published 9/25/07
Tantalizing Research About Acupuncture For Low Back Pain
Compelling new acupuncture evidence … with a twist ending
by Paul Ingraham, Vancouver, Canada MOREclose
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
Credentials and qualifications
I am a writer and retired Registered Massage Therapist (unusually well-trained for a massage therapist, a 3000-hour program). I’m almost done with a Bachelor of Health Sciences degree. I am a peer reviewer for The Natural Standard, and a copyeditor for Science-Based Medicine. My most important qualification is more than a decade of workaholic post-graduate study, clinical experience, and constant conversations with readers from around the world, including many experts who have provided countless suggestions and criticisms.
For more information, see: Who Am I to Say? More information about my qualifications, credentials and professional experiences for my readers and customers.
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In 2005, the Annals of Internal Medicine looked at all the available scientific evidence through to that year and grandly concluded, “Acupuncture effectively relieves chronic low back pain,” but added that, “No evidence suggests that acupuncture is more effective than other active therapies.”
Well, that evidence has arrived. Sort of.
The problem with earlier research is that it had never been controlled. And that’s not a minor problem — “controlling” research by comparing a therapy or medicine to a fake is extremely important. The methodical Germans made note of this, writing that acupuncture has “never been directly compared” with a placebo or with conventional therapy. So they did it. The results were just published in Archives of Internal Medicine. It literally constitutes the first ever controlled study of acupuncture for back pain. Exciting!
This was a big study (good sample size), and extremely well designed. Looks to me like they really put all past research to shame: a “randomized, multicenter, blinded, parallel-group trial.” Phew. That’s all very good. And the results are just so … tantalizing! There were two clear, contradictory findings:
- Both acupuncture and sham acupuncture were better than conventional physical drugs, physical therapy, and exercise.
- And … wait for it … acupuncture was no better than sham acupuncture.
Yes, you read that correctly: acupuncture was no better than a sham … but both acupuncture and the sham were better than conventional therapy. Ouch! Not a good morning to be a physical therapist! Or an acupuncturist! Sort of!
This is a big, weird deal. It’s both a significant and strange package of good and bad news for everyone concerned.
comic strip by cectic.com
My interpretation of the evidence is simple: as we know perfectly well from countless other sources, the expectation of positive outcome, simple optimism, is by far the most significant factor in healing from back pain. People who believe that they are going to get better, get better. (For instance, see Schultz.) And people who receive acupuncture — the real thing, or a clever imitation — simply feel better cared for, while conventional therapies simply fail to reassure.
Patients are cynical about conventional therapies. Believe me! I know. I see it every day. It’s why alternative health care professionals have busy practices.
Expectation of positive outcome is by far the most significant factor in healing from back pain.
But patients should obviously now be cynical about acupuncture, too. The authors of the study say the lack of difference between acupuncture groups “forces us to question the underlying action mechanism of acupuncture and to ask whether the emphasis placed on ... traditional Chinese acupuncture points may be superfluous.” Yes, rather!
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