Pro/Con Editorials Look at Evidence on Acupuncture for Symptom Relief

Article ID: 603500

Released: 28-May-2013 11:00 AM EDT

Source Newsroom: International Anesthesia Research Society (IARS)

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Is Acupuncture a Research-Proven Treatment—Or Just a 'Theatrical Placebo?'Newswise — San Francisco, CA. (May 28, 2013) – With more than 3,000 clinical trials to date, is acupuncture is a proven-effective treatment with a low complication rate? Or is it just a "theatrical placebo" with little or no effect on pain or other outcomes? Opposing viewpoints are presented in a pair of "Pro and Con" editorials in the June issue of Anesthesia & Analgesia, official journal of the International Anesthesia Research Society (IARS).

Dr Shu-Ming Wang of University of California-Irvine and colleagues write, "[C]linical trials support the efficacy of acupuncture in reducing postoperative nausea and vomiting and postoperative pain." But David Colquhoun, PhD, of University College London and Dr Steven P. Novella of Yale University School of Medicine take a different view, concluding, ""[T]he benefits of acupuncture are likely nonexistent, or at best are too small and too transient to be of any clinical significance."

Research on Acupuncture: Evidence for Effectiveness…Both groups of authors evaluate the research literature on acupuncture for management of three problems commonly seen anesthesia practice, for which current drug treatments aren't completely effective: postoperative nausea and vomiting (PONV), postoperative pain, and chronic pain conditions. Acupuncture studies pose unique challenges, especially in terms of selecting inactive "placebo" comparison treatments.

While acknowledging these difficulties, Dr Wang and coauthors note that many studies have reported benefits of acupuncture. In their view, the evidence is strongest for acupuncture's effectiveness in preventing PONV. One recent research summary, including data on nearly 4,900 patients, concluded that treatment directed at one specific "acupoint" is as effective as conventional drug treatments in preventing PONV, with only minor side effects.

Other studies have reported that acupuncture can reduce the need for pain medication after surgery. Although evidence on chronic pain is mixed, some reports have found acupuncture to be a "reasonable option" for certain conditions, such as knee pain from osteoarthritis. Studies have also supported the cost-effectiveness of acupuncture, showing improvements in health-related quality of life at a small additional cost.

Dr Wang and colleagues also cite brain imaging studies showing different responses to active acupuncture versus inactive treatments. Acupuncture should be viewed as "a medical option that not only treats disorders but also fosters a greater awareness of how harmonic interactions between self, family, work, and environment play a role in promoting health and restoring order," they conclude.

…Or Minimal to No Effect, Compared with Placebo?But evaluating the same research, Drs Colquhoun and Novella note that the largest, highest-quality studies of acupuncture find no significant reduction in pain, compared to inactive treatments. Although studies typically report a small reduction in pain scores after the start of acupuncture, almost the same pattern is observed in patients receiving any type of treatment, whether active or inactive. Based on the evidence, they write, "It seems that acupuncture is little or no more than a theatrical placebo."

Drs Colquhoun and Novella cite a number of weaknesses in the research evidence, including selectively focusing on a few positive results and "publication bias"—publishing only those studies that show positive effects of acupuncture. They note that even for PONV—the problem with the strongest body of evidence—most studies supporting acupuncture were performed by one group of researchers, with significant scientific weaknesses.

With this history of "variable and inconsistent" results, acupuncture should be regarded as "an inactive intervention," Drs Colquhoun and Novella believe. "Since it has proved impossible to find consistent evidence after more than 3000 trials, it is time to give up," they conclude. "It seems very unlikely that the money that it would cost to do another 3000 trials would be well-spent."

Read the PRO article in Anesthesia & Analgesia or Read the CON article in Anesthesia & Analgesia

About the IARSThe International Anesthesia Research Society is a nonpolitical, not-for-profit medical society founded in 1922 to advance and support scientific research and education related to anesthesia, and to improve patient care through basic research. The IARS contributes nearly $1 million annually to fund anesthesia research; provides a forum for anesthesiology leaders to share information and ideas; maintains a worldwide membership of more than 15,000 physicians, physician residents, and others with doctoral degrees, as well as health professionals in anesthesia related practice; sponsors the SmartTots initiative in partnership with the FDA; and publishes the monthly journal Anesthesia & Analgesia in print and online.

About Anesthesia & AnalgesiaAnesthesia & Analgesia was founded in 1922 and was issued bi-monthly until 1980, when it became a monthly publication. A&A is the leading journal for anesthesia clinicians and researchers and includes more than 500 articles annually in all areas related to anesthesia and analgesia, such as cardiovascular anesthesiology, patient safety, anesthetic pharmacology, and pain management. The journal is published on behalf of the IARS by Lippincott Williams & Wilkins (LWW), a division of Wolters Kluwer Health.

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