The past fortnight I’ve been recovering from having my tonsils removed – something that I am now convinced should happen when you’re young enough to think that jelly and icecream is a fabulous treat, and have quite a lot more ‘bounce-back’ than I had. Not a pleasant experience, but hopefully one that will pay off in time. This coming fortnight I’m going to Rotorua to the NZ Pain Society Annual Scientific Meeting. It’ll be a busy time because I’m giving three papers and running the occupational therapy workshop – oh and a bit of sight-seeing as well, with any luck. I was a kid last time I spent any longer than a night in Rotorua, and it’s a truly awe-inspiring place if you love geothermal activity and culture.
Despite the busyness, an article that caught my eye just yesterday is this one: Acupuncture: What Does the Most Reliable Evidence Tell Us? written by Edzard Ernst, it reviews several Cochrane reviews of acupuncture in an attempt to summarise the state of play in terms of evidence for acpuncture. First a proviso – it is very difficult, if not impossible to use a double-blind methodology in acupuncture research, so it’s not an easy procedure to adequately investigate. At the same time, apologists for acupuncture are often unswayed by ‘evidence’ and prefer to rely on anecdote or opinion, so perhaps this is not as much of a problem as first thought (hmmph!). Suffice to say, at least one new guideline for low back pain endorses the use of acupuncture, so the jury is still out for some at least…
Anyway, in this paper, Ernst reviews 32 Cochrane reviews, twenty-five of them failed to demonstrate the effectiveness of acupuncture. Five reviews arrived at positive or tentatively positive conclusions and two were inconclusive. The conditions ranged from headache to nausea – and chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache were the only conditions in which evidence was found.
The reasons, however, for bringing this study to your attention are that Ernst spends some time discussing the limitations of Cochrane reviews – something which is worth debating, given the contradictory results for things like CBT for low back pain, and injection therapy for low back pain. Although Cochrane reviews represent a synthesis of evidence on a topic, the methodology is not fool-proof, and over time, it can be seen that reviews differn in their recommendations. I don’t think this is surprising because this is the nature of science – as evidence is gathered, I’m sure that some of the things I’ve felt strongly about will be found to lack support over time. Similarly, it won’t surprise me at all to find that almost all Cochrane reviews suggest further research is required, that few studies are methodologically strong, and that conclusions drawn are preliminary.
Ernst also discusses whether it is worthwhile continuing to carry out studies on the use of acupuncture – surely after some time, it’s useful to indicate when science simply doesn’t back a treatment (I keep thinking of homeopathy in this regard). Ernst suggests that perhaps acupuncture may not yet be at this point saying ‘Opinions may differ regarding whether further trials of acupuncture are warranted. In my view, we should clarify whether or not the clinical effects of acupuncture are specific or nonspecific. This means that we should consider conducting trials comparing real acupuncture with placebo acupuncture using the non-penetrating devices that recently became available. Such comparisons should be conducted in those clinical areas where the current evidence is most convincing.’
Unfortunately, proponents of acupuncture, like anyone who has invested time and money, and truly ‘believes’ in its usefulness, probably won’t be swayed by the findings in this review. And that, to me, is the saddest thing of all – because patients may persist with a treatment that has ‘non-specific’ effects only. At the same time, their belief that something outside of them is responsible for their recovery – and fail to develop confidence (a) in their own ability to cope with their pain and (b) that pain is tolerable, albeit unpleasant.
I’ll post intermittently over the next fortnight – in the meantime, if you’ve enjoyed this post, and want to read more – there’s a few archived posts on here, just use the search button to look for a topic, or the category search to the left, or just below it, the tag cloud. There’ll be something there to chew over!
Ernst, E. (2009). Acupuncture: What Does the Most Reliable Evidence Tell Us? Journal of Pain and Symptom Management, 37 (4), 709-714 DOI: 10.1016/j.jpainsymman.2008.04.009