Acupuncture "not as safe as advertised"

[arthwollipot]

The first ever study of the adverse effects of acupuncture in state-funded acupuncture clinics in the UK has found that the procedure is largely safe, but not as safe as advertised. In extreme cases, it could even put lives at risk.

http://www.newscientist.com/article/dn22247

 

[tracer]

Poppycock! How could sticking needles into your body possibly be unsafe?

 

[Dogdoctor]

I have a client that went to the ER after having accupuncture done on themselves and they had a pneumothorax.

 

[Skeptic Ginger]

I have a client that went to the ER after having accupuncture done on themselves and they had a pneumothorax.

First I agree, zero benefit and any risk = don't do it.

But the risks are pretty minimal. We shouldn't get carried away here. The reason to council against acupuncture is it doesn't work, not that it's terribly dangerous.

 

[Acleron]

The British Acupuncture Council, a professional association, cites two studies "showing the risk of a serious adverse reaction to acupuncture is less than 1 in 10,000. This is far less than many orthodox medical treatments".

First I agree, zero benefit and any risk = don't do it.

But the risks are pretty minimal. We shouldn't get carried away here. The reason to council against acupuncture is it doesn't work, not that it's terribly dangerous.

Indeed!

 

[Bell]

Next you tell me that sticking needles in a doll doesn't work.

 

[Andrew Wiggin]

Next you tell me that sticking needles in a doll doesn't work.

Depends on the desired outcome. If you want to convince someone you're a creep, showing them a doll representing them with needles stuck into it is a very effective way to do so. If you're anticipating some medical outcome, i.e. the voodoo doll has a needle in its heart so the person it represents will have heart trouble, not so much.

 

[autumn1971]

I have a client that went to the ER after having accupuncture done on themselves and they had a pneumothorax.

I don't see how the two could be related. I've had a few chest tubes put in me, and cutting through the tissues to get into the thoracic cavity took quite a bit of work.
ETA: Oh, I failed to see the "needles left in patients" bit. I suppose one could work its way in after a while, but am amazed that could happen un-noticed.

 

[Dogdoctor]

I don't see how the two could be related. I've had a few chest tubes put in me, and cutting through the tissues to get into the thoracic cavity took quite a bit of work.

The needle penetrated through the rib muscles between the ribs and into the lung causing air to leak out. Much easier to poke a needle than to cut into the chest.

 

[Deetee]

My alltime favourite acupuncture video:
http://www.youtube.com/watch?v=sYUfooNlxk0

 

[Andrew Wiggin]

I would hope that reputable practice in accupuncture would require a sharps count to be kept. I know that it's a pretty big deal in surgery when the sharps count or sponge count isn't correct; that can mean that something was left behind. As someone claiming to be a health care provider, an acupuncturist has an affirmative duty to protect the patients under their care, and if they aren't doing common sense things like making sure that they aren't leaving pins in, they're failing at that.

Another personal issue I see is that every time I've seen pictures of acupuncture they've got great big long needles sticking out, when the supposed points are just a few millimeters under the skin. I know that acupuncture needles come in lengths down to just a millimeter or so, so my personal opinion is that having a big needle sticking out is part of the placebo. It looks dramatic and makes it more visible to the patient. I can see a danger in using extra long needles though, in that if they ARE left behind, a needle with three inches of potential penetration can go a lot deeper into the body than one with a few millimeters. (I've heard the argument that longer needles are easier to manipulate but short needles come with full size handles and it's not the needle shank that's being manipulated.)

 

[not_so_new]

First I agree, zero benefit and any risk = don't do it.

But the risks are pretty minimal. We shouldn't get carried away here. The reason to council against acupuncture is it doesn't work, not that it's terribly dangerous.

I have never had an acupuncture treatment and I have never conducted a clinical trial... but I was under the impression that there were some trials conducted that showed some benefits?

http://phys.org/news194418635.html
http://phys.org/news186082782.html
http://phys.org/news186942003.html
...etc


To be clear, I am not talking about magic...



I am talking about verifiable scientific testing. I could be off base but it seems like there is some evidence of benefits from acupuncture.

Are we throwing the baby out with the bathwater here because of the woo surrounding acupuncture? I have to think that may be the case. It was the case for me anyway, I always assumed acupuncture was complete BS until I started to see some of the studies... now I am not so sure it is all BS.

 

[Skeptic Ginger]

I have never had an acupuncture treatment and I have never conducted a clinical trial... but I was under the impression that there were some trials conducted that showed some benefits?

http://phys.org/news194418635.html
http://phys.org/news186082782.html
http://phys.org/news186942003.html
...etc


To be clear, I am not talking about magic...



I am talking about verifiable scientific testing. I could be off base but it seems like there is some evidence of benefits from acupuncture.

