Acupuncture Q&A

[ChristineR]

And you still say you're not redefining acupuncture?

Rolfe.

What would you like to call sticking needles into the large muscles, possibly applying an electrical current, in order to stimulate endorphin production and reduce pain levels?

 

[Rolfe]

Something else.

Rolfe.

 

[ChristineR]

Something else.

Rolfe.

Hedging a bit, are we?

 

[Rolfe]

You just invented a procedure of your own. How should I know what to call it? It's not acupuncture though, except by redefining acupuncture.

Rolfe.

 

[ChristineR]

You just invented a procedure of your own. How should I know what to call it? It's not acupuncture though, except by redefining acupuncture.

Rolfe.

I didn't invent any procedure. These are procedures being used by people who call themselves acupuncturists. Sometimes the term "scientific acupuncture" is used, but that is also used by the guys who unblock the meridians. I also found a reference to "Evidence-based neuro-electric stimulation," so if you prefer, I will stop referring to acupuncture and call it evidence-based neuro-electric stimulation.

 

[Rolfe]

That would be a good idea, and should clarify the discussion. To go back to your original statement:

Acupuncture works. All that stuff about "Chi" and "meridians" is bogus, and most of the claims are nonsense....

You then went on to describe a very specific procedure that you said did work. However, how can you say "acupuncture" works, in the same breath as you say that chi and meridians are bogus, when the overwhelming majority of people who practise acupuncture consider these features to be essential, indispensible parts of acupuncture? And when many acupuncturists do stuff which is very very different from what you now describe as evidence-based neuro-electric stimulation.

You can't simply slice out a tiny corner of a practice, claim that this works, and thus declare that the entire field "works", while explicitly denying the vast swathe of its practices.

As I said, I was at a big discussion meeting about acupuncture last week, and the speaker poined out that in order to decide who had pratised acupuncture and when, you had to define acupuncture. He gave four criteria. My notes are in the car, but he included the use of very fine needles causing minimal trauma, their positioning according to meridians, and their use to manipulate chi. I've forgotten the fourth, maybe you have to twiddle the needles.

You refer to

sticking needles into the large muscles, possibly applying an electrical current, in order to stimulate endorphin production and reduce pain levels

which excludes almost everything that is actually practised as acupuncture, and indeed everything that was ever done by the Chinese. It needs a new name, and "evidence-based neuro-electric stimulation" sounds reasonable to me.

Now, about that evidence. Can you provide references? As I understand it the evidence that this can relieve pain is scanty, due to difficulties with blinding, and the stuff about endorphins is only speculation.

Rolfe.

 

[ChristineR]

Classic acupuncture, with needles, is a primitive form of neuro-electric stimulation. Some practitioners claim the needles aren't necessary at all, but the mechanisms are poorly understood and not well studied (as you pointed out). The point is that even when the practitioner believes he is unblocking meridians and all that stuff, he is getting real, measurable results from the neuro-electric stimulation. This sort of bogus theorizing is common in the history of medicine, and it often turns out that what sounds silly (positioning of needles) has a valid clinical basis (maximizing endorphin production) even if the historical theory gives a nonsense explanation (unblocking Chi).

Classic acupuncture involves inserting the needles and then twirling them, which generates a weak electric current. Many classic acupuncturists also put an electrical charge on the needles.

I posted this before, but here is a link to the large NIH study which actually managed to be blinded and controlled. They used needles, and the practitioners were positioning the needles based on meridians. Nonetheless, there were actual results. They may have gotten better and safter results with the techniques of evidence-based neuro-electric stimulation, but they got results. The acupuncture worked.


http://
http://www.annals.org/cgi/content/abstract/141/12/901

Here's a SI article about it:

http://www.csicop.org/si/2003-03/acupuncture.html

There was also a cover story in Skeptic some time ago, but I don't think it's online.

Your speaker may not consider the modern techinques to be "acupuncture," but then what I'm saying is that "acupuncture is a subset of techniques of neuro-electric stimulation, which is a poorly studied but effective technique." And as I said before, I would consider sticking a thin needle into a person to be acupuncture, even if you are not positioning the needles according to TCM theories.

 

[casebro]

The first link is busted.

From the second link, in which there are no statistics given, only

"By 2001 functional magnetic resonance imaging (fMRI) studies, especially those of Professor Z.H. Cho of the University of California Medical School at Irvine, demonstrated significant supporting evidence of a biological basis for acupuncture"

You realize that "significant" means "statistically significant", and NOT that patients got any significant relieve of symptoms? Like way back at post #16, 2.8% is NOT of significant benefit, though it is "statistically significant".

 

[Rolfe]

Measurable results? Indeed?

So what do you think this technique can cure? In the 19th century it was promoted as a cure for cholera. How about that?

