May 20, 2009 — Actual or simulated acupuncture therapy appears to be more effective than usual care for chronic low back pain, according to the results of a randomized controlled trial reported in the May 11 issue of the Archives of Internal Medicine.
"Acupuncture is a popular complementary and alternative treatment for chronic back pain," write Daniel C. Cherkin, PhD, from the Center for Health Studies in Seattle, Washington, and colleagues. "Recent European trials suggest similar short-term benefits from real and sham acupuncture needling. This trial addresses the importance of needle placement and skin penetration in eliciting acupuncture effects for patients with chronic low back pain."
"Although acupuncture was found effective for chronic low back pain, tailoring needling sites to each patient and penetration of the skin appear to be unimportant in eliciting therapeutic benefits," the study authors write. "These findings raise questions about acupuncture's purported mechanisms of action. It remains unclear whether acupuncture or our simulated method of acupuncture provide [sic] physiologically important stimulation or represent [sic] placebo or nonspecific effects."
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Gary comments:
Currently New Zealand's Accident Compensation scheme (ACC) is suffering unsustainable cost blowouts. It is appropriate to review all areas of cost. One area that receives insufficient attention for review is the effectiveness of treatments such as orthotics, anti inflammatory medication, ultrasound and acupuncture. Under the bright lights of critical analysis, I am of the opinion that these therapies can not be justified in most cases of injury rehabilitation; yet they constitute the principal forms of therapy (and clinic income) for many health practitioners.
I am now into thirty years working in the fitness and rehabilitation business and have yet to see any convincing evidence that therapies like acupuncture really works beyond that of the Placebo Effect.
While I have only seen the summary of this study about acupuncture, the findings support my own impression that acupuncture is an ineffective treament for chronic pain conditions such as low back pain.
That this study found simulated and sham acupuncture to be more effective than "usual care" indicates just how poorly back patients are served by modern medicine!
Needling does little more than exert a strong placebo effect plus a couple of incidental side benefits that give
temporary relief to pain. These are: 15-30 minutes of enforced rest (The neeedles ensure this!) during the middle of the day (If you have low back pain, lying down and daydreaming during the middle of the day is so relieving).
The other benefit is possible reduction of muscle spasm caused by a carefully placed needle inhibiting the contraction and stimulating the release of endorphins. But this will only be a passing benefit, since the needling does not deal with the complex
underlying causes of chronic muscle and joint pain. The benefit may be better for acute pain as opposed to chronic pain.
If acupuncture is mostly ineffective for chronic pain, why do so many therapists use it?
What I am about to say is sure to generate shrill, emotive protestations from those who practice acupuncture; but I am going to write this anyway because it needs to be said (I am always happy to participate in informed debate, btw).
Time pressures
Many, if not most therapists who practice acupuncture have, on average, just 15 minutes patient (sorry - "client") contact time. This is the way medical and allied therapies fees are structured in New Zealand, so the pressure goes on clinics to pump the patients through the door just to survive, let alone afford that luxurious house in Khandallah, the flash Alfa Romeo and private schooling for the children. This time pressure makes other therapies that really do work, like massage impractical because these take an hour to do.
With acupuncture, the therapist inserts the needles, then leaves the client for ten minutes and goes and deals with the other clients lying in the other cubicles or gets on with the ACC paperwork. With five minutes to go, the therapist returns, removes the needles, rubs the areas quickly with Antiflamme (It has a big whiff of menthol for dramatic effect) while making positive suggestions about feeling better. It has to be working! And that's it - easy money! It reminds me of painting by numbers which was popular when I was a child.
Not too much effort please!
The most effective therapy (not on its own, mind you!) for chronic pain is massage; but massage is hard work very few allied medical therapists know how to massage properly and few can do this day in and day out without themselves requiring serious therapy! Good massage, not of the tickle and rub kind, is tough on the knuckles, wrists and elbows and best reserved for the hardy therapist with big hands and strong arms.
Medicine and Rehabilitation are businesses for Profit first - Health last
Medicine has aligned with big Pharma so that it can profitably process about one client per doctor every 10 minutes, relying on computer generated prescriptions for drugs that are approved and funded by Pharmac (using your tax dollars - of course!).
With the current financial model driving the sytem, modern medicine has little choice but to remain in bed with Big Pharma. This explains why a doctor will only ever give lip service to natural health alternatives and seldom, if ever prescribe a nutrient supplement and only if it is a Big Pharma product - Bauer's Elevit for pregnant women is one of these rare exceptions. To prescribe, or even acknowledge a natural alternative is dealing with the enemy. But I am beginning to digress.....
Acupuncture, like ultrasound, cupping and orthotics, is Rehabilitation's equivalent to medical prescriptions - Perfect for the business that is pressured to process many injured clients in quick succession over a long working day. These additional procedures usually brings in a nice to have surcharge fee that is paid either by the recipient or the health scheme - or both.
So, what do you do if you are prescribed acupuncture?
Save the country, your insurer and yourself a lot of money by challenging it. Ask to be shown the scientific evidence proving that it is a valid therapy for your condition. Are there other therapies that better suit your injury? Be sceptical and wary of single therapy solutions.
You could start by putting your legs up and reading the free articles about injury management that you can find here on my website. Read my advice about massage for chronic pain and do not overlook the powerful contribution nutrition has to play in addressing the underlying causes of chronic pain. If it is back pain that you suffer from, you could get a copy of my Back Pain Book.
Is your pain due to medication side effects? Talk to your doctor. If you are unsure you can even write to me and I will help you sort through your medication to identify possible contributors, either individually or through interactions.
In most cases, the solution to your pain lies within yourself and there are usually several related factors at work which helps explain why single therapy solutions are usually very disappointing. The first step is to carry out a series of investigations, including blood tests and a hair tissue mineral analysis in addition to the usual physical ones. The next step is to work up a list of factors that can be worked on and to prioritise these in terms of difficulty and treatability. An intervention plan is devised which targets just some of these factors and away we go!
An incremental multifactoral approach slowly, but surely chips away at the problem. Relief from chronic pain can be surprisingly rapid in many cases, sometimes within three weeks or so; but patience is required in most cases, sometimes several months or even a year or so. Please read my articles here about client feedback to get an idea of how well this patient, multifactoral approach works.
Do you have a question?
Email Gary: gary at myotec.co.nz (Replace the "at" with @ and remove spaces). Please include any relevant background information to your question.
