(Originally posted on bcotoronto.com on Oct 18th, 2012)
Last week we discussed the history of acupuncture and the place it has found in the current healthcare community. This week we will be exploring the world of acupuncture research, what works, what doesn’t, and what’s out there now.
First off, let’s talk about the scientific process of research to set up the background we need. There are many different ways to design a study but the golden standard is called a Randomized Clinical Trial. This means that there are two groups (randomly assigned from the volunteer subjects) who either receive the treatment being tested or a placebo or a different treatment type. This way all the subjects think they have received the treatment and the desired outcomes are measured to compare the treatment against the placebo or the other treatment. Sometimes a third group is added where the subjects do not receive any type of treatment to determine the effect of the placebo as well.
Randomized Clinical Trials are considered the highest form of scientific evidence. On the other end of the spectrum is Anecdotal evidence, or “Case Studies”. This evidence is still important because it drives the direction high quality evidence takes but by itself it is not enough to show a connection between a treatment or therapy and a specific outcome.
So now let’s get down to how acupuncture fits into this system. Over the past half century or so a large body of evidence has been created with regards to acupuncture. The problem is that the results have been fairly conflicting in nature. A little more than half have said that acupuncture is no better than placebo and the rest have said it is more effective. So which is it, and why is there such a dichotomy here? Well, one of the main problems is the issue of the placebo treatment. There have been a couple of different approaches to this problem.
The first is to place the needles in points outside of the meridian pathways (the pathways of energy used in acupuncture) but as any acupuncturist worth their salt will tell you, these are still considered acupuncture points called, “Ah Shi” points (You can imagine what we called them in school). This is part of acupuncture where you place the needles where the pain is or surround the area with needles. The second technique is to use blunted needles against the skin so that the subjects think they have received the regular sharp needle but in reality have just had the pressure on their skin. Well, this is just silly because this is a technique unto itself called Acupressure. So you are not providing a sham treatment, you are in fact, providing a different but related therapy. Another way is to not use any sham treatment at all which critics say does not truly test the technique. The last technique is to complete the study using animal subjects as they are generally considered unable to experience a placebo effect. But this is commonly viewed as lower quality evidence because it is on a species different from us.
So as you can tell, it is difficult to design research studies to properly test acupuncture within the scientific method and provide the highest quality level of evidence. But this difficulty and struggle are no reason to throw the baby out with the bathwater. Just because it does not fit within this system of evidence does not mean that acupuncture is worthless or that it does not work. Within the last 5-6 years there has been an outpouring of research that has shown, through controlled trials measuring small physiological and chemical changes rather than larger subjective ones, the amazing power of acupuncture.
In 2012, a study out of Japan, despite using the blunted needle “placebo” control group, showed a significant clinical improvement in patients with Chronic Obstructive Pulmonary Disease (COPD) after a 12 week course of acupuncture treatments1. Also in 2012 a study out of Georgetown University was published which demonstrated the protein associated with elevated stress in humans decreased in rats when treated with electroacupuncture at a single acupuncture point2. It is very exciting to see this kind of, in the author’s own words, “molecular proof of benefit”.
Along the same lines, the results of a yet unpublished study were presented at a conference early in 2012 which showed decreased levels of genetic expression of the gene Atrogin-1 which is responsible for protein degradation in muscles3. This means that the fibres within muscles that make them work will not be broken down as quickly. These results absolutely blow my mind and are incredible proof of the power of acupuncture. You can’t get much more of a physiological effect than altering genetic expression. This study was also performed in rodents but this gene and its regulation is common between most mammals.
In 2010, a study utilizing a novel approach to determining the effects of acupuncture was presented at a conference. Functional Magnetic Resonance Imaging (fMRI) was used on patient experiencing a pain stimulus both with and without acupuncture treatment. The fMRI provided images of the brain activity during these two conditions and demonstrated a change metabolic change in the areas of the brain that process pain4.
I wasn’t completely honest before when I said that the Randomized Clinical Trial was the highest level of evidence. It is the highest for a long period of time until you have a large body of research and then there can be one level above them. This is called a Systematic Review or a Meta-analysis. A systematic review is when all the research pertaining to a specific topic is brought together and the conclusions are compared and a general consensus is reached. A Meta-analysis is a little different. The empirical data from the results of all of the collected clinical trials is taken and combined. Then statistical analysis will produce the overall impression of the combined data. This provides an excellent view of what the trends in the literature suggest for a specific topic.
One such meta-analysis was published in the Archives of Internal Medicine in 2010 explored the research published about acupuncture as a treatment for chronic pain. It looked at 29 randomized control trials with a cumulative 17,922 subjects all together. The authors found that, despite the previous general consensus about acupuncture, it was superior to both the control (no treatment) and the sham treatment groups5.
There is a long way to go to uncover the full effects of acupuncture and I’m sure there will be a lot of resistance along the way from people who are afraid because they do not trust or understand acupuncture which will only make the wait longer. But there is definitely enough evidence to show there is something to this treatment that should not be ignored.
What do you think of all of this? Could acupuncture be something you might try next time you are in pain?
Thanks for reading,
1. JAMA and Archives Journals (2012, May 14). Acupuncture appears linked with improvement in patients with chronic obstructive pulmonary disease. ScienceDaily. Retrieved September 10, 2012, from http://www.sciencedaily.com/releases/2012/05/120514122751.htm
2. Georgetown University Medical Center (2012, January 10). Acupuncture reduces protein linked to stress in first of its kind animal study.ScienceDaily. Retrieved August 15, 2012, from http://www.sciencedaily.com/releases/2011/12/111219150915.htm
3. Federation of American Societies for Experimental Biology (FASEB) (2012, April 23). Acupuncture can improve skeletal muscle atrophy. ScienceDaily. Retrieved April 29, 2012, from http://www.sciencedaily.com/releases/2012/04/120423162247.htm
4. Radiological Society of North America (2010, November 30). Acupuncture changes brain’s perception and processing of pain, researchers find. ScienceDaily. Retrieved October 10, 2012, from http://www.sciencedaily.com/releases/2010/11/101130100357.htm
5. JAMA and Archives Journals (2012, September 10). Acupuncture may be better than no acupuncture, sham acupuncture for chronic pain. ScienceDaily. Retrieved October 2, 2012, from http://www.sciencedaily.com/releases/2012/09/120910161548.htm