Are we throwing the baby out with the bathwater here because of the woo surrounding acupuncture? I have to think that may be the case. It was the case for me anyway, I always assumed acupuncture was complete BS until I started to see some of the studies... now I am not so sure it is all BS.

There is a lot of evidence that acupuncture is not effective and the research studies with positive results have issues.

 

[not_so_new]

There is a lot of evidence that acupuncture is not effective and the research studies with positive results have issues.

So the research that shows positive results is bad and only the research that shows negative results can be trusted?

Sounds a little like confirmation bias to me.



I am very skeptical of the research, yes there are some mixed results and I must emphasize again, flat out the magical claims are complete and utter BS. But to say that "all the scientific research that show positive results are bad" smells very fishy to me.

I posted some links to research above which appear to have been done in a thoughtful scientific manner. Here are some additional results.

This is a very interesting study....

http://phys.org/news/2010-11-acupuncture-brain-perception-pain.html

In the study, conducted in close collaboration with the Department of Complementary and Integrative Medicine at University of Duisburg-Essen, 18 healthy volunteers underwent fMRI while an electrical pain stimulus was attached to the left ankle. Acupuncture needles were then placed at three places on the right side, including between the toes, below the knee, and near the thumb. With the needles in place, fMRI was repeated while electrical currents were again directed at the left ankle. The researchers then compared the images and data obtained from the fMRI sessions with no acupuncture to those of the fMRI sessions with acupuncture.

"Activation of brain areas involved in pain perception was significantly reduced or modulated under acupuncture," Dr. Theysohn said.

.... and these...

http://phys.org/news/2011-03-acupuncture-curbs-severity-menopausal-hot.html
http://phys.org/news203266862.html
http://phys.org/news/2010-12-acupuncture-older-children-lazy-eye.html
http://phys.org/news184511570.html
http://phys.org/news184482586.html
http://phys.org/news181311011.html
http://phys.org/news169984727.html
http://phys.org/news169120620.html
http://phys.org/news161279190.html
http://phys.org/news159456540.html
http://phys.org/news197198059.html
http://phys.org/news189317612.html
http://phys.org/news131514301.html

These are not coming from some crackpot site. These are all coming from Phys.org which is a fairly reputable source. I have a good deal of respect for you so this isn't to call you out. It's just that the fact that you are dismissing these out of hand is curious to me.

Again, YES there are other studies showing negative results and NO I don't believe in ANY of the magical attributes of acupuncture. I just don't see how we can completely throw out all the positive study results above (and many many more) so easily. I question if something else is really going on here.

 

[jdc324]

So the research that shows positive results is bad and only the research that shows negative results can be trusted?

Sounds a little like confirmation bias to me.



I am very skeptical of the research, yes there are some mixed results and I must emphasize again, flat out the magical claims are complete and utter BS. But to say that "all the scientific research that show positive results are bad" smells very fishy to me.

I posted some links to research above which appear to have been done in a thoughtful scientific manner. Here are some additional results.

This is a very interesting study....

http://phys.org/news/2010-11-acupuncture-brain-perception-pain.html



.... and these...

http://phys.org/news/2011-03-acupuncture-curbs-severity-menopausal-hot.html
http://phys.org/news203266862.html
http://phys.org/news/2010-12-acupuncture-older-children-lazy-eye.html
http://phys.org/news184511570.html
http://phys.org/news184482586.html
http://phys.org/news181311011.html
http://phys.org/news169984727.html
http://phys.org/news169120620.html
http://phys.org/news161279190.html
http://phys.org/news159456540.html
http://phys.org/news197198059.html
http://phys.org/news189317612.html
http://phys.org/news131514301.html

These are not coming from some crackpot site. These are all coming from Phys.org which is a fairly reputable source. I have a good deal of respect for you so this isn't to call you out. It's just that the fact that you are dismissing these out of hand is curious to me.

Again, YES there are other studies showing negative results and NO I don't believe in ANY of the magical attributes of acupuncture. I just don't see how we can completely throw out all the positive study results above (and many many more) so easily. I question if something else is really going on here.

I did a brief summary of acupuncture for this post: http://jdc325.wordpress.com/2012/01/22/an-a-z-of-alternative-medicine/

One review described a small analgesic effect of acupuncture, which seems to lack clinical relevance and cannot be clearly distinguished from bias. The researchers stated that it was unclear whether needling "reduces pain independently of the psychological impact of the treatment ritual". They refer to some of the issues with acupuncture trials: "Thirteen trials (3025 patients) involving a variety of pain conditions were eligible. The allocation of patients was adequately concealed in eight trials. The clinicians managing the acupuncture and placebo acupuncture treatments were not blinded in any of the trials." It looks to me like they're saying that blinding was inadequate in several studies and that none of the trials were double-blind.

