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Puncturing the Acupuncture Myth

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Description: Discussion of eSkeptic article
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bluegray
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« on: October 08, 2008, 11:54:03 AM »

A nice summary of the history of acupuncture.
eSkeptic: October 8th, 2008
To start with, this ancient Chinese treatment is not so ancient and may not even be Chinese! From studying the earliest documents, Chinese scholar Paul Unschuld suspects the idea may have originated with the Greek Hippocrates of Cos and later spread to China. It’s definitely not 3000 years old.
...
Psychologists can list plenty of other things that could explain the apparent response to acupuncture. Diverting attention from original symptoms to the sensation of needling, expectation, suggestion, mutual consensus and compliance demand, causality error, classic conditioning, reciprocal conditioning, operant conditioning, operator conditioning, reinforcement, group consensus, economic and emotional investment, social and political disaffection, social rewards for believing, variable course of disease, regression to the mean — there are many ways human psychology can fool us into thinking ineffective treatments are effective. Then there’s the fact that all placebos are not equal — an elaborate system involving lying down, relaxing, and spending time with a caring authority can be expected to produce a much greater placebo effect than simply taking a sugar pill.
...
Guess what? It doesn’t matter where you put the needle. It doesn’t matter whether you use a needle at all. In the best controlled studies, only one thing mattered: whether the patients believed they were getting acupuncture. If they believed they got the real thing, they got better pain relief — whether they actually got acupuncture or not! If they got acupuncture but believed they didn’t, it didn’t work. If they didn’t get it but believed they did, it did work.
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benguela
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« Reply #1 on: October 08, 2008, 15:31:34 PM »

Nice article. The physio's I'm having a robust discussion with are saying they do "dry needling" not acupuncture. To me this like the religion in intelligent design clothing. The physios's are using the argument that "dry needling is based on modern scientific neurophysiology and anatomy" like it says in this article http://findarticles.com/p/articles/mi_qa3987/is_20080603/ai_n27512855.

I can't find any skeptical articles to expose what I suspect is a fraud although the article helps a little, "It doesn’t matter where you put the needle". What is incredible is that this appears to be accepted mainstream practise is physiotherapy.  Huh?

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maydont
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« Reply #2 on: October 31, 2008, 16:32:48 PM »

Acupuncture is a difficult one.  Difficult to disprove simply because a double-blinded trial is really hard to construct.  However we are left with a modality that if it does work, it's very difficult to determine how.

Firstly there seems to be two types: Traditional and Modern.  Traditional is based on the 14 meridians and by doing so it claims to balance the QI/CHI (it's claim is that it is an imbalance in Qi that causes illness).  Modern uses localised acupuncture (e.g. it will put pins in around an arthritic joint)...and they are really 2 different claims. 

The meridian theory is the idea that 14 energy lines flow through the body.  The idea is that the practitioner places pins on the meridian.  However, if this be so and the practitioner can only be accurate to a degree (he/she doesn't use measurements or microscopes when placing the pins), then the lines must be big and therefore detectable.  However the advent of microbiology still has never identified anything close to meridians nor evidence of energy flow.  So if Qi exists it is as yet undetectable: basically magic.

With regard to the modern form.  There are quite a few cases of people experiencing pain-relief.  But of course pain is one of the symptoms most susceptible to the placebo effect.  There is obviously a reaction (auto-immune or whatever) to the placing of the pins into the skin, however there is certainly no evidence of significant pain reduction here.  It hasn't shown any significant effects in trials and of course is difficult to blind. 

