I've been meaning to comment on this blog post from the New York Times http://well.blogs.nytimes.com/2010/08/23/studying-acupuncture-one-needle-prick-at-a-time/?scp=4&sq=acupuncture&st=cse for some time now. It covers a number of issues concerning acupuncture research. It first cites a recent study from MD Anderson School of Medicine exploring osteoarthritis of the knee and the effectiveness of acupuncture. The link to that article is here.http://onlinelibrary.wiley.com/doi/10.1002/acr.20225/abstract. The study is actually trying to determine if the clinical attention given to the patients affected outcome, thus getting at the ever present problem of "placebo" in acupuncture research. What they found in the study is that acupuncture worked about the same as sham acupuncture. Because of that, the study's lead author concludes that acupuncture does not work, since in your typical drug study if the drug works the same as a placebo the determination is that the drug does not work. ( We will leave aside the issue that many drugs on the market now,Prozac for example, work no better than placebo and still enjoy widespread use.) But another way to parse the outcome of the study is that acupuncture works even if poorly administered. In this particular study the sham acupuncture was less stimulative, shallow needling, so the acupuncture defenders can claim that acupuncture was performed. The NYTimes article goes on to mention the German Insurance Company studies which showed that drug (analgesic) usage was dramatically reduced with acupuncture and sham acupuncture in back pain patients versus the controls, and that only 15% of acupuncture patients needed pain medication versus 29% of sham 59% of controls. German Insurance Companies now pay for acupuncture as a result of these studies, btw. The article also mentions the study comparing effexor to acupuncture covered in this blog post.(http://www.blogger.com/post-edit.g?blogID=6188135334037051688&postID=1694074355474832229)
The placebo issue still plagues acupuncture research, and keeps the discussion from going further than whether we can trust the studies, and then whether acupuncture really works or not. It gets tiresome, especially given the scant funding for acupuncture research. One veteran British acupuncture researcher I met at the latest Society for Acupuncture Research conference is recommending that we simply design studies comparing one dosage of acupuncture (time, frequency, length of treatment, point selection) to another so we can finally get beyond the underlying premise of the MD Anderson study, ie that it's the clinical setting or attitude that is determining outcome. You would think that the animal studies would put some of the placebo chatter to rest a bit, but it doesn't seem to.
I have no interest in dispensing placebos, nor am I interested in delivering acupuncture using specific points, if it would be just as effective to use any random points on everyone. It would save lots of time and the effort of charting. I am dedicated to studying and learning what the actual mechanisms of acupuncture are so that we can use it more effectively in a no nonsense approach. If studies repeatedly indicate that one point is as good as another, so be it. But I don't think we're there yet.
In the spirit of "first doing no harm" however, I wish that other treatment modalities were held to the high standard that acupuncture is and were better scrutinized for bias, placebo and safety.
Showing posts with label back pain. Show all posts
Showing posts with label back pain. Show all posts
Monday, October 11, 2010
Monday, August 24, 2009
Another Popular Back Procedure found to be ineffective
The Mayo clinic has found that using medical cement to fix cracks in the brittle vertebrae of elderly people is no better than placebo. The reason that this article is of interest to me is that it fits in the category of things that make sense from a Western Medicine point of view, and so are enthusiastically performed even though there is no evidence for efficacy. Or as my blog post of 4.2.09 was titled, "Believing in Treatments that Don't Work." Given the rigorous standards for acupuncture research, the use of sham needles, sham placement or even (ridiculously) trying to control for the practitioner interaction, it is nice to see the Mayo clinic applying the same rigor to a "logical," popular, western medical procedure.
They go on to say at the end of article that the "miraculous" recoveries seen could be due to the anesthesia, placebo, or the fractures healed on their own. The anesthesia in this case was local anesthesia, so it is possible that the needling helped.
