Nav: Home

Should doctors recommend acupuncture for pain?

March 07, 2018

Some see acupuncture as a safe alternative to drugs, while others argue there's no convincing evidence of clinical benefit and potential for harm. So should doctors recommend acupuncture for pain? Experts debate the issue in The BMJ today.

Acupuncture is a safe alternative to drugs for chronic pain, argues Mike Cummings, Medical Director of the British Medical Acupuncture Society and Associate Editor of the journal Acupuncture in Medicine, published by BMJ.

In the US, acupuncture is recommended for back pain, but in the UK, it is no longer included in the National Institute for Health and Care Excellence's (NICE) guidelines for low back pain, although it remains in the NICE guideline on headaches, he explains.

The biggest and most robust dataset for acupuncture in chronic pain comes from a review of data from 20,827 patients, showing moderate benefit for acupuncture compared with usual care, but smaller effects compared with sham acupuncture, he writes. Importantly, it also shows that 85% of the effect of acupuncture is maintained at one year.

Further evidence that sham acupuncture is linked to better quality of life compared with usual care for patients with chronic pain "should urge a more flexible approach from guideline developers," adds Cummings.

He acknowledges that acupuncture "seems to incur more staffing and infrastructure costs than drug based interventions, and in an era of budget restriction, cutting services is a popular short term fix." But argues that group clinics in the community "can provide more treatment at much lower cost."

Another challenge is the lack of commercial sector interest in acupuncture, he adds, meaning that it does not benefit from the lobbying seen for patented drugs and devices.

In summary, he says the pragmatic view sees acupuncture as a relatively safe and moderately effective intervention for a wide range of common chronic pain conditions.

"For those patients who choose it and who respond well, it considerably improves health related quality of life, and it has much lower long term risk for them than non-steroidal anti-inflammatory drugs. It may be especially useful for chronic musculoskeletal pain and osteoarthritis in elderly patients, who are at particularly high risk from adverse drug reactions," he concludes.

In a linked patient commentary, Kumari Manickasamy says acupuncture gave her hope when she had exhausted all avenues offered by conventional medicine for severe pelvic girdle pain during pregnancy.

She points out that there are few safe options for pain relief in pregnancy, and says women with pelvic girdle pain "have to strike a difficult balance between controlling their pain and risking harm to their child."

But Professors Asbjørn Hróbjartsson at the University of Southern Denmark and Edzard Ernst at the University of Exeter, argue that doctors should not recommend acupuncture for pain "because there is insufficient evidence that it is clinically worthwhile."

Overviews of clinical pain trials comparing acupuncture with placebo find a small, clinically irrelevant effect that "may be due to bias rather than acupuncture," they write.

Acupuncture enthusiasts often emphasise "pragmatic" comparisons between acupuncture and usual care. However, they argue that "unblinded pragmatic trials cannot differentiate possible true effects of acupuncture from placebo effects and bias." To inform us reliably of any causal relation between acupuncture and effect, "we need to focus on adequately blinded "explanatory" acupuncture trials," they say.

"If acupuncture is endorsed as a theatrical placebo we should be discussing the ethics of placebo interventions, not the elusive effect of acupuncture," they add.

They also point to harms of acupuncture as well as costs to the NHS, which they say may amount to £25m (€28m; $34m) a year. "Health services funded by taxpayers should use their limited resources for interventions that have been proved effective."

"After decades of research and hundreds of acupuncture pain trials, including thousands of patients, we still have no clear mechanism of action, insufficient evidence for clinically worthwhile benefit, and possible harms. Therefore, doctors should not recommend acupuncture for pain," they conclude.
-end-


BMJ

Related Chronic Pain Articles:

Molecular link between chronic pain and depression revealed
Researchers at Hokkaido University have identified the brain mechanism linking chronic pain and depression in rats.
How chikungunya virus may cause chronic joint pain
A new method for permanently marking cells infected with chikungunya virus could reveal how the virus continues to cause joint pain for months to years after the initial infection, according to a study published Aug.
Gastroesophageal reflux associated with chronic pain in temporomandibular joint
Gastroesophageal reflux (GERD) is associated with chronic, painful temporomandibular disorder -- pain in the temporomandibular joint -- and anxiety and poor sleep contribute to this association, according to a study in CMAJ.
One step closer to chronic pain relief
While effective drugs against chronic pain are not just around the corner, researchers from Aarhus University, Denmark, have succeeded in identifying a protein as a future potential target for medicinal drugs.
Gut bacteria associated with chronic pain for first time
In a paper published today in the journal Pain, a Montreal-based research team has shown, for the first time, that there are alterations in the bacteria in the gastrointestinal tracts of people with fibromyalgia.
Nearly 5.4 million cancer survivors suffer chronic pain
A new report finds about one in three cancer survivors (34.6%) reported having chronic pain, representing nearly 5.4 million cancer survivors in the United States.
New opioid speeds up recovery without increasing pain sensitivity or risk of chronic pain
A new type of non-addictive opioid developed by researchers at Tulane University and the Southeast Louisiana Veterans Health Care System accelerates recovery time from pain compared to morphine without increasing pain sensitivity, according to a new study published in the Journal of Neuroinflammation.
New target for chronic pain relief confirmed by scientists
A research group at Hiroshima University observed a potential new target for chronic pain treatment.
Menopause symptoms nearly double the risk of chronic pain
In addition to the other health conditions affected by estrogen, it has also been shown to affect pain sensitivity.
Research finds opioids may help chronic pain, a little
In a study published today by the Journal of the American Medical Association (JAMA), McMaster University researchers reviewed 96 clinical trials with more than 26,000 participants and found opioids provide only small improvements in pain, physical functioning and sleep quality compared to a placebo.
More Chronic Pain News and Chronic Pain Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Reinvention
Change is hard, but it's also an opportunity to discover and reimagine what you thought you knew. From our economy, to music, to even ourselves–this hour TED speakers explore the power of reinvention. Guests include OK Go lead singer Damian Kulash Jr., former college gymnastics coach Valorie Kondos Field, Stockton Mayor Michael Tubbs, and entrepreneur Nick Hanauer.
Now Playing: Science for the People

#562 Superbug to Bedside
By now we're all good and scared about antibiotic resistance, one of the many things coming to get us all. But there's good news, sort of. News antibiotics are coming out! How do they get tested? What does that kind of a trial look like and how does it happen? Host Bethany Brookeshire talks with Matt McCarthy, author of "Superbugs: The Race to Stop an Epidemic", about the ins and outs of testing a new antibiotic in the hospital.
Now Playing: Radiolab

Speedy Beet
There are few musical moments more well-worn than the first four notes of Beethoven's Fifth Symphony. But in this short, we find out that Beethoven might have made a last-ditch effort to keep his music from ever feeling familiar, to keep pushing his listeners to a kind of psychological limit. Big thanks to our Brooklyn Philharmonic musicians: Deborah Buck and Suzy Perelman on violin, Arash Amini on cello, and Ah Ling Neu on viola. And check out The First Four Notes, Matthew Guerrieri's book on Beethoven's Fifth. Support Radiolab today at Radiolab.org/donate.