To accept the modern form is kind of like saying well I accepted that Santa Clause is fake, but I reckon his elves are real.  Modern acupuncture is really just a different chapter of the same mythical story.
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« Reply #3 on: November 01, 2008, 21:46:52 PM »

When I was studying pharmacy during the early 90's, we did a couple of lectures in anatomy on the modern type of acupuncture i.e. connecting the needles with an electric charge etc. The whole idea was that it affected the levels of Prostaglandins and Cyclooxygenase to produce and anti-inflammatory or analgesic effect. The effect of the change in levels of Prostaglandins and Cyclooxygenase is well known and has led to the development of some of the worlds best and frequently used anti-inflammatories and analgesics. As I recall, probably because of the so-called mechanism of action, not one of people in our class questioned the validity of the claims. The pharmacy school had no time for homeopathy, so I find it strange that they would include the modern form of acupuncture is the claims were not valid.
I ended up in retail pharmacy for about 5 years and dispensed huge quantities of pain-killers and anti-inflammatories, but funnily enough never ended up sticking acupuncture needles into anyone!
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« Reply #4 on: November 15, 2008, 21:37:16 PM »

I had this blog flagged in my list of article to read without realising, just noticed it now. Steven Novella clears up what I mention as being transcutaneous electrical stimulation (TENS) and not acupuncture.
the effects on pain of electrical stimulation through acupuncture needles. This is not acupuncture - it is transcutaneous electrical stimulation (TENS), which is an accepted treatment for chronic pain, masquerading as acupuncture.
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« Reply #5 on: February 18, 2009, 16:01:24 PM »

I came across this publication from the World Health Organisation (WHO) which says acupuncture is the bees knees

Acupuncture: Review and Analysis of Reports on Controlled Clinical Trial

there is a positive review Acupuncture: Review And Analysis Of Reports On Controlled Clinical Trials

and below is an apparent extract from the book which claims acupuncture can effectively treat all sorts of stuff. Is this for real? Does the WHO have any credibility  Huh?

The following is an excerpt from an official WHO document entitled “Acupuncture:
Review and Analysis of Reports on Controlled Clinical Trials.” Compiled by John A.
Amaro D.C., FIAMA, Dipl.Ac, L.Ac.
Email: DrAmaro@IAMA.edu
Diseases and disorders that can be treated with acupuncture
The diseases or disorders for which acupuncture therapy has been tested in controlled clinical trials
reported in the recent literature can be classified into four categories as shown below.
Diseases, symptoms or conditions for which acupuncture has been proved—through
controlled trials—to be an effective treatment:
Adverse reactions to radiotherapy and/or chemotherapy
Allergic rhinitis (including hay fever)
Biliary colic
Depression (including depressive neurosis and depression following stroke)
Dysentery, acute bacillary
Dysmenorrhoea, primary
Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
Facial pain (including craniomandibular disorders)
Headache
Hypertension, essential
Hypotension, primary
Induction of labour
Knee pain
Leukopenia
Low back pain
Malposition of fetus, correction of
Morning sickness
Nausea and vomiting
Neck pain
Pain in dentistry (including dental pain and temporomandibular dysfunction)
Periarthritis of shoulder
Postoperative pain
Renal colic
Rheumatoid arthritis
Sciatica
Sprain
Stroke
Tennis elbow
Diseases, symptoms or conditions for which the therapeutic effect of acupuncture
has been shown but for which further proof is needed:
Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
Acne vulgaris
Alcohol dependence and detoxification
Bell’s palsy
Bronchial asthma
Cancer pain
Cardiac neurosis
Cholecystitis, chronic, with acute exacerbation
Cholelithiasis
Competition stress syndrome
Craniocerebral injury, closed
Diabetes mellitus, non-insulin-dependent
Earache
Epidemic haemorrhagic fever
Epistaxis, simple (without generalized or local disease)
Eye pain due to subconjunctival injection
Female infertility
Facial spasm
Female urethral syndrome
Fibromyalgia and fasciitis
Gastrokinetic disturbance
Gouty arthritis
Hepatitis B virus carrier status
Herpes zoster (human (alpha) herpesvirus 3)
Hyperlipaemia
Hypo-ovarianism
Insomnia
Labour pain
Lactation, deficiency
Male sexual dysfunction, non-organic
Ménière disease
Neuralgia, post-herpetic
Neurodermatitis
Obesity
Opium, cocaine and heroin dependence
Osteoarthritis
Pain due to endoscopic examination
Pain in thromboangiitis obliterans
Polycystic ovary syndrome (Stein–Leventhal syndrome)
Postextubation in children
Postoperative convalescence
Premenstrual syndrome
Prostatitis, chronic
Pruritus
Radicular and pseudoradicular pain syndrome
Raynaud syndrome, primary
Recurrent lower urinary-tract infection
Reflex sympathetic dystrophy
Retention of urine, traumatic
Schizophrenia
Sialism, drug-induced
Sjögren syndrome
Sore throat (including tonsillitis)
Spine pain, acute
Stiff neck
Temporomandibular joint dysfunction
Tietze syndrome
Tobacco dependence
Tourette syndrome
Ulcerative colitis, chronic
Urolithiasis
Vascular dementia
Whooping cough (pertussis)
Diseases, symptoms or conditions for which there are only individual controlled trials
reporting some therapeutic effects, but for which acupuncture is worth trying
because treatment by conventional and other therapies is difficult:
Chloasma
Choroidopathy, central serous
Colour blindness
Deafness
Hypophrenia
Irritable colon syndrome
Neuropathic bladder in spinal cord injury
Pulmonary heart disease, chronic
Small airway obstruction
Diseases, symptoms or conditions for which acupuncture may be tried provided the
practitioner has special modern medical knowledge and adequate monitoring
equipment:
Breathlessness in chronic obstructive pulmonary disease
Coma
Convulsions in infants
Coronary heart disease (angina pectoris)
Diarrhoea in infants and young children
Encephalitis, viral, in children, late stage
Paralysis, progressive bulbar and pseudobulbar
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Rigil Kent
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« Reply #6 on: February 18, 2009, 20:44:00 PM »