A paper looking at pain due to osteoarthritis of the knee concluded that acupuncture provided no additional improvement in pain scores compared with a course of six sessions of physiotherapy-led advice and exercise. "Compared with advice and exercise alone there were small, statistically significant improvements in pain intensity and unpleasantness at two and six weeks for true acupuncture and at all follow-up points for nonpenetrating acupuncture. [...] Small benefits in pain intensity and unpleasantness were observed in both acupuncture groups, making it unlikely that this was due to acupuncture needling effects."

Cochrane review of acupuncture for osteoarthritis - statistically significant benefits, which are small, do not meet the authors' pre-defined thresholds for clinical relevance, and are probably due at least partially to placebo effects from incomplete blinding.

I get the impression that (a) blinding is tricky in acupuncture studies (b) where trials show benefits of acupuncture those benefits are small and not thought to be clinically relevant and (c) it seems likely that the benefits are mostly explained by placebo effects.

 

[jdc324]

On safety, Professor Woo reckons that acupuncture infections might be under-reported / under-diagnosed: http://news.bbc.co.uk/1/hi/8574445.stm (I had a look for the article in the BMJ but it seems to be paywalled).

Ernst found 86 deaths following acupuncture: http://iospress.metapress.com/content/5178037868k43029/?p=02b581d7e6d748cbad9cd835682fb230&pi=1 (inadequate reporting makes it difficult to ascertain causality, and he thinks there may be under-reporting).

Pneumothorax: 9 patients in 10 years reporting to a Korean hospital with pneumothorax following acupuncture - http://www.ncbi.nlm.nih.gov/pubmed/19196054

Letter describing a case of pneumothorax: http://emj.bmj.com/content/21/3/398.full

Now, serious side-effects from acupuncture do seem to be pretty rare but if the benefits are small and possibly due to placebo effects then it seems to me it's not worth the risk (even if it is very small) of something going wrong.

 

[not_so_new]

I did a brief summary of acupuncture for this post: http://jdc325.wordpress.com/2012/01/22/an-a-z-of-alternative-medicine/

<snip some great replies>

Thank you for the well presented post. As I said I am also skeptical of the positive results I have seen.

That said, there are a few studies that are interesting to a layman such as myself.

The one I mentioned in my second post above is an example.....

http://phys.org/news/2010-11-acupunc...tion-pain.html

In the study, conducted in close collaboration with the Department of Complementary and Integrative Medicine at University of Duisburg-Essen, 18 healthy volunteers underwent fMRI while an electrical pain stimulus was attached to the left ankle. Acupuncture needles were then placed at three places on the right side, including between the toes, below the knee, and near the thumb. With the needles in place, fMRI was repeated while electrical currents were again directed at the left ankle. The researchers then compared the images and data obtained from the fMRI sessions with no acupuncture to those of the fMRI sessions with acupuncture.

"Activation of brain areas involved in pain perception was significantly reduced or modulated under acupuncture," Dr. Theysohn said.

This could be a problem with blinding but it does sown something is going on. Perhaps some sort of mind over matter (which would be interesting enough on its own) or it could be something to do with acupuncture? I don't really know but it does leave the door open for me on the subject.

This mouse study makes me wonder if we are dismissing acupuncture too quickly. Does working with mice remove the double blind issues? I don't really know but I would like to learn.

Anyway....

http://phys.org/news194418635.html

"Acupuncture has been a mainstay of medical treatment in certain parts of the world for 4,000 years, but because it has not been understood completely, many people have remained skeptical," said Nedergaard, co-director of the University's Center for Translational Neuromedicine, where the research was conducted. "In this work, we provide information about one physical mechanism through which acupuncture reduces pain in the body," she added.

<snip>

To do the experiment, the team performed acupuncture treatments on mice that had discomfort in one paw. The mice each received a 30-minute acupuncture treatment at a well known acupuncture point near the knee, with very fine needles rotated gently every five minutes, much as is done in standard acupuncture treatments with people. The team made a number of observations regarding adenosine:

- In mice with normal functioning levels of adenosine, acupuncture reduced discomfort by two-thirds.

- In special "adenosine receptor knock-out mice" not equipped with the adenosine receptor, acupuncture had no effect.

- When adenosine was turned on in the tissues, discomfort was reduced even without acupuncture.

- During and immediately after an acupuncture treatment, the level of adenosine in the tissues near the needles was 24 times greater than before the treatment.

AGAIN, I remain skeptical but I feel there is enough evidence for me to keep an open mind on the subject.

 

[Skeptic Ginger]

So the research that shows positive results is bad and only the research that shows negative results can be trusted?

Or, it's like I said and when you get down in the weeds on acupuncture research, you find there is an especially large amount of bad research showing positive results for this medical treatment.

Sounds a little like confirmation bias to me.

Yes, your confirmation bias that I haven't reviewed the acupuncture research objectively.


