Acupuncture is vastly superior
to conventional treatments for low back pain, according
to a large German study in the September 24 Archives
of Internal Medicine.
Surprised? Well, there is a catch.
A pretty big one, in fact: the study results were the
same whether the acupuncture performed was real or sham.
The whole thing appears to be due to a funny kind of
placebo effect.
ON
PINS & NEEDLES
There's fairly widespread agreement these days that,
in the management of moderate pain, acupuncture is a
serious option. Most studies into acupuncture show enough
of a benefit to at least keep the question open, but
none have ever really demonstrated conclusively that
acupuncture can match conventional treatment for pain.
Enter the Germans, with probably the best and biggest
single trial to date of acupuncture in low back pain.
The researchers — all from
reputable teaching hospitals — recruited 1,162
patients with low back pain of an average eight years'
duration. The patients were divided into three treatment
groups — and this is where things get interesting.
One major obstacle when comparing
acupuncture to conventional treatment is that it's impossible
to blind the trial, because patients can generally tell
the difference between drugs and physiotherapy on the
one hand, and being stuck with needles on the other.
The solution, the researchers decided, was to introduce
a third treatment category, sham acupuncture. These
patients were pierced with needles, but not in the points
recommended by Chinese medicine, not to the recommended
depth of 5-40mm, and without the needle manipulation
which is part of the real treatment.
In the event, both the real and
the sham acupuncture group showed significantly more
improvement in symptoms than the conventional therapy
group. Response, defined by quantified improvements
on validated pain and disability scales, was 47.6% in
the real acupuncture group, 44.2% in the sham acupuncture
group and 27.4% in the conventional therapy group.
Conventional treatment included
physiotherapy, massage, heat therapy, electrotherapy,
back school, injections, guidance, infusions, yoga,
hydrojet treatment and swimming. Analgesics were also
given to 95% of these patients.
PAIN
DISTRACTION
One potential weakness of this study was the recruitment
method - the study was announced on television, radio,
newspapers and the internet, and patients encouraged
to sign up. The obvious risk is that patients predisposed
to a belief in acupuncture would preferentially sign
up, especially since subjects in all treatment arms
were offered a free acupuncture course at study's end.
The researchers came up with a cunning way to discourage
such patients, by offering all recruits an alternative
place in a study of adverse events in acupuncture, in
which all treatment arms would get the needles.
Another potential pitfall was that
subjects would guess whether they were getting real
or sham acupuncture. But a questionnaire at the end
of the study suggested few had figured it out.
The researchers aren't sure why
the real and sham acupuncture both showed such positive
results, but they speculate it could be due to one kind
of pain distracting the body from another. "The superiority
of both forms of acupuncture suggests a common underlying
mechanism that may act on pain generation or transmission
of pain signals ... and is stronger than the action
mechanism of conventional therapy," said lead author
Dr Michael Haake.
The result of this study is a fillip
for the principle of sticking needles in people, but
a body-blow to the traditional Chinese medical dogma
that comes with it.
|