Rolfe.

 

[Loon]

I think what this research shows is that accupuncture (or at least the sticking of needles in the body at various locations, to avoid the definition war) can have a measureable and statistically significant beneficial effect. Alas, this doesn't mean much (other than maybe the impetus for research that would tell us why) because we have treatments that have a much greater effect.

 

[Rolfe]

Since it doesn't seem to matter where you stick the needles, it's very difficult to say whether there's anything going on beyond fairly marked suggestibility. I'm waiting to see any support for either "evidence-based" or the assertion that endorphins are involved.

There's no denying that when you stick a pin in someone's body, the person and the body tend to notice. Thus it's hardly surprising that you can measure things happening in the brain and some chemicals (like cortisol and glucose) increasing in the blood. This is as you would expect, simply as a result of having pins stuck in you.

If at the same time you tell people that this pin-sticking will have a beneficial effect on some extremely subjective symptom, I for one am not necessarily bowled over with astonishment if a fair number of the subjects dutifully report experiencing exactly that effect.

When acupuncture was originally introduced (and it has come and gone in several waves over the last couple of hundred years) it was claimed to cure all sorts of illnesses. Soulie de Morant, who was a great French acupuncture proponent in the early years of the 20th century, was convinced it could cure cholera.

That sort of claim has now been entirely abandoned as preposterous. Even claims that actual anaesthesia can be achieved using acupuncture are being gradually relinquished as reproducible evidence fails to be accumulated. What we are now seeing is a retreat into the realm of the wholly subjective, such as the relief of chronic pain, and even (God help us) giving up smoking! Traditional Chinese Medicine? Smoking??

Now, I simply can't see any evidence beyond what you'd expect from the known fact that you can influence people to report different perceptions by psychological suggestion, and the idea that reinforcing these suggestions by sticking needles in the patient seems neither paranormal, surprising, nor evidence of some great new field of medicine.

Rolfe.

 

[ChristineR]

It's the same link I gave before, an abstract of a double blind study that used a tube device that either inserted a needle or poked a person. Tests on the device indicated that patients could not tell if they were getting real acupuncture, or were just being poked. There was a signifigant difference between the improvement in the poked group and the punctured group, and the confidence level was 95%. If the blinding device really does work as claimed, this could not have been due to placebo or suggestion. So far as I know this is the only large acupuncture study to effectively blind the patients.

http://www.annals.org/cgi/content/abstract/141/12/901

I know of know evidence that acupuncture cures anything, certainly not cholera. But thousands of useful drugs and procedures do not cure anything. It can be used to treat pain, just as hydrocodone can.

The 2.8% was after four weeks. After 26 weeks, it was much higher. What this shows is that if you're not willing to go through a lot of sessions, you may not get much relief. But there's been very little study of how best to adminster evidence-based neuro-electric stimulation, so it's pretty impressive that they got such good results using Chi theory.

The endorphins are just a theory, so far as I know, but they do seem to fit the known facts. That stuff about the MRI is too vague--I really don't know what they're talking about.

 

[Rolfe]

Evidence-based? One study? I don't think so.

Oh yes. It can be used to treat pain. So can sugar pills. The question is, is there any useful effect? One study? Come again.

Neuro-electric? Well, I presume electricity is inolved, but why neuro? Of course there are nerves everywhere in the body, but what's so "neuro" about this?

I see we're already down to "electric stimulation". Hmmm, we'll soon see the usual false analogies with TENS devices coming out I suppose.

One study? The jury hasn't even begun to hear the case yet, I'm afraid.

Rolfe.

 

[ChristineR]

I wouldn't give much credence to one study, but it's actually more like one blinded study, lots of unblinded studies, and some animal studies. I think there's pretty strong evidence at this point that acupuncture does in fact have some effect beyond placebo. Not a real amazing effect.

Still, if nobody can replicate this, I will be willing to return acupuncture to the list of non-treatments. The study does appear to have been well designed, and the confidence level was 95%. But it wouldn't be the first study to crash and burn....

 

[Rolfe]

Animal studies!!!!



Oh dearie, dearie me!

Look, I've sat through too many hours of forensic shredding of the evidence in this area to be able to summarise it at all sensibly, but I really do think you are reading far too much into a few hopeful publications by enthusiasts. And with the greatest respect, and no doubt about to be taken to task for appeal to authority, I tend to give the senior lecturer in the department of pain management at the John Radcliffe quite a lot of credence.

Rolfe.

 

[ChristineR]

You're the one with the Kitty Avatar.

Okay, I agree to wait and see, although I still think there is a measurable effect above and beyond placebo and suggestion. I wouldn't suggest anyone run out and get acupuncture, but people in pain have been known to try things.