Acupuncture for chronic low back pain.

Citation

Evidence Type: Research (Generic)
N Engl J Med. 2010 Jul 29;363(5):454-61. doi: 10.1056/NEJMct0806114. - Acupuncture for chronic low back pain. - PubMed - NCBI Score: 0.0/0.0

Discussion

This is a curious piece of research indeed.

The research investigates the effectiveness of acupuncture for lower back pain, and finds it to be no more effective than a placebo. They also found that almost 5% of patients had adverse reactions. After concluding that acupuncture is ineffective, the authors then suggest that doctors send patients to acupuncturists for treatment.

If that didn't make you do a double take then reread that last paragraph again. It is difficult to know exactly why the authors would promote the use of acupuncture in the same research paper which concludes it is ineffective, but it is worth noting that they are practitioners of "integrative medicine", a field which itself promotes the use of such "alternative medicines". Helping people alleviate pain is a good thing. But if you find that twirling a toothpick is just as effective, that acupuncture can have serious complications, and admit that it is likely a placebo effect, how can you still in good faith still advise people follow a belief in mystical qi energy being unlocked by piercing? Is not the more ethical choice to use the less dangerous, cheaper, equally effective, and doesn't promote belief in magic?

When reading this research it is well worth keeping in mind that the authors practice and promote complementary medicine, a branch of medicine that relies upon the use of alternative treatments. Of course simply being associated with a branch of research doesn't automatically mean that bias is present, nor does reaching conclusions contrary to what others say. But if the evidence tells you something can be dangerous and is ineffective and you then endorse the use of it, that there is a good example of bias.

This research is discussed at NEJM and Acupuncture: Even the best can publish nonsense. and Acupuncture Pseudoscience in the New England Journal of Medicine

Strengths/Weaknesses

Conclusions

Strength/Weakness 1

Strong strength: Demonstrable Bias

Despite finding acupuncture to be ineffective, these practitioners of alternative medicines still promoted the use of acupuncture. If that isn't a good example of bias then it is difficult to tell what is.


Strength/Weakness 2

Mild weakness: Well Designed Research

The researchers reach conclusions contrary to that stated by the evidence, they speak as if they were looking at large bodies of data when in fact they were looking at just 2 studies, and so on


Strength/Weakness 3

Strong weakness: Known Advocate

The authors are known advocates of acupuncture, homeopathy, and various other practices not based on scientific evidence


Conclusion 1

The authors claim that this research supports acupuncture. It really does not.


Conclusion 2

Despite the authors claims to the effectiveness of acupuncture, this research demonstrates otherwise. They state that both real and sham acupuncture produce similar results, and both appear to be better than doing nothing. All this really shows is that there is some form of Placebo Effect is likely present. In other words if people expect that getting pricked with tiny needles will make them feel better, and they get pricked with tiny needles, they will feel better.

This is completely different from saying that acupuncture works and is an effective treatment.


Conclusion 3

The research includes reports on adverse effects, noting that "8.6% reported at least one adverse event, and 2.2% reported one that required treatment". This is far from the level of safety which is touted by practitioners and advocates.


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