I am the first to admit that there are mysteries in the healing process and that placebo can play a large roll in any therapy, including acupuncture. But Western Medical procedures should be treated with the same level of skepticism as acupuncture is, if not more, since they are often more dangerous and almost always much more expensive. A quick search to determine how much the back cement treatment costs shows that it it runs $526-558 for the first level and then $236 for each level after that. That doesn't include the anesthesia or recovery room fees etc... In addition, particularly with the drama of surgical procedures the placebo effect has the potential to be quite powerful indeed.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/06/MNN9194H2O.DTL
Cement for backs ineffective from San Francisco Chronicle,
Stephanie Nano, Associated Press
Thursday, August 6, 2009
A common treatment that uses medical cement to fix cracks in the spinal bones of elderly people worked no better than a sham treatment, the first rigorous studies of the popular procedure reveal.
Pain and disability were virtually the same up to six months later, whether patients had a real treatment or a fake one.
Tens of thousands of Americans each year are treated with bone cement, especially older women with osteoporosis, some of them stooped and unable to stand up straight. The treatment is so widely believed to work that the researchers had a hard time getting patients to take part when it was explained that half of them would not get the real thing...
"All of us who do the procedure have seen apparently miraculous cures," said Dr. David F. Kallmes, a radiologist at the Mayo Clinic who led one of the studies. But he said there were also "miraculous cures" among those who got the fake treatments.
Bone cement has long been approved for many medical uses, but this particular use had not been tested.
The findings, published in today's New England Journal of Medicine, mean patients and doctors need to review the options together, wrote Dr. James N. Weinstein of Dartmouth Medical School in an accompanying editorial. "When best evidence suggests a tossup between treatment options and no benefit, informed patient choice is essential," he said.
The researchers do not know why people felt better, but suggest it could be due to the anesthesia, the placebo effect or that the fractures healed on their own over time.
They go on to say at the end of article that the "miraculous" recoveries seen could be due to the anesthesia, placebo, or the fractures healed on their own. The anesthesia in this case was local anesthesia, so it is possible that the needling helped.
I am the first to admit that there are mysteries in the healing process and that placebo can play a large roll in any therapy, including acupuncture. But Western Medical procedures should be treated with the same level of skepticism as acupuncture is, if not more, since they are often more dangerous and almost always much more expensive. A quick search to determine how much the back cement treatment costs shows that it it runs $526-558 for the first level and then $236 for each level after that. That doesn't include the anesthesia or recovery room fees etc... In addition, particularly with the drama of surgical procedures the placebo effect has the potential to be quite powerful indeed.
http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2009/08/06/MNN9194H2O.DTL
Cement for backs ineffective from San Francisco Chronicle,
Stephanie Nano, Associated Press
Thursday, August 6, 2009
A common treatment that uses medical cement to fix cracks in the spinal bones of elderly people worked no better than a sham treatment, the first rigorous studies of the popular procedure reveal.
Pain and disability were virtually the same up to six months later, whether patients had a real treatment or a fake one.
Tens of thousands of Americans each year are treated with bone cement, especially older women with osteoporosis, some of them stooped and unable to stand up straight. The treatment is so widely believed to work that the researchers had a hard time getting patients to take part when it was explained that half of them would not get the real thing...
"All of us who do the procedure have seen apparently miraculous cures," said Dr. David F. Kallmes, a radiologist at the Mayo Clinic who led one of the studies. But he said there were also "miraculous cures" among those who got the fake treatments.
Bone cement has long been approved for many medical uses, but this particular use had not been tested.
The findings, published in today's New England Journal of Medicine, mean patients and doctors need to review the options together, wrote Dr. James N. Weinstein of Dartmouth Medical School in an accompanying editorial. "When best evidence suggests a tossup between treatment options and no benefit, informed patient choice is essential," he said.
The researchers do not know why people felt better, but suggest it could be due to the anesthesia, the placebo effect or that the fractures healed on their own over time.
Thursday, June 18, 2009
Britain's National Health Service Prioritizes Acupuncture for Back Pain
(I'm not sure how I missed this study which came out in May. This is great news for the practice of acupuncture and great news for patients in Britain. )
"NHS pins its hopes for treating back pain on acupuncture"
"Unprecedented approval for alternative therapies from health service watchdog"
"Tens of millions of pounds are being wasted by the NHS(National Health Service) on useless treatments for back pain, money that should be diverted to alternative therapies such as acupuncture and spinal manipulation, a health service watchdog says today.
