Placebo and Acupuncture vs Acupuncture for Dogs

Compare and contrast.
A study looking AGAIN at acupuncture for osteoarthritis after the biggest study ever done on acupuncture put the placebo issue to rest. Why don't we see this scrutiny with anti-depressant studies? Or stents? There can actually be some hazards with either of those...
Meanwhile other groups are moving on and using acupuncture in dogs for post operative pain. Because it's all about the placebo effect...

Practice, practitioner, or placebo? A multifactorial, mixed-methods randomized controlled trial of acupuncture.
White P, Bishop FL, Prescott P, Scott C, Little P, Lewith G
Faculty of Health Sciences, University of Southampton, Highfield, Southampton, UK.
Abstract
The individual practitioner and the patient's belief had a significant effect on outcome. The 2 placebos were equally as effective and credible as acupuncture. Needle and nonneedle placebos are equivalent. An unknown characteristic of the treating practitioner predicts outcome, as does the patient's belief (independently). Beliefs about treatment veracity shape how patients self-report outcome, complicating and confounding study interpretation.

Electroanalgesia for the postoperative control pain in dogs.
Cassu RN, Silva DA, Genari Filho T, Stevanin H.Acta Cir Bras. 2012 Jan;27(1):43-8.
Unoeste, Presidente Prudente, SP, Brazil.
To evaluate the analgesic and neuroendocrine effects of electroanalgesia in dogs undergoing ovariohysterectomy.
RESULTS: EA and EAD- treated dogs had lower pain scores than DER treated dogs one hour postoperatively. Fewer EA and EAD-treated dogs required rescue analgesia. Serum cortisol did not differ among treatments.
CONCLUSION:Preoperative application of electrical stimuli to acupuncture points isolated or in combination with peri-incisional dermatomes provides a reduced postoperative opioid requirement and promotes an effective analgesia in dogs undergoing ovariohyterectomy.

So do dogs' beliefs influence outcomes too?

Info on my practice here.

Comparison of celebrex, glucosamine, glucosamine chondroitin and placebo

The University of Utah School of Medicine has published a review looking at the popular supplement, glucosamine, and its efficacy in comparison to celebrex, placebo, and the combination of glucosamine-condroitin.
http://www.ncbi.nlm.nih.gov/pubmed/20525840
Ann Rheum Dis. 2010 Aug;69(8):1459-64.
"Clinical efficacy and safety of glucosamine, chondroitin sulphate, their combination, celecoxib or placebo taken to treat osteoarthritis of the knee: 2-year results from GAIT."

Osteoarthritis is a significant cause of disability, and knee osteoarthritis is one of the more prevalent subsets of debilitating osteoarthritis. The methods of the study are as follows.
"METHODS: A 24-month, double-blind, placebo-controlled study, conducted at nine sites in the US ancillary to the Glucosamine/chondroitin Arthritis Intervention Trial, enrolled 662 patients with knee OA who satisfied radiographic criteria (Kellgren/Lawrence grade 2 or 3 changes and baseline joint space width of at least 2 mm). This subset continued to receive their randomised treatment: glucosamine 500 mg three times daily, CS 400 mg three times daily, the combination of glucosamine and CS, celecoxib 200 mg daily, or placebo over 24 months. The primary outcome was a 20% reduction in Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain over 24 months. Secondary outcomes included an Outcome Measures in Rheumatology/Osteoarthritis Research Society International response and change from baseline in WOMAC pain and function."

Their conclusions were as follows.
"CONCLUSIONS: Over 2 years, no treatment achieved a clinically important difference in WOMAC pain or function as compared with placebo. However, glucosamine and celecoxib showed beneficial but not significant trends. Adverse reactions were similar among treatment groups and serious adverse events were rare for all treatments."

From this study, though glucosamine and celecoxib achieved some benefit, it was not significant. In my practice I have had patients' have GI problems with celecoxib, which is anecdotal, of course. As with all supplements, or medications, each person reacts differently, so it is important to keep an open mind and try the safest solutions first. From this study, if patients wanted to try a supplement, I could recommend glucosamine with the same enthusiasm as celebrex, but might urge them to try the avocado and soybean unsaponifiables (ASU) from yesterday's post. Of course, there are many more targeted herbal therapies, but don't have the benefit of clinical studies behind them.

