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Sat, Dec 20, 2014

Dr. Kestner: Research: Real and fake acupuncture more effective than drugs for chronic pain

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A friend sent me a news story the other day. The headline read: Real and Fake Acupuncture More Effective than Drugs for Chronic Headaches. The article detailed how acupuncture has been shown to be more effective than medication in relieving chronic headaches.

Since I have been using acupuncture for over a decade and have seen many remarkable responses, this did not surprise me. There are many similar studies that show acupuncture is effective for pain in the neck, back, knees, shoulders, wrists and other places. There are also studies showing benefits for many other conditions.

The interesting point to me in the story was that the “fake acupuncture” was also more effective than the drugs. I wondered what the researchers were calling fake acupuncture. That’s one of the difficulties in trying to research something like acupuncture; it is nearly impossible to have a placebo group as part of the study.

It is often necessary to have what is known as a placebo group in a study of effectiveness so that the effect of the intended treatment can be judged against the effect of a sham treatment. Otherwise, the effects could possibly be due to the participants’ expectations of receiving the treatment.

Typically in studies to test treatments such as drugs, participants would be randomly divided into three or more groups; one group receiving the new drug, one receiving a product that resembles the new drug, and one receiving no product at all. The participants receiving products would not know whether they were given the real or the fake.

The problem with trying to conduct this kind of research with acupuncture is that it is very difficult to devise fake acupuncture treatment. In some studies, participants will be needled in known acupuncture points for the real group, and the sham group will be needled in areas that are not labeled as known points.

The first problem with this design is that in addition to the 361 classic acupuncture points known for thousands of years, more than 600 additional points have been discovered. Additionally, everyone has dozens of unique acupuncture points called ah-shi points that vary in location. Trying to find a point that is not active in acupuncture energetics is very difficult.

The second problem lies in the fact that it is not conclusively known how large or how deep acupuncture “points” are. Some theorists hold fast to the concept that an effective point is very precise, about the size of a BB. Many modern clinical acupuncturists contend that the actual effective size of the points may be much larger. This would mean that needling “fake” points may be affecting true points without intending to.

Modern research methods are further complicated by variety in techniques. In many parts of the world, notably Japan, there are widely used acupuncture techniques that don’t actually involve inserting needles. I frequently use a Japanese acupuncture instrument called a teishin. This “needle” doesn’t actually pierce the skin. This procedure has been remarkably effective in many cases, with no piercing at all. Non-piercing, pressure-based techniques for acupuncture points predates using needles by thousands of years. I also use electrical microcurrent and laser devices to stimulate the points. Because of these widely variable techniques, random controlled trials (RCT’s) to test acupuncture are virtually impossible.

Meanwhile, other researchers are content to rely on the mountains of anecdotal evidence of the effectiveness of acupuncture. The evidence for effectiveness is strong enough for three branches of the military to spend the money and time to provide their doctors with acupuncture training. In February of 2009, the Air Force announced they had begun training combat doctors in the use of acupuncture because of its effectiveness in controlling pain. The Navy has been providing acupuncture in their hospitals for several years. The Navy also treats Marines.

It is interesting and perhaps indicative of Western arrogance that around the world, hundreds of millions of people have relied on acupuncture for thousands of years, and yet we Americans have to spend millions of dollars on testing before we will accept that it is effective.

Next week, seven things you need to do to prepare for spring!

Dr. Mark Kestner
mkestner@DrKestner.com
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