September 10, 2012

expert reaction to meta-analysis of studies into acupuncture and chronic pain

Archives of Internal Medicine published a meta-review of 29 randomized controlled trials, suggesting that acupuncture may be better than no acupuncture or sham acupuncture for the treatment of some chronic pain. A Before the Headlines analysis was also sent out.

Prof Edzard Ernst, Emeritus Professor of Complementary Medicine at the University of Exeter, said:

“This important analysis confirms impressively and clearly that the effects of acupuncture are mostly due to placebo; the differences between the results obtained with real and sham acupuncture are small and not clinically relevant. Crucially, they are probably due to residual bias in these studies. Several investigations have shown that the verbal or non-verbal communication between the patient and the therapist is more important than the actual needling. If such factors would be accounted for, the effect of acupuncture on chronic pain might disappear completely.

“In addition, there are several problems with this technically well-done meta-analysis. For instance, its findings are strongly driven by the large German acupuncture trials; they received much press attention in Germany when they were conducted which, in turn, rendered their patient-blinding more than questionable. Moreover, we should be clear about the fact that, in all of these trials, the therapist knew whether he was administering real or sham acupuncture. Arguably, it is next to impossible to completely keep this information from the patient. In other words, a trial is either both patient and therapist-blind, or not blind at all.

“Acupuncturists tend to tell us that therapist blinding is impossible, but this is clearly not true. I fear that, once we manage to eliminate this bias from acupuncture studies, we might find that the effects of acupuncture exclusively are a placebo response.”

‘Acupuncture for Chronic Pain – Individual Patient Data Meta-analysis’ by Andrew J. Vickers et al., published in Archives of Internal Medicine on Monday 10th September.