Supplements and Osteoarthritis:

I just came across two interesting abstracts concerning supplements for osteoarthritis. I will review each in its own post. The first one, Phys Sportsmed. 2010 Jun;38(2):71-81, is titled,
"A potential role for avocado- and soybean-based nutritional supplements in the management of osteoarthritis: a review."
http://www.ncbi.nlm.nih.gov/pubmed/20631466

The article discusses osteoarthritis and its prevalence and importance and then goes on to say, "Although the ultimate goal is to slow or prevent OA progression, at present, medical management of OA is aimed primarily at controlling symptoms of pain and stiffness and maintaining joint mobility and quality of life. Because of the lack or perceived lack of response to many conventional therapies for OA as well as concerns regarding the long-term administration of drugs (eg, nonsteroidal anti-inflammatory drugs), oral joint health supplements (OJHSs) have become increasingly popular among patients with OA." It then describes some of the molecular mechanisms and concludes " Basic scientific research studies and a systematic review and meta-analysis of the available high-quality randomized clinical trials indicate that 300 mg of ASU (avocado and soybean unsaponifiables) per day (with or without glucosamine and chondroitin sulfate) appears to be beneficial for patients with hip or knee OA." (emphasis mine)

I had not been aware of this definitive research and am glad to have another suggestion for my patients with osteoarthritis. I was also surprised to see the admission that conventional therapies are not always effective.

The cost-effectiveness of acupuncture:German Studies.

In Washington DC this week, President Obama has been having a summit on Health Policy related issues.
In regards to cost containment and effectiveness issues, I would like to highlight a series of studies performed in Germany on the cost effectiveness of acupuncture for a variety of common conditions.
We have to keep in mind, that in Germany, unlike the U.S., the government has a vested interest in keeping the population well because of the universality of their health coverage, unemployment benefits, and sick pay. But the WHO has determined a level of cost-effectiveness for all geographical areas in the world regardless of their particular health policies. The German series uses these preset values in evaluating acupuncture treatment.
(For more information about my practice, please click here.)


Quality of life and cost-effectiveness of acupuncture treatment in patients with osteoarthritis pain.
Eur J Health Econ. 2008 Aug;9(3):209-19.
"The degree of cost-effectiveness was influenced by gender, with female patients achieving a better cost-effectiveness ratio than men. In conclusion, acupuncture was a cost-effective treatment strategy in patients with chronic osteoarthritis pain.

Pragmatic randomized trial evaluating the clinical and economic effectiveness of acupuncture for chronic low back pain.
Am J Epidemiol. 2006 Sep 1;164(5):487-96.
"Acupuncture plus routine care was associated with marked clinical improvements in these patients and was relatively cost-effective."

Cost-effectiveness of acupuncture treatment in patients with chronic neck pain.
Pain. 2006 Nov;125(1-2):107-13. Epub 2006 Jul 13.
"According to international cost-effectiveness threshold values, acupuncture is a cost-effective treatment strategy in patients with chronic neck pain."

Cost-effectiveness of acupuncture treatment in patients with headache.
Cephalalgia. 2008 Apr;28(4):334-45.
"According to international cost-effectiveness threshold values, acupuncture is a cost-effective treatment in patients with primary headache."

Cost-effectiveness of acupuncture in women and men with allergic rhinitis: a randomized controlled study in usual care.
Am J Epidemiol. 2009 Mar 1;169(5):562-71.
"Acupuncture, supplementary to routine care, was beneficial and, according to international benchmarks, cost-effective."

I think you get the idea.

We are grateful to the following team: Witt CM, Reinhold T, Jena S, Brinkhaus B, Willich SN at the Departments of Social Medicine, Epidemiology, and Health Economics at the Charité University Medical Center, Berlin, Germany for performing the above studies.