Acupuncture for Pets Now.

[WelshBloke]

If you can't figure out the difference, I can't help you.

No come on, why would sticking a very thin needle in your skin stimulate blood flow, nerves, muscles and connective tissue more than giving it a good rub?

 

[Mr. Pedantic]

If you can't figure out the difference, I can't help you.

It's a very good question. Show me how acupuncture compares in terms of physiological effect to sham acupuncture, or other forms of physical manipulation. Show me it's a real effect independent of practitioner presence. Show me it's not placebo.

 

[jagec]

Depends on how you define 'works'. It'll make everyone feel better all round. But it won't really improve much.

On the contrary, the placebo effect can produce marked, long-lasting improvements in a surprising number of cases. This has been well-studied.

 

[Capt Caveman]

It's a very good question. Show me how acupuncture compares in terms of physiological effect to sham acupuncture, or other forms of physical manipulation. Show me it's a real effect independent of practitioner presence. Show me it's not placebo.

Here's one study that compared acupuncture, sham acupuncture and normal therapy:

http://archinte.ama-assn.org/cgi/content/abstract/167/17/1892

Background To our knowledge, verum acupuncture has never been directly compared with sham acupuncture and guideline-based conventional therapy in patients with chronic low back pain.

Methods A patient- and observer-blinded randomized controlled trial conducted in Germany involving 340 outpatient practices, including 1162 patients aged 18 to 86 years (mean ± SD age, 50 ± 15 years) with a history of chronic low back pain for a mean of 8 years. Patients underwent ten 30-minute sessions, generally 2 sessions per week, of verum acupuncture (n = 387) according to principles of traditional Chinese medicine; sham acupuncture (n = 387) consisting of superficial needling at nonacupuncture points; or conventional therapy, a combination of drugs, physical therapy, and exercise (n = 388). Five additional sessions were offered to patients who had a partial response to treatment (10%-50% reduction in pain intensity). Primary outcome was response after 6 months, defined as 33% improvement or better on 3 pain-related items on the Von Korff Chronic Pain Grade Scale questionnaire or 12% improvement or better on the back-specific Hanover Functional Ability Questionnaire. Patients who were unblinded or had recourse to other than permitted concomitant therapies during follow-up were classified as nonresponders regardless of symptom improvement.

Results At 6 months, response rate was 47.6% in the verum acupuncture group, 44.2% in the sham acupuncture group, and 27.4% in the conventional therapy group. Differences among groups were as follows: verum vs sham, 3.4% (95% confidence interval, &#8211;3.7% to 10.3%; P = .39); verum vs conventional therapy, 20.2% (95% confidence interval, 13.4% to 26.7%; P < .001); and sham vs conventional therapy, 16.8% (95% confidence interval, 10.1% to 23.4%; P < .001.

Conclusions Low back pain improved after acupuncture treatment for at least 6 months. Effectiveness of acupuncture, either verum or sham, was almost twice that of conventional therapy.

 

[bradley]

I'm not a huge fan of acupuncture, as there are better ways to accomplish the same thing. However, cytokines, TGF-beta, PDGF, VEGF, Smad3 are all known scientific concepts and terms affected by something like acupuncture. It's pretty much just common sense.

 

[Gibsons]

Here's one study that compared acupuncture, sham acupuncture and normal therapy:

http://archinte.ama-assn.org/cgi/content/abstract/167/17/1892

Showing sham acupuncture works about as well as conventional acupuncture.

 

[Mr. Pedantic]

On the contrary, the placebo effect can produce marked, long-lasting improvements in a surprising number of cases. This has been well-studied.

Yes, in cases where physiological function can be plausibly and drastically modified by brain function. So for things like depression, pain, and some endocrine disorders, it may be of benefit. I doubt it would help for nerve impaction or trauma (as in the case of the OP article) or shrink a tumour.

Here's one study that compared acupuncture, sham acupuncture and normal therapy:

http://archinte.ama-assn.org/cgi/content/abstract/167/17/1892

1) All that showed is that it doesn't really matter where you stick the needles. It doesn't compare whether actually sticking the needles is required. I will refer you to the article below for an actual systematic review (not just one isolated study):

Yuan J, Purepong N, Kerr DP, Park J, Bradbury I, McDonough S. Effectiveness of acupuncture for low back pain: a systematic review. Spine (Phila Pa 1976). 2008 Nov 1;33(23):E887-900.

