Real acupuncture is often ignored in clinical research

 

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When providers dive into the clinical research about acupuncture and pain, they find many papers that conclude acupuncture is simply a placebo. Yet what the papers are calling”real”, “true” or “verum” acupuncture is often not.  This post is a brief discussion about this issue, written for the lay person.

Research often A./ oversimplifies the diagnosis and care that patients receive in real clinical situations and B./ misses many important phenomena that require investigation.

A./ Oversimplified diagnoses and treatments

The actual care L.Ac.’s provide to their patients could be compared to an equation,

Treatment = [the exact nature of the problem] + [many individual details of the patient]

Due to time and money constraints, the second term is usually ignored and the first term is over simplified.   So for a study looking at back pain, the patients are all grouped together without clarification of their stress levels, psychological history, exactly what tissue/ muscle group is causing the pain, how genes involved in central sensitization are being expressed or not expressed, levels of blood markers for inflammation, other metabolic differences, etc. etc. The study looks at this group of patients with this wide variety of physiological states and gives them all one label, eg. mechanical back pain.  The study then puts severe restrictions on what points the practitioner can use and how to use them, due to the limitation of the statistics they want to use at the end.  The practitioners then cannot change anything to match the individual needs of the patient when it appears early in the care that that point prescription will not work for them.   In other words, the forced clinical behavior in the study would not survive the first week internship in any acupuncture school.

Imagine 2 patients aged 60 with a slipped disc at L5 causing back pain.  One is a robust ex pro football payer with years of fibrosis and fat marbling in the muscles around the injured nerve. The other is anemic, hypothyroid and who lived a very sedentary life and is also being treated for anxiety due to an abusive marriage.  The ball player may receive thick needles with strong stimulation with 100 Hz electro-acupuncture and deep tissue massage. Most L.Ac.’s could predict that were I to provide the same treatment in the anxious patient, I would likely make them worse.  The patient with an anxious, weaker metabolism needs a much lighter touch so as to not trigger the flight or fight reflex nor increase fatigue or cause other damage.

This is common sense, but is in fact quite difficult to add this common sense into a clinical study using current research techniques.  Unfortunately, the poorer quality studies are not removed from the statistics of the meta-reviews so we have quite a bit of “garbage in, garbage out” when maths is applied to the body of the research.

B./ Phenomena missing in the research that could disprove placebo predominance

I find the really interesting thing about acupuncture is that when I change something in the treatment that the patient is not aware of, their symptoms can change suddenly.   As I fine tune the treatment, I can see symptoms get strongly better or even strongly worse.   Thus I can navigate the patient to improvement in a very clear manner.  A placebo would not be able to have this power.

Even testing points before needling shows wide variety of results, allowing me to choose the best points.  Migraines are a great example.  I ask the patient “When I press on a point, please tell me if this makes the pain worse, better or has no effect on the pain.”

If acupuncture was only placebo, why do some points make the patient feel worse and some make the patient feel better?  With light pressure on one point, immediate exacerbation. With light pressure on another point, an 8/10 headache can completely clear.

Again, due to limited funding and the limits of current technology, many of these sorts of daily phenomena are not brought into the peer reviewed clinical research but do show up in the basic investigational research. They are crucial to elucidating the physiological mechanism of “real” acupuncture.

The moral of the story is that when you receive treatment by an L.Ac., they will pay attention to you and your symptoms in order to always try to optimize the best outcome during care.

 

 

 


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