As many of you know, I am a small animal vet. I am writing a series of evidence-based educational pamphlets for clients about common veterinary CAM practices. Eventually, I hope to make this into colorful, glossy pamphlets with pictures, bullet points, and all that jazz and make them avaiable on the web as well as to my clients. For now, I’m posting the text of the first of these here, both for general interest and for any feedback or commentary you may have. I am open to any suggestions about the material, the way it is written, things I may have gotten wrong or missed, additional sources of information or examples of good educational materials I can follow (especially from you MDs out there!), and so on.
I’m a bit afraid this may just turn into a debate on the pros and cons of the individual therapies, which is fine, but I don’t plan on participating in that sort of debate since I’ve been there/done that already, and that isn’t really the purpose of this thread.
What is it?
Acupuncture is the practice of inserting needles into the skin in order to treat disease. The practices currently popular in the United States and Europe are derived from a variety of systems which originated in China, perhaps as long as 2000 years ago. Acupuncture is based on the idea that a vital energy, called Ch’i, flows through the body in channels called meridians, and that imbalances or blockages of Ch’i can cause disease, which can then be treated by inserting needles into meridians at specific points.
Ch’i is not detectable by any known means, and meridians cannot be identified as physical structures in the body or through any kind of medical imaging. The number and location of meridians and acupuncture points has changed often through history. Today, there is great variety among acupuncturists as to the sites used, the method of stimulating them, and the depth the needles are inserted. In addition to needle insertion, some acupuncturists burn herbs at acupuncture points, pass electric current through the needles, or use laser light or other methods to manipulate the patient’s Ch’i. Thus, the underlying principles and the specific points used in acupuncture are impossible to examine or identify in any scientific way, and there is no uniform theory or practice among proponents of acupuncture beyond the basic concept of Ch’i.
The popularity of acupuncture has risen and fallen many times in China and the West. After being largely replaced in China by Western medical practices in the 19th and early 20th centuries, the practice underwent a resurgence in the 1950s and 1960s, as an effort by the Communist Party to provide cheap, and ideologically non-Western health care. It has since become a relatively minor element of medical care in China among those with access to more popular, Western scientific medical therapies. The current popularity of acupuncture in Europe and the United States began in the 1970s, following the reopening of China to outsiders.
Historically, acupuncture as understood today was not applied to animals in China, and the earliest Chinese veterinary texts specifically deny that human acupuncture techniques can be applied to animals. Nevertheless, with the rise in interest in acupuncture in the West during the 1970s, the meridian and acupuncture points in use for animals today were created in the by extrapolating from charts made for humans. The logic of this is sometimes questionable, as for example in the use of a “gallbladder meridian” for acupuncture treatment in horses despite the absence of a gallbladder in this species.
Does It Work?
There is an enormous amount of scientific research devoted to acupuncture in humans. As always, some studies support its use and others find no evidence of benefit. It can be difficult to sort out the real answer from this confusion.
Studies performed by proponents of acupuncture or published in journals devoted to the practice are almost always positive. Studies performed by critics or neutral researchers are generally negative or inconclusive. Often, negative studies are not published since they are disappointing to the researchers and not attractive to journals, so there is some inherent bias in the literature for acupuncture as for every other medical treatment. The best quality studies require that the patients and researchers not know whether each subject is getting the real acupuncture treatment or a fake (placebo) treatment. But it is very difficult to fool a person about whether or not they are being stuck with a needle, and it is impossible to fool the acupuncturist doing the treatment. And subjects who volunteer for acupuncture treatment studies usually already believe acupuncture will help them, which may influence their experience.
When the best quality studies with reasonable numbers of subjects and good controls for bias are reviewed, they find no benefit from acupuncture for most diseases. The evidence is mixed or shows some benefit for some types of chronic pain, and for nausea. The largest, best designed, and most recent studies have found that sham or fake acupuncture (using random locations or not actually puncturing the skin with the needles) seems to have about the same benefit as real acupuncture treatment. And patients who believe they are getting real acupuncture even when they aren’t get more relief than those who actually get acupuncture but think they are getting the placebo treatment.
So the evidence for humans indicates that acupuncture may make people with chronic pain or nausea more comfortable, though this is probably due to altering their perception or awareness of the discomfort rather than treating the source of the discomfort in the body. This may have some benefit as an adjunct to traditional scientific medical treatment.
Does it work for animals? This is even harder to determine than for humans because of the lack of well-conducted research and the fact that our patients cannot tell us about their symptoms. The quality of acupuncture studies in veterinary medicine is usually very low. A recent systematic review in the Journal of Veterinary Internal Medicine found so few trials of such poor quality that despite reports of benefit from acupuncture in some studies, the authors concluded that “there is no compelling evidence to recommend or reject acupuncture for any condition in domestic animals.”
This is similar to the situation in human medicine in the 1970s and 1980s during the latest rise in the popularity of acupuncture in the West. Early studies with low numbers of patients and poor design showed some benefit. As the number and quality of studies has increased, the evidence has been steadily less supportive of acupuncture as a beneficial treatment. For now, we can only say that it appears somewhat helpful for subjective discomfort, such as pain or nausea, in humans, especially if the patient believes it will be helpful. The evidence is not available to say with certainty whether it is helpful to veterinary patients.
Is it Safe?
The incidence of complications from acupuncture in humans is low. It has been reported to cause minor local pain and bleeding fairly commonly. More serious side effects, including fainting, vomiting, hepatitis, permanent nerve damage, and death from collapsed lungs have been reported but are extremely rare. Adverse effects of acupuncture in animals have not been reported in the sparse literature that exists on the subject.
There is no evidence for the reality of the underlying principles of acupuncture: Ch’I energy, meridians, or acupuncture points.
In humans, acupuncture may have some benefits for reducing the perception of chronic pain and nausea, but it is doubtful that our animal patients will experience this same benefit since it seems to be highly dependant on what the subject believes about their disease and treatment. Acupuncture has been shown to be ineffective for most other medical problems in humans.
In animals, there is almost no reliable, good-quality research, and the studies that have been done have found both positive and negative results.
Acupuncture is unlikely to be harmful to most patients.
With no apparent harm, and no evidence of benefit, the use of acupuncture in animals should be seen as an experimental adjunct to conventional therapy, not a replacement for proven medical treatments.
References and More Information
Barker Bausell, R., Snake Oil Sciene: The Truth About Complementary and Alternative Medicine, Oxford University Press, 2007
Ernst, E., White, A.R., Prospective studies of the safety of acupuncture: a systematic review. Am J Med. 2001 Apr 15;110(6):481-5
Habacher, G., Pittler, M.H., Ernst, E., Effectiveness of acupuncture in veterinary medicine: systematic review. J Vet Int Med. 2006 May-Jun;20(3):480-8.
Ramey, D., Rollin, B., Complementary and Alternative Medicine Considered, Iowa State Press, 2004
Sing, S., Ernst, E., Trick or Treatment: The Undeniable Facts About Alternative Medicine, W.W. Norton & Company, 2008
The Cochrane Collaboration, The Cochrane Reviews, a searchable database of systematic reviews of the human medical literature at http://www.cochrane.org/reviews/
© Brennen McKenzie, 2008