Whiplash injuries are both common and difficult to treat. They frequently become chronic and can cause much suffering and high cost. Given these facts, an effective treatment would be more than welcome.
Might acupuncture be such a therapy? If we listen to the proponents of this approach, the answer would most certainly be affirmative. However, there are only very few trials which convincingly support this optimistic view – and this is why a recent Australian studyis particularly valuable.1
Its authors randomised 124 patients with chronic or sub-acute whiplash into receiving 12 sessions of real or sham electro-acupuncture over six weeks. The follow-up period lasted six months.
After adjusting for baseline differences, only pain – but not disability – was improved in the acupuncture group compared with the sham group. Disappointingly, this difference was small and ‘probably not clinically significant’. There were mild adverse effects in both groups, but no serious complications were noted.
This trial has several strengths: it was relatively large, it studiously avoided bias and it had a sufficiently long follow-up period. Its weakness, acupuncturists will argue, is the fact that the sham treatment might not have been entirely inert. Whenever the results do not show what they had hoped, acupuncturists point out that inserting needles into non-acupuncture points – the method used as sham in this study – will also have therapeutic effects, and is therefore an invalid comparison.
Sceptics might counter that first, the effect size is clinically not relevant, and second, that the small pain differential might be due to non-specific effects rather than the treatment itself. For instance, the unblinded acupuncturist might have brought it about via verbal or non-verbal communication with his patients.
Whatever the interpretation of this interesting study, one message comes out loud and clear: acupuncture is not the optimally effective treatment for whiplash so many acupuncture fans claim it to be.
But there is a second, perhaps more important message as well, I think. In the upside-down world of alternative medicine, everyone seems to claim everything regardless of evidence. When reliable data are finally put on the table, they tend to be ignored or rubbished. Bogus claims are not just wrong, they are often also counter-productive, costly or even dangerous.
Professor Edzard Ernst is the emeritus professor of complementary medicine at the Peninsula Medical School, University of Exeter
1. Cameron D, Wang E, Sindhusake D. A randomised trial comparing acupuncture and simulated acupuncture for sub-acute and chronic whiplash. Spine 2011. http://www.ncbi.nlm.nih.gov/pubmed/21494196