s Complementary MedicineEvaluation Committee.

“This study is severely limited by the fact that there is no definition for placebo acupuncture – or even any standardised form of acupuncture. Unlike drug treatments for pain, it is very difficult to blind acupuncture trials – doctors know when they are giving it and patients generally know when they are receiving it. More…

Pain is not a single entity and most trials have been done on chronic pain, which is a complex condition. The problem is that placebo acupuncture still works and trials see a reduction in drug therapy with either placebo or real acupuncture. Pain involves both mental and physical aspects but patients don’t care about separating out physiological and psychological components – they want pain relief and acupuncture seems to provide this.

A NHMRC funded multi-centre trial of acupuncture for acute pain relief in emergency departments is currently underway though RMIT University and two Melbourne hospitals.”

Professor Charlie Xue is Head of the Division of Chinese Medicine at the School of Health Sciences, RMIT University

“Madsen and colleagues raise a very important question concerning whether or not acupuncture is of significant benefit in the management of pain through a systematic review of 13 trials. Unfortunately, however, the review is not conclusive and further investigation is needed.

For any systematic review of this nature, readers need to be extremely cautious about the quality of the studies that were included. In this review the quality of the studies varies widely. Chronic pain is a complex condition. This review lumps headache, knee pain, back pain and pain experienced during colonoscopy in one study and this limits the rigor of any conclusions.

The included studies employed various forms of acupuncture procedures and different frequency and duration of treatment, which further limits the value of any findings.

Acupuncture represents a broad range of practices that may use manual needling or electro-acupuncture on different points. This review failed to inform readers whether the treatments used in these studies are consistent and replicable. The question raised by the authors will need to be answered by multi-centre, larger sample size trials. However there are still no validated placebo controls for acupuncture and no standardised treatment protocols for specific conditions, which limits the ability of systematic reviews to produce conclusive results.”

News wrap:

Press Association: Acupuncture pain relief questioned