I don’t care for anecdotal evidence, but yesterday I saw a rather heavy, short neighbor woman in her 70s (?+) trying to go down the steps to her front porch and having a great deal of trouble doing so.  Today, I got this e-mail message she sent to a fair number of people.

Comments?

Occam
======
OKAY Friends.  ......Tell me how this works.  You know I intend to get a hip replacement very soon.  So I am bouncing off the walls, using a cane .....real pain !!
I just returned from my first Acupuncture appointment and I feel GREAT… I am not limping and have so much energy….just like a few years ago. This was the best $10 co-payment I ever made…..I have another appt. for next week.

How does this work?
Betty

Ahhh, acupuncture for pain. Great big messy topic.

The short answer is that the best studies in terms of design, controls for bias, etc. suggest it is a placebo. This means it changes people’s perception of their discomfort so that when asked they rate their pain as lower (usually ~15% or so, though it varies a lot) on pain scales, though nowhere near the degree of effect most pain control drugs exhibit. It does not appear to have any measurable effect on the actual disease process for osteoarthritis (as this woman probably has). The analagesic effect is the same for “fake” acupuncture given at places not considered acupuncture points by some acupuncturists (though there are some acupuncturists who don’t believe in points anyway), and for essentially random pricking of the skin with toothpicks or any other mild local irritant.

Since pain is inherently subjective, this benefit is “real,” but again it doesn’t seem to be significant in terms of measurable indices of disease or as strong as the benefits of medication. The process is pretty close to harmless (a few reports of infections, hepatitis, and the sorts of things that you get from breaking the skin with foreign objects), so I personally have no objection to people doing it so long as it doesn’t interfere with pursuing therapies that really affect the disease (such as the total hip replacement). The problems come up when people begin to believe that the effect on their perception of discomfort is somehow evidence supporting all the metaphysical claims and other purported benefits for acupuncture. Apart from pain, nausea, anacupuncture pretty consistently fails to show any real benefits in good studies.

Of course, the real answer is much longer and more nuanced. There is a lot of bandying about of terms like “endorphins” with regard to acupucture, and there’s no question that poking needles into people causes all kinds of chemicals to appear in the blood or tissues. the problem is translating this into a clinically significant therapeutic effect, and after about 40 years of pretty voluminous research, we haven’t been able to do so, which is part of why I think the placebo answer is the most likely. Really good, detailed discussions of this can be found in:

Trick or Treatment: The Undeniable Truth about Alternative Medicine by Edzard Ernst and Simon Singh

Snake Oil Science by R. Barker Bausell

You can also check out the topic reference section at Science-Based Medicine

There’s also acupuncture where they use electricity across the needles. IIRC there is good evidence to support electricity based treatments as numbing pain, but that has nothing to do with acupuncture per se and so shouldn’t be considered evidence for the practice.

dougsmith - 28 June 2010 11:06 PM

There’s also acupuncture where they use electricity across the needles. IIRC there is good evidence to support electricity based treatments as numbing pain, but that has nothing to do with acupuncture per se and so shouldn’t be considered evidence for the practice.

Yes, it is called TENS, and is used to stimulate muscles. I haven’t used it for about 6 years, and used it infrequently then, so I can’t help with that but I believe that studies were promising.

Whenever the subject of accupuncture came up, one of a group of veterinary college colleagues, claimed that horses - very pain sensitive - could be subjected to surgery with nothing more than acupuncture.

There was no evidentiary support for that position, but that one veterinary colleague insisted it was true ... another veterinarian told him so!

I thank the “seeder” of this subject. In some scientific experiments, double blind clinical trials, the “placebo” group can often - 30-50% - exhibit positive responses.

“The power of positive thinking”??

asanta - 11 June 2010 06:08 PM

Dead Monky - 11 June 2010 05:49 PM

You know, this gives me an idea.  I think I’ll open Crazy Monky’s Drive-Thru Acupuncture.  People will drive up to one of my many, conveniently placed establishments, pull up to the drive-thru window, pay me, then I’ll hit them in the face with a porcupine tied to a stick.  I’ll be rich!  Rich as a king!

Yes, I really don’t think it will matter how or where you hit them, just as long as they get hit with needles!

As the body contains a huge interconnected neural network designed to make the brain aware of and respond to external irritants, I can imagine a beneficial effect by placing irritants (needles) in certain strategic locations to mask pain or stimulate certain more or less controllable neuro/chemical responses.
Dentists employ music by providing earphones to patients in order to occupy the mind (endorphins?) while undergoing painful dental procedures. Is that not comparable with the judicious application of acupuncture under certain circumstances? Of course it is not a cure-all, but is it useless?

I don’t know.  Does stabbing needles into yourself make you feel better?

Dead Monky - 29 September 2010 02:40 PM

I don’t know.  Does stabbing needles into yourself make you feel better?

To some it does produce a flood of endorphins and is practised recreationally.

Some say the same thing about having their testicles stomped on or cutting themselves with razor blades.  So I’ll take it with a grain of salt.

writ4u,

Sure, poking needles into the system does something. The question is whether this something is clinically relevant and can be reliably induced if it is. The locations of acupuncture points do not consistently correlate with any identifiable anatomic structure, they were originally chosen in humans according to astrological criteria, and they have been exttrapolated to animals with no attempt to rationalize the system in some scientific way. So with a “huge interconnected neural network designed to make the brain aware of and respond to external irritants,” what are he odds that such a system will happen upon “strategic” points that have a clinically menaingful effect? And if by some fluke i has, why can’t this be consistently shown in clinical trials despite 40+ years of trying? The criticisms many of us level at acupuncture are not arbitrary, dogmatic, or uninformed, but even the elements of he apporach that have some plausibility, as you suggest, have not so far demonstrated themselves to be of real benefit.

Dead Monky - 29 September 2010 02:49 PM

Some say the same thing about having their testicles stomped on or cutting themselves with razor blades.  So I’ll take it with a grain of salt.

Well, just recently a guy cut off his arm and refused reattachement on threat of cutting it off again. This clearly speaks of mental disorder rather than medical application of an localized irritant.

mckenzievmd - 29 September 2010 02:57 PM

writ4u,

Sure, poking needles into the system does something. The question is whether this something is clinically relevant and can be reliably induced if it is. The locations of acupuncture points do not consistently correlate with any identifiable anatomic structure, they were originally chosen in humans according to astrological criteria, and they have been exttrapolated to animals with no attempt to rationalize the system in some scientific way. So with a “huge interconnected neural network designed to make the brain aware of and respond to external irritants,” what are he odds that such a system will happen upon “strategic” points that have a clinically menaingful effect? And if by some fluke i has, why can’t this be consistently shown in clinical trials despite 40+ years of trying? The criticisms many of us level at acupuncture are not arbitrary, dogmatic, or uninformed, but even the elements of he apporach that have some plausibility, as you suggest, have not so far demonstrated themselves to be of real benefit.

Thank you. I accept your authority on the subject.

Well, just recently a guy cut off his arm and refused reattachement on threat of cutting it off again. This clearly speaks of mental disorder rather than medical application of an localized irritant.

That guy was probably disturbed, yes.  My point was that doing something because it makes you feel good due to the release of endorphins does not make it a viable medical procedure.