“There’s no real evidence to suggest that acupuncture really works, or is there?”
One of the most common statements that we hear in the clinic is as follows:
“There’s no real evidence to suggest that acupuncture really works.”
This could not be further from the truth. The statement that “there is no evidence that acupuncture is effective for condition X” can mean two different things:
- clinical trials have been conducted, and the results were negative, or
- no, or very few, high-quality clinical trials have been conducted.
Both statements are inherently flawed and point to a continued lack of awareness of and potential bias against research showing the efficacy and effectiveness of acupuncture.
As a holistic medicine, acupuncture research depends on charity and state funding; clinical trials are expensive. Consequently, clinical trials are often small, involving less than 100 participants, and available evidence may still be limited for many conditions. However, this is improving.
Medical evidence users, including clinicians, patients, and policymakers, generally regard Cochrane systematic reviews as the gold standard. As of February 1st, 2023, there are 17,579 clinical trials of acupuncture and 140 systematic reviews in the Cochrane database.
CURRENT LIMITATIONS WITHIN ACUPUNCTURE RESEARCH:
Regarding acupuncture research, there are still significant limitations to be addressed within its methodology, most notably those of sham acupuncture intervention and double-blinding.
- Firstly, sham acupuncture is essentially fake acupuncture and is used as a control in scientific studies to determine whether or not the effects of acupuncture are quantifiable. However, the sham acupuncture needle is not the perfect placebo and is often an actual acupuncture needle. For sham acupuncture needles to be a trustworthy control, they must be indistinguishable and physiologically inserted but without treatment function. Research cannot continue to assume their physiological effect as inert. As the effects of sham acupuncture have not been rigorously tested, its inclusion as a control continues to be unreliable, leading to confusing or potentially misleading trial results that underestimate the effects of and promote a bias against acupuncture. There continue to be significant problems with sham interventions and a lack of clarity on how they are applied in acupuncture trials across the board. With this in mind, sham acupuncture in its current form renders most research unreliable until its effect can be quantified.
- Secondly, double-blinding is problematic because most types of placebo acupuncture cannot easily be blinded for the acupuncturist and often for the patient. Blinding protects against bias. The success of blinding is seldom assessed and/or reported clearly in clinical trials, including in studies of acupuncture, where blinding represents a significant challenge and is a crucial component in all high-quality research.
These two issues aside, systematic reviews of acupuncture are generally methodologically rigorous. Many of the reviews indicate that there is not sufficient evidence to draw a firm conclusion as to acupuncture’s efficacy or effectiveness. However, it is essential to remember that this does not mean acupuncture is ineffective. In addition, one must bear in mind that, as a holistic and highly individualised approach to medicine, acupuncture cannot and will never easily fit a one-size-fits-all western research model. It is, however, based on c. 2000 years of clinical observation and practical experience. Like any medical intervention, success relies on the practitioner, the diagnosis, the treatment and the specifics of each patient.
HIGH-QUALITY RESEARCH AND ACUPUNCTURE’S ENDORSEMENT WITHIN PRIMARY HEALTHCARE:
On the other hand, based on this research, the National Institute for Health and Care Excellence (NICE) now endorses acupuncture in the treatment of chronic pain [NG193] and has stated that it proves more effective in the management of chronic primary pain than analgesics. Studies (27 in total) showed that acupuncture reduced pain and improved quality of life in the short term (up to 3 months) compared with usual care or sham acupuncture. In addition, NICE recommends acupuncture in the treatment of migraine and tension-type headaches.
Since 1975, more than 10,000 randomised controlled trials on acupuncture have been published. Between 2000 and 2020, the Web of Science listed 2,471 systematic reviews relating to acupuncture, with the number of systematic reviews continuing to increase exponentially every year. Given the rapid increase in the literature, evidence-based practice and policy-making require systematic reviews of the available RCTs.
A recent overview of systematic reviews of acupuncture found that, of 77 conditions investigated, acupuncture showed a moderate to significant effect with moderate or high-quality evidence in relation to eight conditions:
- improvement in functional communication of patients with post-stroke aphasia,
- relief of neck and shoulder pain
- relief of myofascial pain
- relief of fibromyalgia-related pain,
- relief of non-specific lower back pain,
- increased lactation rate within 24 hours of delivery,
- severity reduction of vascular dementia symptoms, and
- improvement of allergic rhinitis nasal symptoms.
However, instead of endorsement in health policies and widespread use in clinical practice, few healthcare systems incorporated acupuncture into clinical practice guidelines and national health coverage for these conditions. Therefore, evidence on acupuncture therapies continues to be underused in health policy and clinical practice.
CONCLUSION:
With the increasing popularity of acupuncture and the rapid rise in research, it is vital to use the increasing body of evidence to inform clinical and policy decision-making and establish funding and research agendas globally. Creating a climate of evidence-informed decision-making on acupuncture, building a coordinated multistakeholder effort to facilitate the generation and implementation of evidence, and using digitised repositories to facilitate knowledge will enable a more evidence-based approach to inform practice, policy, research agenda, and funding priorities moving forward. Join the revolution.
REFERENCES:
To read more about high-quality research relating to acupuncture, check out the following links:
- Cochrane Library: Trusted evidence. Informed decisions .Better health
- The British Acupuncture Council (BAcC): Acupuncture Research
- The British Medical Journal (BMJ): Evidence on acupuncture therapies is underused in clinical practice and health policy
- Evidence Based Acupuncture (EBA): Ancient Medicine. Modern Research. Evolutionary Thinking.
Can acupuncture help me?
For the most up-to-date research and evidence on the efficacy of acupuncture, please visit the British Acupuncture Council (BAcC) website.
If you would like to learn more about how acupuncture may be able to help you, please contact us today.
