MD, PhD, FMedSci, FRSB, FRCP, FRCPEd.

Many experts doubt that acupuncture generates the many positive health effects that are being claimed by enthusiasts. Yet, few consider that acupuncture might not be merely useless but could even make things worse. Here is a trial that seems to suggest exactly that.

This study evaluated whether combining two so-called alternative medicines (SCAMs), acupuncture and massage, reduce postoperative stress, pain, anxiety, muscle tension, and fatigue more than massage alone.

Patients undergoing autologous tissue breast reconstruction were randomly assigned to one of two postoperative SCAMs for three consecutive days. All participants were observed for up to 3 months. Forty-two participants were recruited from January 29, 2016 to July 11, 2018. Twenty-one participants were randomly assigned to massage alone and 21 to massage and acupuncture. Stress, anxiety, relaxation, nausea, fatigue, pain, and mood (score 0-10) were measured at enrollment before surgery and postoperative days 1, 2, and 3 before and after the intervention. Patient satisfaction was evaluated.

Stress decreased from baseline for both Massage-Only Group and Massage+Acupuncture Group after each treatment intervention. Change in stress score from baseline decreased significantly more in the Massage-Only Group at pretreatment and posttreatment. After adjustment for baseline values, change in fatigue, anxiety, relaxation, nausea, pain, and mood scores did not differ between groups. When patients were asked whether they would recommend the study, 100% (19/19) of Massage-Only Group and 94% (17/18) of Massage+Acupuncture Group responded yes.

The authors concluded tha no additive beneficial effects were observed with addition of acupuncture to massage for pain, anxiety, relaxation, nausea, fatigue, and mood. Combined massage and acupuncture was not as effective in reducing stress as massage alone, although both groups had significant stress reduction. These findings indicate a need for larger studies to explore these therapies further.

I recently went to the supermarket to find out whether combining two bank notes (£10 + £5) can buy more goods than one £10 note alone. What I found was interesting: the former did indeed purchase more than the latter. Because I am a scientist, I did not stop there; I went to a total of 10 shops and my initial finding was confirmed each time: A+B results in more than A alone.

It stands to reason that the same thing happens with clinical trials. We even tested this hypothesis in a systematic review entitled ‘A trial design that generates only ”positive” results‘. Here is our abstract:

In this article, we test the hypothesis that randomized clinical trials of acupuncture for pain with certain design features (A + B versus B) are likely to generate false positive results. Based on electronic searches in six databases, 13 studies were found that met our inclusion criteria. They all suggested that acupuncture is effective (one only showing a positive trend, all others had significant results). We conclude that the ‘A + B versus B’ design is prone to false positive results and discuss the design features that might prevent or exacerbate this problem.

But why is this not so with the above-mentioned study?

Why is, in this instance, A even more that A+B?

There are, of course, several possible answers. To use my supermarket example again, the most obvious one is that B is not a £5 note but a negative amount, a dept note, in other words: A + B can only be less than A alone, if B is a minus number. In the context of the clinical trail, this means acupuncture must have caused a negative effect.

But is that possible? Evidently yes! Many patients don’t like needles and experience stress at the idea of a therapist sticking one into their body. Thus acupuncture would cause stress, and stress would have a negative effect on all the other parameters quantified in the study (pain, anxiety, muscle tension, and fatigue).

My conclusion: in certain situations, acupuncture is more than just useless; it makes things worse.

11 Responses to Acupuncture is more than useless for patients recovering from breast surgery

  • This is entirely my personal opinion, with no evidence base whatsoever (so I am making no definite claims):

    Massage is a powerfully pleasant experience. Performed by a qualified person, and provided there are not underlying contra-indications, having a massage makes you feel good. Acupunture is not of itself a pleasant treatment. It is not necessarily THAT unpleasant, but you have needles stuck in you, and you have to lie or sit still for a period, which can seem boring and unproductive (unlike massage, where something is going on the whole time).

    As processes in themselves therefore, apart from measurement of any clinical outcomes: Massage therefore has highly +ve Pleasantness, and acupuncture slightly -ve Pleasantness.

    This fits with Professor Ernst’s suggestion – adding a slightly negative quantity to a positive one diminishes the size of the positive.

    One could imagine a study (but hopefully not carry it out) where Massage alone is compared with Massage followed by Beating by a Gang of Thugs. The size of the -ve from the latter would, one feels, be so large as to entirely cancel the +ve from the massage, and the treatment group would have worse outcomes than any non treatment group……

    • However this trial seems to be an outlier. The majority of acupuncture trials show positive responses from subjects when it comes to relaxation and quality of life scores. There aren’t any details available about the treatments given in this trial, other than they were by a ‘board certified acupuncturist’, so it’s hard to comment further, other than to suggest perhaps they weren’t very good?

      • when you see a negative result of a drug trial, do you also suggest that perhaps the manufacturer put too little active ingredient in the pills?

        • Surely you look at the totality of the evidence? So if a small one-off drug trial showed markedly different results to the overall results, I’d question it yes.

          • and the totality of the evidence shows convincingly that acupuncture reduces axienty?

            This review aims to examine the volume and quality of the evidence base which supports the use of acupuncture in the treatment of anxiety disorders. A literature review was conducted using Pubmed, Google scholar, AMED, BMJ, Embase, Psychinfo, Cochrane library, Ingenta connect, and Cinahl databases. Keywords were “anxiety,””anxious,””panic,””stress,””phobia,” and “acupuncture” limited to year 2000 onwards and English language where available. The quality of research examining the use of acupuncture in the treatment of anxiety disorders is extremely variable. There is enormous variety regarding points used, number of points used in a session, duration of sessions, frequency of treatment and duration of treatment programme. While the generally poor methodological quality, combined with the wide range of outcome measures used, number and variety of points, frequency of sessions, and duration of treatment makes firm conclusions difficult. Against this, the volume of literature, consistency of statistically significant results, wide range of conditions treated and use of animal test subjects suggests very real, positive outcomes using a treatment method preferred by a population of individuals who tend to be resistant to conventional medicine. (https://pubmed.ncbi.nlm.nih.gov/22070429/)
            no, it does not!

  • Extremely variable quality of trials etc., but ‘the volume of literature, consistency of statistically significant results, wide range of conditions treated and use of animal test subjects suggests very real, positive outcomes’. The author describes the results of these trials as ‘almost universally positive’, which is my point – the trial you present here is an outlier. Also, that review is a decade old so it would be interesting to see an updated one.

    • you point is a very poor one: “The majority of acupuncture trials show positive responses from subjects when it comes to relaxation and quality of life scores.” If the trials are flimsy, they show very little other than the inability of acupuncturists to do decent research.

  • So it’s better to draw sweeping conclusions (i.e. acupuncture is at best useless) based on a single small study than to lean towards the ‘almost universal’ results of the available evidence? Personally I agree with the author of the review you cited, that there is the suggestion of very real, positive outcomes.

    • it’s better to read more than the headline of my posts:
      My conclusion: in certain situations, acupuncture is more than just useless; it makes things worse.

    • @Tom on Monday 23 November 2020 at 13:05

      “there is the suggestion of very real, positive outcomes.”

      Medicine does not operate on the basis of suggestions, unlime SCAM artists like you.

      • @Frank those aren’t my words, they’re the words of the author (a medical doctor) of the review Edzard chose to cite. But I do agree with them. Not very friendly to call me a scam artist.

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