A lot of the problems stem from the currently unreliable studies out of China. The face-saving culture has had such a negative impact on research out of China that a lot of professionals won't consider any results from Chinese medical researchers. The country recognizes and is trying to address the cultural barrier to joining the modern world scientific communities.

Interestingly, when you look at carefully controlled, well done acupuncture research, you don't find more than a placebo effect.


Acupuncture: what does the most reliable evidence tell us?

Ernst E.; Source: Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, Exeter, United Kingdom. edzard.ernst@pms.ac.uk
Abstract
Many trials of acupuncture and numerous systematic reviews have recently become available. Their conclusions are far from uniform. In an attempt to find the most reliable type of evidence, this article provides an overview of Cochrane reviews of acupuncture. Such reviews were studied, their details extracted, and they were categorized as: reviews with a negative conclusion (no evidence that acupuncture is effective); reviews that were inconclusive; and reviews with a positive or tentatively positive conclusion. Thirty-two reviews were found, covering a wide range of conditions. Twenty-five of them failed to demonstrate the effectiveness of acupuncture. Five reviews arrived at positive or tentatively positive conclusions and two were inconclusive. The conditions that are most solidly backed up by evidence are chemotherapy-induced nausea/vomiting, postoperative nausea/vomiting, and idiopathic headache. It is concluded that Cochrane reviews of acupuncture do not suggest that this treatment is effective for a wide range of conditions.

Nausea, vomiting, and headache with no recognized cause... proving a greater effect than placebo would need a valid sham acupuncture to have been used in the studies. I'd be willing to look at the studies to see if they show anything more than placebo. But of the many many studies I have looked at, placebo effect would be the most likely reason for a positive effect.


From the people with confirmation bias wanting acupuncture to work: Paradoxes in Acupuncture Research: Strategies for Moving Forward

First, a number of well-designed clinical trials have reported that true acupuncture is superior to usual care, but does not significantly outperform sham acupuncture, findings apparently at odds with traditional theories regarding acupuncture point specificity. Second, although many studies using animal and human experimental models have reported physiological effects that vary as a function of needling parameters (e.g., mode of stimulation) the extent to which these parameters influence therapeutic outcomes in clinical trials is unclear.

Note the claim, acupuncture was superior to usual care but no better than placebo!!! And they call this "a paradox"! No, it's evidence all you have is placebo. Good grief, these people conclude there is something there, they just can't show it.

 

[Skeptic Ginger]

.... AGAIN, I remain skeptical but I feel there is enough evidence for me to keep an open mind on the subject.

Of course, someone open to new evidence should it be forthcoming, but feels there is currently sufficient evidence to say acupuncture doesn't do more than placebo, is just confirming their own bias and doesn't have an open mind.

Of course, you aren't confirming your own bias. Perhaps I can dent that for you. Consider what it is you are accepting as evidence:

....The one I mentioned in my second post above is an example..... http://phys.org/news/2010-11-acupuncture-brain-perception-pain.html

(The copied link is dead, BTW, only the one in the original post still works.)

Only 18 subjects and no placebo. That's fine for a pilot study. But this is just the kind of thing that makes people believe there is actual positive evidence. Little pilot studies, done by people expecting positive results (look at who did the research) are not good evidence when better studies failed to find results. The acupuncture research field, more so than a lot of other research fields, is full of this kind of misleading stuff.


Follow your mouse study to its source, don't only go by a summary from a science reporter or whoever it is that wrote that summary. Even if you can only get to the abstract for free, it's still better than a science news summary.

Acupuncture is an invasive procedure commonly used to relieve pain. Acupuncture is practiced worldwide, despite difficulties in reconciling its principles with evidence-based medicine. We found that adenosine, a neuromodulator with anti-nociceptive properties, was released during acupuncture in mice and that its anti-nociceptive actions required adenosine A1 receptor expression. Direct injection of an adenosine A1 receptor agonist replicated the analgesic effect of acupuncture. Inhibition of enzymes involved in adenosine degradation potentiated the acupuncture-elicited increase in adenosine, as well as its anti-nociceptive effect. These observations indicate that adenosine mediates the effects of acupuncture and that interfering with adenosine metabolism may prolong the clinical benefit of acupuncture.

I'm not sure from the abstract how they measured pain and pain relief in mice but let's assume they did have an accurate measurement. The study suggests a mechanism for an action that has yet to be shown to actually exist beyond placebo. Sticking needles in mice (how did they figure out the meridians? Mice and humans have knees? ) released adenosine. That's all they've shown here. Did they compare sticking needles elsewhere in the mice?

The findings are meaningless other than interesting results. Perhaps it will lead to a better understanding of the placebo effect.

 

[Andrew Wiggin]

Acupuncture trials are extra hard to double blind. There are some sham techniques that can potentially (arguably) blind the patient to which treatment group they're in but it's really hard to blind the practitioner, and the practitioner's expectations affect the patient's expectations.