From Edzard Ernst
Acupuncture: new meta-analysis suggests it is effective beyond placebo
“The discussion whether acupuncture is more than a placebo is as long as it is heated. Crucially, it is also quite tedious, tiresome and unproductive, not least because no resolution seems to be in sight. Whenever researchers develop an apparently credible placebo and the results of clinical trials are not what acupuncturists had hoped for, the therapists claim that the placebo is, after all, not inert and the negative findings must be due to the fact that both placebo and real acupuncture are effective.
Laser acupuncture (acupoint stimulation not with needle-insertion but with laser light) offers a possible way out of this dilemma. It is relatively easy to make a placebo laser that looks convincing to all parties concerned but is a pure and inert placebo. Many trials have been conducted following this concept, and it is therefore highly relevant to ask what the totality of this evidence suggests.
A recent systematic review did just that; specifically, it aimed to evaluate the effects of laser acupuncture on pain and functional outcomes when it is used to treat musculoskeletal disorders.
The authors concluded that moderate-quality evidence supports the effectiveness of laser acupuncture in managing musculoskeletal pain when applied in an appropriate treatment dosage; however, the positive effects are seen only at long-term follow-up and not immediately after the cessation of treatment.
Surprised? Well, I am!
This is a meta-analysis I always wanted to conduct and never came round to doing. Using the ‘trick’ of laser acupuncture, it is possible to fully blind patients, clinicians and data evaluators. This eliminates the most obvious sources of bias in such studies. Those who are convinced that acupuncture is a pure placebo would therefore expect a negative overall result.
But the result is quite clearly positive! How can this be? I can see three options:
– The meta-analysis could be biased and the result might therefore be false-positive. I looked hard but could not find any significant flaws.
– The primary studies might be wrong, fraudulent etc. I did not see any obvious signs for this to be so.
– Acupuncture might be more than a placebo after all. This notion might be unacceptable to sceptics.
I invite anyone who sufficiently understands clinical trial methodology to scrutinise the data closely and tell us which of the three possibilities is the correct one.” (Bold emphasis added)
This from a writer who, agree with him or not, doesn’t pull punches when it comes to acupuncture.
It will be interesting to follow the comments on this one I think, particularly whether anyone with the requisite knowledge is willing to have a go at answering Edzard’s invitation.
But beyond questions of meta-analytical methodology, the question I’m most interested in is, what possible mechanism could explain why shining a concentrated beam of light on an individual’s skin has any benefit at all, and why is this only seen at long term follow up?
There’s so much going on at NOI in 2015 – ep3 is shaping up to be another blockbuster three day event and spaces are filling fast, the worldwide faculty are running courses in England, Germany, Switzerland, Norway, Denmark, Netherlands, Sweden, Spain, Ireland, Greece, India, Canada, the United States and Australia, The Explain Pain Handbook: Protectometer is now shipping and our new website protectometer.com has gone live. Don’t miss a thing – follow us on Twitter, Facebook and Instagram, you can follow us here on noijam and join us at noigroup.
The way laser-acupucture is explained to the patients – belief – with change in beliefs–> patients move more….
Second: regression to the mean?
Thanks Wouter – I too think regression to the mean probably played a role in the long term outcomes seen – I can still not think of any plausible biological mechanism which could explain why shining a laser light at people would reduce pain.
Some interesting comments now on the original post – http://edzardernst.com/2015/02/acupuncture-new-meta-analysis-suggests-it-is-effective-beyond-placebo/ . Of course, staunch supporters of laser acupuncture will claim these are semantic attacks trying to obscure the real benefits – however I still await any attempts to explain how it might work!
Well I suppose we attract what we think and feel – The “Secret”. I had a patient today who was, many years ago stung, in Peru, by a highly venomous scorpion. The result was severe pain and acute swelling of the leg. Recently, on returning to Peru she was confronted by a scorpion of the same species. She was terrified but not stung. Yes, you guessed it, her leg became very swollen and was acutely painful for a few days……..Brown snakes don’t have all the glory……..Geoff Maitland was often adamant that, one day science would explain that which he new to be true from clinical experience. I’ve lived long enough to say ” Yes Geoff you were right”……..
Finally – a contender for the best “bitten by dangerous animal story”! Lorimer has been unchallenged for too long 😉 The really lovely extra bit in this scorpion story is the swelling. Clearly a pain response is not the only thing a human can construct when faced with perceived threat.