May I coin a phrase? A wango list.

Mintaka

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« Reply #7 on: February 18, 2009, 21:38:59 PM »

That's a good one!  Cheesy
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benguela
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« Reply #8 on: February 19, 2009, 08:51:36 AM »

May I coin a phrase? A wango list.

yea but comming from the WHO? wtf!?
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« Reply #9 on: February 24, 2009, 22:51:30 PM »

'My' Physio practice dry needling but calls it acupuncture. 

Quote
When I was studying pharmacy during the early 90's, we did a couple of lectures in anatomy on the modern type of acupuncture i.e. connecting the needles with an electric charge etc. The whole idea was that it affected the levels of Prostaglandins and Cyclooxygenase to produce and anti-inflammatory or analgesic effect. The effect of the change in levels of Prostaglandins and Cyclooxygenase is well known and has led to the development of some of the worlds best and frequently used anti-inflammatories and analgesics.

After a couple of sessions, I got round to asking her why she was using this method.  Her reply was that "amongst others, the nett effect of the needle entering the muscle increases blood flow (and healing) to that area".  She also told me that 'acupuncture' increased energy levels in some patients, and drowsiness or calmness in others. 

Now here's the thing:  Every time after dry-needling I had to go to the nearest Mugg & Bean (thanks to his noodliness only about 50m away) to drink a cup of caffeinated coffee just to be able to get on the road!  I do not drink caffeine if I can avoid it as it I am very sensitive to its effects (i.e. 3 minutes flat and no waiter wants to serve my table).