Basically, for no treatment protocol (acupuncture vs placebo, acupuncture plus conventional therapy vs placebo plus conventional therapy, and acupuncture vs conventional therapy) can it be reliably shown that acupuncture is better than placebo. For one arm, acupuncture plus conventional treatment vs conventional treatment alone, there appears to be effect. But we already knew this, and I do not see how this is different to comparisons between acupuncture vs no treatment. It's not placebo-controlled, therefore it has no real place in any discussion of efficacy or effectiveness.

Also noteworthy is that only six of 23 studies included were characterised as high quality. Noted in the review is the tendency for low-quality studies to consistently show a positive effect (probably publication bias; at least a low-quality positive study has novelty value. Nobody wants to read a study that is both poor quality and negative) and for higher-quality studies to show negative results. The study you linked is one of the high quality ones. Given its flaws in terms of standardizing treatment arms, I'm not sure whether this is a good thing or a bad thing. However, even so, the study you linked is resoundingly negative.

The review authors therefore advocate the inclusion of acupuncture into European low back pain guidelines, but the comments pretty adequately sum up the general medical opinion on this advocacy:

A recent systematic review by Yuan et al concludes that &#8220;acupuncture versus no treatment, as an adjunct to conventional care should be advocated in the European Guidelines for the treatment of chronic low back pain.&#8221;1,2 We disagree, because:
1. More issues than just 1 systematic review on effectiveness should be taken into account to recommend a procedure (safety, standardization, indication criteria, application conditions, etc.).2
2. Actual results from the review suggest that the effect attributed to acupuncture derives from unspecific effects (placebo, more time and attention from therapists, etc.), or invalid comparison groups (procedures also lacking any evidence of effectiveness vs. placebo).1,3
3. The most consistent result in the review is that actual acupuncture has the same effect as sham acupuncture (&#8220;placebo&#8221😉, which includes puncturing anywhere in the skin (not necessarily on acupuncture points), or even just simulating doing so with a toothpick.4 Therefore, it would be more cost/effective and similarly (in) effective to recommend that LBP patients use toothpicks to press their skin anywhere they want.
4. It makes no sense to recommend the use of procedures that have consistently shown not to be better than placebo, especially when there is a need for cost containment.

Letters to the editor: Kovacs, Francisco M. MD, PhD; Zanoli, Gustavo MD, PhD. Reply to: Yuan J, Purepong N, Kerr DP, et al. Effectiveness of acupuncture for low back pain. A systematic review. Spine 2008;33:E887&#8211;E900.

2) This is a comment to the RCT you posted:

Haake et al1 reported that real and sham acupuncture yielded the same results and were both vastly superior in reducing chronic back pain to standard care, which generated very disappointing outcomes. The authors offer various explanations for those "surprising results."1 The findings become a little less amazing if we consider the following: the 2 acupuncture groups were treated by their physician at least 10 times for 30 minutes with a "hands-on" intervention. The third group essentially received 10 sessions of physiotherapy or a normal consultation with their physician. "Hands-on" treatment by your physician is certainly unusual these days and therefore perhaps more prone than treatment by physiotherapists or normal physician consultations to promote patients' expectation. This explanation would go some way toward explaining the "surprising results,"1 both in terms of good outcome for the 2 types of acupuncture and the relatively poor outcome of the usual care group. It might also have the following far-reaching implications: (1) the effectiveness demonstrated in this study1 is unrelated to acupuncture itself; (2) investing into acupuncture services would therefore be unwise; and (3) delegating treatments to others is less effective than administering them ourselves.

Edzard Ernst, MD, PhD, FRCP, FRCPEd. Reply to: Haake M, Müller HH, Schade-Brittinger C, Basler HD, Schäfer H, Maier C et al. German Acupuncture Trials (GERAC) for chronic low back pain: randomized, multicenter, blinded, parallel-group trial with 3 groups. Arch Intern Med. 2007 Sep 24;167(17):1892-8.

So basically, it's impossible to know from this study alone whether acupuncture actually works, rather than just spending time with a medical professional. Which we already know improves health outcomes through its own placebo effect.