|
Acupuncture Scientific Research - Health Web |
|
 Evidence-based medicine
There is scientific agreement that an evidence-based medicine (EBM) framework should be used to assess health outcomes and that systematic reviews with strict protocols are essential. Organisations such as the Cochrane Collaboration and Bandolier publish such reviews.
The development of the evidence base for acupuncture was summarized in a review by researcher Edzard Ernst and colleagues in 2007. They compared systematic reviews conducted (with similar methodology) in 2000 and 2005:
The effectiveness of acupuncture remains a controversial issue. The results indicate that the evidence base has increased for 13 of the 26 conditions included in this comparison. For 7 indications it has become more positive (i.e. favoring acupuncture) and for 6 it had changed in the opposite direction. It is concluded, that acupuncture research is active. The emerging clinical evidence seems to imply that acupuncture is effective for some but not all conditions.
For low back pain, a Cochrane review (2005) stated:
Thirty-five RCTs covering 2861 patients were included in this systematic review. There is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low-back pain. For chronic low-back pain, results show that acupuncture is more effective for pain relief than no treatment or sham treatment, in measurements taken up to three months. The results also show that for chronic low-back pain, acupuncture is more effective for improving function than no treatment, in the short-term. Acupuncture is not more effective than other conventional and "alternative" treatments. When acupuncture is added to other conventional therapies, it relieves pain and improves function better than the conventional therapies alone. However, effects are only small. Dry-needling appears to be a useful adjunct to other therapies for chronic low-back pain.
A review by Manheimer et al. in Annals of Internal Medicine (2005) reached conclusions similar to Cochrane's review on low back pain. A review for the American Pain Society/American College of Physicians found fair evidence that acupuncture is effective for chronic low back pain.
For nausea and vomiting: The Cochrane review (Lee and Done, 2006) on the use of the P6 acupoint for the reduction of post-operative nausea and vomiting concluded that the use of P6 acupoint stimulation can reduce the risk of postoperative nausea and vomiting with minimal side effects, albeit with efficacy less than or equal to prophylactic (i.e., preventative) treatment with antiemetic drugs. Cochrane also stated: "Electroacupuncture is effective for first day vomiting after chemotherapy, but trials considering modern antivomiting drugs are needed."
A 2007 Cochrane Review for the use of acupuncture for neck pain stated:
There is moderate evidence that acupuncture relieves pain better than some sham treatments, measured at the end of the treatment. There is moderate evidence that those who received acupuncture reported less pain at short term follow-up than those on a waiting list. There is also moderate evidence that acupuncture is more effective than inactive treatments for relieving pain post-treatment and this is maintained at short-term follow-up.
For headache, Cochrane concluded (2006) that "(o)verall, the existing evidence supports the value of acupuncture for the treatment of idiopathic headaches. However, the quality and amount of evidence are not fully convincing. There is an urgent need for well-planned, large-scale studies to assess the effectiveness and cost-effectiveness of acupuncture under real-life conditions."
For osteoarthritis, reviews since 2006 show acupuncture to be more effective than no treatment at all, but approximately as effective as sham acupuncture (wherein needles are inserted in points that, according to acupuncture theory, should not be effective).
For fibromyalgia, a systematic review of the best 5 randomized controlled trials available found mixed results. Three positive studies, all using electro-acupunture, found short term benefits. The methodological quality of the 5 trials was mixed and frequently low.
For the following conditions, the Cochrane Collaboration concluded there is insufficient evidence that acupuncture is beneficial, often because of the paucity and poor quality of the research and that further research would be needed to support claims for efficacy:- Giving up smoking
- Chronic asthma
- Bell's palsy
- Shoulder pain
- Lateral elbow pain
- Acute stroke
- Rheumatoid arthritis
- Depression
- Induction of labour
Scientists have reported a cultural bias in scientific studies of acupuncture, with studies in Asia tending to show significantly more positive results than those in the West.
In practice, EBM does not demand that doctors ignore research outside its "top-tier" criteria.
|
|
Maneuver
