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Dr Peter Davies MB,BS; DRCOG; DRACOG; M SC; Grad Dip Ed; FACRRM 1999 Although acupuncture has been practised in Asia for thousands of years, it has only recently taken hold in the West, and is often viewed by Westerners doctors with skepticism. There are many reasons for this; Chinese research rarely meets the "conventional"double blind gold standard. Double-blind trails in acupuncture are very difficult to design (as they are for any procedural treatment). In spite of this difficulty, there does exist a small but growing literature of controlled clinical studies demonstrating the effectiveness of acupuncture in treating a variety of common symptoms and illnesses. All of the findings mentioned in the studies below are statistically significant. The fact that some studies have small subject groups does not make the outcomes less meaningful; it simply means that a relatively more robust effect size was necessary in order to have obtained the significant results reported. Similarly, the fact that some of the individualized aspect of acupuncture treatment may have been compromised in the interest of research protocols should not lead one to discredit findings favourable to acupuncture. One more note: Does acupuncture work? and Why and how does acupuncture work? are two separate questions. This summary is only concerned with Does acupuncture work? After two weeks of treatment, the experimental group showed significantly lower cocaine metabolite levels in urine specimens than the placebo group. Konefal, Duncan and Clemence (1994) randomized substance abuse patients at a treatment clinic into three groups: 1) usual care, 2) usual care plus frequent urine testing, 3) usual care, frequent urine testing, and acupuncture. Patients in the acupuncture group became clean (negative urine test) in 57% of the time required for the frequent urine testing group. Bullock, et al (1989) treated 40 severe recidivist alcoholics with acupuncture at points specific to substance abuse (treatment group), and 40 subjects with acupuncture at non_specific points (control group). Significant differences were found at the time of a six_month follow_up: more of the control group expressed a moderate to strong need for alcohol, and the control group had twice the number of both drinking episodes and admissions to a detoxification centre. Clavel_Chapelon et al (1997) showed that acupuncture was comparable to nicotine gum in long term smoking cessation programs. The measures used were number of anginal attacks (6.1 vs. 10.6), performance before onset of pain during exercise (82 W vs. 94 W), and intensity of pain at maximal workload (1.4 vs. 0.8). A life quality questionnaire confirmed improved feeling of well_being. Zhou and Liu (1993) investigated the effect of acupuncture on exercise_induced pain in sufferers of angina pectoris. 15 subjects were blindly randomized into an acupuncture group (n=5) and control groups: sham acupuncture (n=5), and no treatment (n=5). The group that received acupuncture was able to exercise significantly longer than either of the two control groups before onset of anginal attack, with no significant difference between the two control groups. Also the anginal pain decreased more quickly after cessation of exercise in the acupuncture group than in either of the control groups. Ballegard et al (1986) randomized 26 stable angina pectoris patients resistant to medical treatment into true and sham acupuncture groups. It was found that the acupuncture group showed a significantly greater improvement in work capacity than the placebo group, as measured in exercise tests. Performance was measured using a spiro_ergometer test at the beginning and end of a five_week period, with one treatment session per week. The subjects from the true acupuncture group improved significantly in maximum performance and also physical performance at the anaerobic threshold, whereas the control groups showed no improvement. They found that the group of patients receiving acupuncture (n=11) reported statistically significant longer pain_free time durations after surgery, as well as less pain intensity than the placebo group (n=8). Simmons et al (1993) found that subjects receiving auricular electro_acupuncture (n=20) experienced a statistically significant 18% elevation in dental pain threshold as measured by a hand_held dental pulp tester. A placebo group (n=20) remained essentially unchanged in dental pain threshold. List (1992) compared the effectiveness of acupuncture and conventional occlusal splint therapy in treating cranio-mandibular disorder (CMD). 110 patients were randomly assigned to an acupuncture group, an occlusal splint therapy group and a control group. Immediately after the treatment, and at six and twelve month follow_up investigations, both acupuncture and the standard splint therapy were found to reduce clinical and subjective symptoms of CMD at a statistically significant level, while the control group was essentially unchanged. The effect of acupuncture and conventional treatment were found to be equivalent with no statistically significant differences across all ten assessment variables used in the study. Garvey, Marks, and Wiesel (1989), in a study on trigger_point injection therapy on 63 patients with chronic low back pain, found that acupuncture was at least as effective as, and possibly superior to injected medication. Therapy without injected medication (acupuncture and acupressure) yielded a 63% improvement rate, while therapy with injection yielded a 42% improvement rate. Thomas et al (1994) compared the effect of three different modes of acupuncture stimulation on chronic lower back pain. 40 subjects were randomized into 4 groups: manual acupuncture, low_frequency electro_acupuncture (2hz), high_frequency electro_acupuncture (80 Hz), and a waiting list no_treatment control group. After six weeks, all three acupuncture groups showed significant improvement compared to the controls, while after six months the low_frequency group showed superior results compared with the manual stimulation group and the high_frequency group. Post_treatment reduction in pain scores for true acupuncture were 43% and reduction in medication was 38%. Both improvements were maintained at 4_month and 1_year follow up. Hansen and Hansen (1985) compared true and placebo acupuncture in 18 patients suffering from chronic tension headache (mean disease duration: 15 years). Each patient was treated for six weeks with true acupuncture and for six weeks with placebo acupuncture. A 31% reduction in pain was found, with significantly greater effect in true acupuncture than placebo. Hesse et al; Simon (1994) compared the effect of acupuncture and drug therapy (metoprolol) in preventing headaches in chronic migraine sufferers. 85 patients were randomly assigned to two groups: One received acupuncture plus placebo tablets daily, the other received 100 mg metoprolol plus sham acupuncture. Both groups exhibited significant reduction in frequency and duration of attacks, with no significant difference between the groups. The authors found acupuncture to be superior with regard to side_effects. Vincent (1990) evaluated the efficacy of acupuncture in treating tension headache, using a single_case design with time_series analysis. Each of fourteen patients was given 8 weekly treatments, four of true acupuncture and four of sham acupuncture in random order. Overall, a significant reduction of pain was found in half of the patients, which was maintained at four_month follow up. True acupuncture was shown to be significantly superior to sham in four patients only with no difference observed in the remainder. However, the design of the experiment (randomly varying true and sham acupuncture treatments, over the course of 8 weeks) may have been insensitive to the cumulative therapeutic effect of acupuncture over a course of treatments. Carlsson et al (1990) compared the effect of acupuncture and physiotherapy on 62 chronic tension headache patients. The intensity and frequency of headaches was significantly reduced in both the acupuncture group (31) and the physiotherapy group (31), with a significant superiority in the physiotherapy group. The improvement in both groups persisted unchanged 7_12 months after treatment. In the first study, one group (n=25) received acupuncture at point P_6 (traditionally used to reduce nausea) along with 100 mg meptazinol, another group (n=25) receiving drug treatment only. In the second study, there were three groups: 25 women receiving acupuncture plus 10 mg nalbuphine, 25 women receiving sham acupuncture plus nalbuphine, and 25 receiving drug treatment only. In both studies, needling for five minutes at P_6 resulted in a significant reduction in peri_operative nausea and vomiting compared with the control groups (including the sham acupuncture group). Belluomini et al (1994) investigated the effectiveness of acupressure in reducing nausea and vomiting in pregnant women. A treatment group (n=30) self_applied acupressure at the point P_6 for 10 minutes 4 times per day for 7 days. A control group (n=30) used acupressure on a sham acupuncture point. Over the course of the study both groups experienced a reduction in nausea, but the reduction in nausea was significantly greater in the treatment group. Also, both groups experienced a reduction in frequency of vomiting, but there was no significant difference between the groups. De Aloysio et al (1992) conducted a randomized, double_blind, cross_over, placebo_controlled study on the use of acupressure at P_6 to control nausea in early pregnancy. 60 women were randomly divided into two groups, which switched from treatment condition to placebo_control (sham acupressure) midway through the course of the study. A significant difference was found in the effectiveness of real (60%) vs. placebo treatment (30%). Allen and Kitching (1994) examined the effect of P_6 acupressure on 46 women undergoing laparotomy for gynecological surgery. 23 subjects received acupressure at P_6, and 23 at a sham site. The treatment group requested significantly less anti_emetic therapy than the control group. Fung et al (1986) found that real acupuncture was significantly superior to sham acupuncture in protecting against exercise_induced asthma in nineteen children. Stroke Johansson et al (1993) investigated the effectiveness of acupuncture as a supplement to physical therapy in recovery from stroke. 78 patients suffering from severe hemiparesis of the left or right side within ten days of stroke onset were randomly divided into a control group (n=40) who received daily physical therapy and a treatment group who additionally received two acupuncture treatments per week for ten weeks. Patients receiving acupuncture recovered faster and to a larger extent than controls with significant differences in measures of balance, mobility, quality of life index, and days spent in hospitals/nursing homes. Pang (1994) investigated two particular scalp acupuncture techniques (slow_rapid reinforcing_reducing vs. flat_twisting) in order to compare their effectiveness in treating apoplexy following stroke. He found a significant superiority in the slow_rapid reducing_reinforcing method group (n=52) over the other group (n=33) with respect to improvement in myodynamia and motile functional disturbances of the limbs. While the intention of the study was not to confirm the effectiveness of acupuncture, per se, the results do suggest that differences in technique engender different outcomes.
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