Acupuncture is a treatment modality that has become increasingly popular and mainstream in our society, and has even been accepted by some major organizations.1 According to the National Center for Complementary and Alternative Medicine in 2007 the number of adults seeking help from acupuncture had risen to over 3 million from about 1 million in 2002.2 The World Health Organization has published a position statement in support of using acupuncture for a wide variety of conditions. This has raised a lot of criticisms from experts in the field who claim that “the evidence does not support such claims” and that the “WHO has been infiltrated by missionaries for alternative medicine.” 1 Other organizations have been more reserved in their support of acupuncture with the National Institute of Health stating that overall it was hard to interpret results due to issues with study sample sizes and designs.3 Current research seems to suggest that benefits obtained through acupuncture apply to only a few conditions. In the American Journal of Medicine it was stated “After discarding reviews that are based on only 3 or fewer primary studies, only 2 evidence-based indications emerge: nausea/vomiting and headache. Even this evidence has to be interpreted with caution; recent trials using […] placebos suggest that acupuncture has no specific effects in either of these conditions.”4 Among those who take a more favorable view on the benefits of acupuncture the idea of energy flows has been largely abandoned by those practicing evidence based medicine. There have been a few studies that have hinted at the possibility of either meridians or energy according to one author5 but there is no compelling evidence for either. Other authors are less generous to the idea due to the fact that the entire hypothesis rests on the existence of an “energy” that cannot be seen or measured and therefore has no place in the modern clinic.4 In this study the author, Professor Ernst reviewed current research on acupuncture and its efficacy. A search for research done on acupuncture was performed on Medline, Embase, and Cochrane Library through July 2005. The author also pulled files from his personal library that were relevant to the subject. The studies were grouped in tables according to what they were attempting to look at and their conclusions were listed and compared to the WHO position statement. The results were then looked at and discussed as they applied to the question of whether acupuncture produces a demonstrable clinical change in the conditions being treated. While there are a few tantalizing theories that might explain how acupuncture works, none have been proven. Even “the question of whether it works remains controversial.” Conditions that current research suggests acupuncture is effective in treating are limited to dental pain, fibromyalgia, nausea/vomiting, knee osteoarthritis, insomnia, epicondylitis, chronic back pain, idiopathic headache, resolution of breech presentation, and as an aid in gastrointestinal endoscopy. However this data could turn out to be falsely positive due to inadequate control of placebos since most of the RCT’s that are using the newer sham needles (a needle that collapses as it is pressed on the skin) have found that the only clinical effects acupuncture is associated with is a strong placebo response. The consensus appears to be that more research is needed before any definitive statements can be made about the effectiveness of acupuncture. While this form of intervention is growing in popularity at a very rapid pace the current body of evidence suggest that the scope of acupuncture may be much more limited than many would be led to believe. Within the list of conditions that it has been shown to help acupuncture may be appropriate for use in conjunction with other more traditional interventions or as an alternative if there are contraindications for the use of traditional treatment methods. Some have commented that even if the positive results are a placebo effect, if this effect could exceed the total effect of traditional therapy acupuncture should be accepted as a useful treatment. The study was limited by the constraints of the search methods used as well as the studies that have been performed. Some relevant studies may have been missed when the search was conducted. This study is also limited by the quality of available research on the subject. The use of sham needles and thus the ability to control for placebo response is something that is relatively recent and may change the outcomes of some previous studies. The bias of the researcher may have influenced his conclusions as well though no conflicts of interest were declaired. | |
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1. McCarthy, M (2005). "Critics slam draft WHO report on homoeopathy". The Lancet 366 (9487): http://www.thelancet.com/journals/lancet/article/PIIS0140673605671590/fulltext Accessed October 30, 2010
2. Edwards,E. (2009, March 20). Acupuncture popularity soars despite thin evidence. The New Mexican. http://www.santafenewmexican.com/HealthandScience/Acupuncture--popularity-soars-despite-thin-evidence Accessed October 30, 2010
3. National Institute of Health. (2010) Acupuncture. http://nccam.nih.gov/health/acupuncture/ Accessed October 30, 2010
4. Slack JR, R. (2010) Acupuncture: A Science-Based Assessment. http://www.centerforinquiry.net/uploads/attachments/Acupuncture_Paper.pdf Accessed October 30, 2010
5. ERNST, E. (2006), Acupuncture – a critical analysis. Journal of Internal Medicine, 259: 125–137. doi: 10.1111/j.1365-2796.2005.01584.x
