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Acupuncture for back pain?

Acupuncture is fast becoming an accepted treatment for back pain. Recently, even NICE gave their seal of approval for it. But if you look at the data critically, you will find doubts.

Acupuncture is fast becoming an accepted treatment for back pain. Recently, even NICE gave their seal of approval for it. But if you look at the data critically, you will find doubts.

In particular, there are important questions whether the effect is specific or non-specific, i.e. a placebo-response.

Controlling for placebo-effects is not so easy in acupuncture trials. Yet some trials have succeeded to a great extent, for instance, by employing sham-acupuncture needles. We have developed such a device – it essentially is a miniature stage dagger. The needle looks as though it penetrates the skin but, in fact, it merely shortens like a telescope.

Many of the acupuncture trials that rigorously control for placebo effects show only very small or no effects at all. One perfect way of controlling for placebo effects is, of course, the option to use no needles at all but to employ laser light for stimulating acupuncture points. The control group then gets treatment with a detuned laser device. Such studies can even be double-blind, i.e. the therapist is also unaware what is happening.

The latest such trial was just published. Australian GPs randomised 100 patients with chronic back pain to receive regular laser or sham acupuncture for six weeks. There was a significant improvement at the end of this treatment which, encouragingly, even lasted for six months. But that effect was the same in both groups. So the outcome must be due to placebo-response!

Who cares, you might ask. Patients get better after treatment and that is what counts. I disagree! If it's a placebo effect, then we should be able to generate such a response even without acupuncture while administering something that really works. In this case, our patient would profit not only from the placebo-effect but, in addition, from the specific effect of our treatment.

My conclusion: good medicine banks not on either specific effects or non-specific effects, but on both.

Professor Edzard Ernst Professor Edzard Ernst

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