Of all alternative medicines,
acupuncture has proven to be the most resistant to debunking
by mainstream science. The main reason for its durability
is that it really does control pain, and can prove it
in clinical trials. It's a measure of acupuncture's growing
respectability that the august British Medical Journal
carries new research suggesting that needles can bring
significant pain relief to patients with a currently untreatable
condition: pelvic girdle pain during pregnancy.
In fact, in a three-way analysis,
acupuncture not only outperformed the current standard
treatment — a pelvic belt and some good advice
about getting enough exercise and rest — it also
did better at controlling pain than a regimen of carefully
designed pelvic stabilizing exercises.
The trial involved 386 pregnant
women with pelvic girdle pain who were randomized to
receive either standard treatment consisting of a pelvic
belt and a simple home exercise program; massage treatment
and complex stabilizing pelvic exercises that were carried
out several times a day over six weeks; or acupuncture.
The acupuncture consisted of 17 needles inserted into
various pelvic muscles, left in for 30 minutes, and
manipulated every 10 minutes. Some needle sites were
chosen by palpation to identify sore points, others
were well-known sites commonly used for general pain
relief. Patients underwent this treatment twice a week
for six weeks.
EVEN
THE BLINDED SEE BENEFIT
The women reported pain levels on a 100-point visual
analogue scale at the outset, and each morning and evening
throughout their treatment. They were also assessed
by an independent examiner after the trial, who was
blinded to treatment method. In both self-reported and
physician-assessed measures, acupuncture led the way
in pain relief.
Though all three groups reported
an average morning pain score of 23 points at the study's
outset, one week after treatment's end, the average
morning pain score was 27 in the standard treatment
group, 18 in the stabilizing exercises group, and 15
in the acupuncture group. Moreover, at the study's end,
the standard treatment group was reporting an average
evening pain score of 58 points, the stabilizing exercise
group an average of 45 points, and the acupuncture subjects
an average 30 points as compared to the score at baseline,
which sat around 60-65 points.
The independent examiner also found
that pelvic stabilizing exercises and acupuncture led
to significant improvements in response to specific
pelvic pain diagnostic tests. The authors believe that
acupuncture relieves pain "through activation of both
the segmental pain inhibitory system, involving the
so called gate control mechanism, and the central pain
inhibitory system, involving secretion of endogenous
opioids."
Left unmentioned by the authors
is the possibility that the mechanism for acupuncture's
success in pain control is the placebo effect. In fact,
many practitioners of respectable acupuncture are quite
frank in their belief that placebo effect is the biggest
component in acupuncture pain relief. No other symptom
is so amenable to psychosomatic relief as pain. Unlike
an exercise program, acupuncture can convince patients
that something is being done about their pain. And that
may well be the most important step to relieving it.
BMJ Apr 2, 2005;330:761
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