I cannot however state unequivocally that dry needling had a positive effect on the specific affected muscle.
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« Reply #10 on: February 25, 2009, 13:13:39 PM »

Her reply was that "amongst others, the nett effect of the needle entering the muscle increases blood flow (and healing) to that area".
Mmm, much like a bruised knee will increase blood flow and healing in that area. Wink

The other day I donated some blood. The needle they draw the blood with is quite big, but as far as I could see only pierced the skin and the vein. Didn't come near the muscle. My arm is still a bit sore from that. Can't imagine that a needle inserted into the muscle will feel any better. But it might distract from the first pain...
A smaller needle will obviously do less damage. What sort of needle did she use on you Spike?
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« Reply #11 on: February 25, 2009, 22:06:19 PM »

Shall I get the correct name?  These are incredibly thin, long needles - if done correctly, you don't really feel the needle entering the skin or muscle, but there is an immediate sensation which I cannot describe exactly.  It just feels as if there's somethin' happenin'.  That sensation fades quickly, to be replaced (in my case) with a deeply relaxed feeling.  The needles are left in the muscle(s) for only a few minutes - by which time I am practically asleep. 

In my experience, there is no proof that needling contributes to healing.  At most, the general relaxation contributes to a general lowering in muscle tension in and around the knotty problem, which could be interpreted as successful treatment, but it is neither lasting, nor has it resolved the problem (in my case, a neglected whiplash  injury).
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« Reply #12 on: July 01, 2010, 12:50:17 PM »

Quote
Shall I get the correct name?  These are incredibly thin, long needles - if done correctly, you don't really feel the needle entering the skin or muscle, but there is an immediate sensation which I cannot describe exactly.  It just feels as if there's somethin' happenin'.  That sensation fades quickly, to be replaced (in my case) with a deeply relaxed feeling.  The needles are left in the muscle(s) for only a few minutes - by which time I am practically asleep.

In my experience, there is no proof that needling contributes to healing.  At most, the general relaxation contributes to a general lowering in muscle tension in and around the knotty problem, which could be interpreted as successful treatment, but it is neither lasting, nor has it resolved the problem (in my case, a neglected whiplash  injury).

This is a good description that a lot of people experience: a dramatic experience of change at the beginning but no lasting effect. I would interpret that as a very run of the mill placebo effect
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« Reply #13 on: July 01, 2010, 16:35:51 PM »

I'm no doctor, but would the placebo effect not be neutralised in an experiment when you do the acupuncture under anasthaetic and then test the effect (if any) and compare that with a control group? I've had this done to me many times and can't say it ever helped to alleviate pain.
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« Reply #14 on: July 01, 2010, 17:10:47 PM »

I remember seeing this a while back, about it triggering a natural pain killer (much like munching chilli), however it seems clear that placebo is not ruled out, since "sham" needles that do not enter the skin are just as effective...

http://science.slashdot.org/story/10/05/31/0125223/Acupuncture-May-Trigger-a-Natural-Painkiller?from=rss

Many worthwhile links at the actual slashdot page, but here's the brief:
Quote
USNWR is reporting that the needle pricks involved in acupuncture may help relieve pain by triggering the natural painkilling chemical adenosine. There are also indications that acupuncture's effectiveness can be enhanced by coupling the process with a well-known cancer drug — deoxycoformycin — that maintains adenosine levels longer than usual. Dr. Maiken Nedergaard of the University of Rochester Medical Center and her colleagues administered half-hour acupuncture treatments to a group of mice with paw discomfort. The investigators found adenosine levels in tissue near the needle insertion points was 24 times greater after treatment, and those mice with normal adenosine function experienced a two-thirds drop in paw pain. By contrast, mice that were genetically engineered to have no adenosine function gained no benefit from the treatment." Read below for some acupuncture skepticism engendered by other recent studies.

However, many remain skeptical of acupuncture claims. Ed Tong writes in Discover Magazine that previous clinical trials have used sophisticated methods to measure the benefits of acupuncture, including 'sham needles' (where the needle's point retracts back into the shaft like the blade of a movie knife) to determine if the benefits of acupuncture are really only due to the placebo effect. 'Last year, one such trial (which was widely misreported) found that acupuncture does help to relieve chronic back pain and outperformed "usual care". However, it didn't matter whether the needles actually pierce the skin [paper here with annoying interstitial], because sham needles were just as effective,' writes Tong. 'Nor did it matter where the needles were placed, contrary to what acupuncturists would have us believe.'"
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