If only I had a pound for every time someone asked me that question! It usually comes up when someone is trying to decide how to deal with a health issue and is not sure what to do.
Not so long ago, you went to your family doctor if you were ill. Nowadays, there is a wealth of choice. That’s great in one respect, but it can also be confusing.
How do you decide what to do? Some people ask a friend what worked for them or have a good rummage around the internet. Others look to research for more substantial evidence.
So, what exactly is good evidence? This pyramid explains it nicely. At the bottom we have ideas, opinions, editorials, anecdotal evidence; the equivalent of asking a friend or searching the internet. Right at the top of the tree are thorough studies; randomised controlled trials and meta-analysis. These trials often take years of work and lots of people. Think of them as having lots of friends who really know what they are talking about!
Where does acupuncture fit in this picture? Is there any research at the top of the pyramid? Yes. Way back in 2002 the World Health Organisation reviewed clinical trials researching acupuncture and published a paper ‘Acupuncture; review and analysis of controlled clinical trials’. This said that acupuncture had been proven to be an effective treatment for this long (and sometimes a bit strange!) list of conditions…….
· Adverse reactions to radiotherapy and/or chemotherapy
· Allergic Rhinitis (including hayfever)
· Biliary Colic (abdominal pain due to gallstones)
· Depression (including depressive neurosis and depression following stroke)
· Dysentary (acute bacillary)
· Dysmenorrhoea (painful periods)
· Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastroplasm)
· Facial pain (including craniomandibular disorders)
· Headache, Hypertension (essential)
· Hypotension (primary)
· Induction of labour
· Knee pain
· Leukopenia (low white blood cell count)
· Low back pain
· Malposition of foetus, correction of
· Morning sickness
· Nausea and vomiting
· Neck Pain
· Pain in dentistry (including dental pain and temporomandibular dysfunction)
· Periartritis of the shoulder (frozen shoulder)
· Renal colic (pain from stones in the urinary tract)
· Rheumatoid arthritis
· Tennis elbow
Since then, there has been a growing body of evidence for the effectiveness of acupuncture. You can find more information about specific conditions in the links at the side of this page, but to bring us right up to date a meta-analysis of acupuncture for chronic pain was published last year(i).
This ‘top of the pyramid’ study looked at four common causes of chronic pain:
· nonspecific musculoskeletal pain
· chronic headache
· shoulder pain
Including 20,827 patients, it concluded that acupuncture is effective for the treatment of chronic pain, with treatment effects persisting over time. The researchers found clear evidence that the effects of acupuncture persist over time with only a small decrease, approximately 15%, in treatment effect at 1 year.
The bottom line is that health isn’t a “one size fits all” issue. Even with rigorous research few medicines or therapies are guaranteed to work for everyone. And there are issues with research; not least that rigorous trials are expensive and time consuming. Someone needs to fund them, probably explaining the dominance of pharmaceutical companies in medicine nowadays. A lack of clinical trials or meta-analysis doesn’t necessarily mean that something doesn’t work, but their existence can give you the confidence to make an informed decision.
(i) Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis