Acupuncture

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Acupuncture
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CAM Use in the United States
2004 CDC Vital Health Statistics Survey 343
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Acupuncture

• One part of the ancient, rich system of
  Traditional Chinese Med, generally combined w/
  Chinese herbs
• Yin-Yang - opposing forces in the body. Goal of
  acupuncture is to restore
  their balance.
• Qi - Life energy. Runs along channels
  (meridians). Acupuncture relieves blockages,
  improves flow
• Overarching goal rebalance, redistribute
  Yin-Yang and allow Qi to flow more
  freely.
• Western Acup needles only (without Chinese
  herbs)

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Acupuncture for OA

• Large RCT in the Annals (Berman, 2004)
• Patients (n570) were randomized into three arms
  1) true acup 2) sham acup 3)
  control - educ only
• Elaborate sham acupuncture pressure on random
  points - without skin puncture.
• 2 months of full treatment, followed for 6
  months.
• Successful blinding (equal number guessed they
  got sham in both arms).

Berman. Ann Intern Med 2004141901
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Acupuncture for OA
P.003
Reduction in Pain Score
Ann Intern Med 2004141901
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Acupuncture for Chronic HAs

• Two large high quality studies done in Germany,
  both published in 2005.
• One studied patients with migraine HAs (n302).
  Other studied patients with tension HAs (n270).
  
• Patients were randomized to receive true
  acupuncture vs. sham needling vs. wait list.
• Sham needling involved superficial / minimal
  needling of non-acupuncture points

Linde JAMA 2005 - PMID 15870415 Melchart BMJ
2005 - PMID 16055451
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Acupuncture for Migraines
p
HA days per month
Linde 2005 - PMID 15870415
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Acupuncture for Tension HAs
p
HA days per month
Melchart 2005 - PMID 16055451
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British trial no sham group
Weekly HA score
p
Vickers BMJ 2004 - PMID 15023828
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Acupuncture for LBP

• Large high quality study done in Germany,
  published in 2007.
• 1162 patients with LBP 6 months (mean duration
  of back pain 8 years)
• Pts were randomized to get true acupuncture vs.
  sham needling vs. usual care.
• Sham needling involved superficial / minimal
  needling of non-acupuncture points

Haake Arch Intern Med. 2007 PMID 17893311
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Acupuncture for Low Back Pain
of pts with 33 reduction in pain score
Haake Arch Int Med. 2007 PMID 17893311
At 6 mos. (3 mos after tx end)
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Other high quality RCTs of acupuncture

• Fibromyalgia true acupuncture no better than
  sham acupuncture both improved a lot from
  baseline - no observation arm
• Assefi et al. Ann Intern Med 200514310
• LBP a very large NIH - funded RCT based in
  Seattle will be published within next few months

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Acupuncture - Take Home Points

• Past 4 years theres suddenly good evidence that
  people with OA chronic headaches low back
  pain (maybe fibromyalgia?) get significantly
  better after receiving acupuncture.
• Always better than baseline, always better than
  observation only group
• These were large well-funded studies, with
  rigorous methodology, registered ahead of time so
  not worried about publication bias.

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Acupuncture - Take Home Points

• BUT positive effects (which persisted for many
  months after treatment ended) were not too
  different in patients who got various forms of
  well-blinded sham (such as minimal needling to
  distant non-acupuncture points).
• Although in the one large OA trial the true
  acupuncture group did slightly better than a
  well-blinded non-insertion pressure-like sham
  group.

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Acupuncture - Take Home Points

• Positive physiologic effects of minimal
  needling or pressure sham? Is there such a
  thing as a non-accupuncture point?
• Placebo response? Certainly some part of it.
• May also be important benefits of TCM-based
  acupuncture that were missing (Chinese
  diagnostics / individualization of tx plan)
• May be too complex to tease out placebo we may
  need to rely on whole systems trials