From among 200 treatments and devices claimed to help a bad back, the National Institute for Clinical Excellence (Nice) has passed judgement on what works and what doesn't. X-rays, ultrasound and steroid injections are out and osteopathy, chiropractic and "needling" (i.e. acupuncture) are in, it says.
The new guidelines mark a watershed in the treatment of the condition and for Nice itself. It is the first time that the institute has issued a positive recommendation that the NHS provide, and pay for, alternative therapies.
But Nice says a careful review of the evidence shows that acupuncture and spinal manipulation work."
The article goes on to say that Back pain is among the most common reasons for visits to family doctors (after colds and flu.) The NHS spends 1.5 billion pounds (about 2 billion dollars) treating 2.5 million patients. The study found that most of the money was wasted. The new guidelines pertain to patients whose back pain has persisted more than 6 weeks. The new guidelines say that these patients should be offered three options: an exercise programme, a course of manual therapy including manipulation or a course of acupuncture. If one treatment option does not work, patients may be offered a second.
The panel that drew up the guidelines expects acupuncture to be the most popular option, with an estimated annual cost of over £24m in England and Wales.
"To pay for the new treatments, the panel estimates that ending the use of steroid and other injections into the back will save more than £33m, stopping MRI scans will save £12m, and a further £1m can be diverted from funds for X-rays. Evidence shows that ordering X-rays can make patients worse, by confirming their invalid status. The overall net cost to the NHS of implementing the guidelines is estimated at just £77,000."
"Professor Peter Littlejohns, the clinical and public health director at Nice, said: "Most people will be affected by low back pain at some stage in their lives. The NHS now has evidence-based guidance on how to treat the condition effectively."...""In this case, the evidence was robust enough to make a positive recommendation," he said."
"NHS pins its hopes for treating back pain on acupuncture"
"Unprecedented approval for alternative therapies from health service watchdog"
"Tens of millions of pounds are being wasted by the NHS(National Health Service) on useless treatments for back pain, money that should be diverted to alternative therapies such as acupuncture and spinal manipulation, a health service watchdog says today.
From among 200 treatments and devices claimed to help a bad back, the National Institute for Clinical Excellence (Nice) has passed judgement on what works and what doesn't. X-rays, ultrasound and steroid injections are out and osteopathy, chiropractic and "needling" (i.e. acupuncture) are in, it says.
The new guidelines mark a watershed in the treatment of the condition and for Nice itself. It is the first time that the institute has issued a positive recommendation that the NHS provide, and pay for, alternative therapies.
But Nice says a careful review of the evidence shows that acupuncture and spinal manipulation work."
The article goes on to say that Back pain is among the most common reasons for visits to family doctors (after colds and flu.) The NHS spends 1.5 billion pounds (about 2 billion dollars) treating 2.5 million patients. The study found that most of the money was wasted. The new guidelines pertain to patients whose back pain has persisted more than 6 weeks. The new guidelines say that these patients should be offered three options: an exercise programme, a course of manual therapy including manipulation or a course of acupuncture. If one treatment option does not work, patients may be offered a second.
The panel that drew up the guidelines expects acupuncture to be the most popular option, with an estimated annual cost of over £24m in England and Wales.
"To pay for the new treatments, the panel estimates that ending the use of steroid and other injections into the back will save more than £33m, stopping MRI scans will save £12m, and a further £1m can be diverted from funds for X-rays. Evidence shows that ordering X-rays can make patients worse, by confirming their invalid status. The overall net cost to the NHS of implementing the guidelines is estimated at just £77,000."
"Professor Peter Littlejohns, the clinical and public health director at Nice, said: "Most people will be affected by low back pain at some stage in their lives. The NHS now has evidence-based guidance on how to treat the condition effectively."...""In this case, the evidence was robust enough to make a positive recommendation," he said."
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