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

This review investigated the characteristics, hotspots, and frontiers of global scientific output in acupuncture research for chronic pain over the past decade. the authors retrieved publications on acupuncture for chronic pain published from 2011 to 2022 from the Science Citation Index Expanded (SCI-expanded) of the Web of Science Core Collection (WoSCC). The co-occurrence relationships of journals/countries/institutions/authors/keywords were performed using VOSviewer V6.1.2, and CiteSpace V1.6.18 analyzed the clustering and burst analysis of keywords and co-cited references.

A total of 1616 articles were retrieved. The results showed that:

  • the number of annual publications on acupuncture for chronic pain has increased over time;
  • the main types of literature are original articles (1091 articles, 67.5 %) and review articles (351 articles, 21.7 %);
  • China had the most publications (598 articles, 37 %), with Beijing University of Traditional Chinese Medicine (93 articles, 5.8 %);
  • Evidence-based Complementary and Alternative Medicine ranked first (169 articles, 10.45 %) as the most prolific affiliate and journal, respectively;
  • Liang FR was the most productive author (43 articles);
  • the article published by Vickers Andrew J in 2012 had the highest number of citations (625 citations).

Recently, “acupuncture” and “pain” appeared most frequently. The hot topics in acupuncture for chronic pain based on keywords clustering analysis were experimental design, hot diseases, interventions, and mechanism studies. According to burst analysis, the main research frontiers were functional connectivity (FC), depression, and risk.

The authors concluded that this study provides an in-depth perspective on acupuncture for chronic pain studies, revealing pivotal points, research hotspots, and research trends. Valuable ideas are provided for future research activities.

I might disagree with the authors’ conclusion and would argue that they have demonstrated that:

  1. the acupuncture literature is dominated by China, which is concerning because we know that 1) these studies are of poor quality, 2) never report negative findings, and 3) are often fabricated;
  2. the articles tend to be published in journals that are more than a little suspect.

As we have seen recently, the reliable evidence that acupuncture remains effective is wafer-thin. Therefore, I feel that we are currently being misled by a flurry of rubbish publications that have one main aim: to distract from the fact that acupuncture might be nonsense.

42 Responses to Acupuncture for pain: plenty of useless papers and very little reliable evidence

  • The word “placebo” occurs twice in the review and is not discussed in-depth at all. Likewise for “sham”.
    Placebo needles are not mentioned (Park et al., Takakura & Yajima, Streitberger et al.).
    No studies by E. Ernst are cited.
    The study by Yuyi Wang et al. 2014 that 99.8% of acupuncture trials have reported positive results, reflecting publication bias, is not cited.
    I am not surprised.

  • Almost every non-proven “therapy” becomes an alleged cure for chronic pain because chronic pain, by its very nature, waxes and wanes and is unrelated to tissue injury. This is after studies have debunked utility for acute pain (or any acute condition).

    The irony, however, is that acupuncture in ancient China was part of TCM – a cure for illness, not just for pain. Now that we know it does nothing physiologically, the main claims that are still being made relate to non-objective findings.

    • well observed!

    • ‘…because chronic pain, by its very nature, waxes and wanes and is unrelated to tissue injure.’

      Any reference for this ludricous claim? Not the waxing and waning thing, everything does that… even the moon 😉

      Also ‘TCM’ didnt exist in ancient China.

      ‘Scholars in the history of medicine in China distinguish its doctrines and practice from those of present-day TCM. As Ian Johnson notes, the term “Traditional Chinese Medicine” was coined by “party propagandists” and first appeared in English in 1955.[11]’

      https://en.wikipedia.org/wiki/Traditional_Chinese_medicine

      Honestly, you really should try listening more before you start talking. You know, two ears one mouth type thing.

      It’s like shooting fish in a barrel with you guys – too easy.

  • Professor Quack at it again. Everything you repute to be expert on you then decrie as quackery.

    I’ll challenge any pain clinic you choose in a trial against me practicing acupuncture. I’ll provide my services for free and even travel a reasonable distance.

    If you think acupuncture (which apparently as Professor of Quack Studies you are an expert on) doesn’t work put your money where your mouth is.

    I won’t hold my breath…

    • I don’t normally engage with people who start with ad hominem from the outset.
      In your case, however, I did look up your website [https://drdankeown.com/treatment] which says:

      Acupuncture works by reminding your body how it should be working. Our bodies, like this computer, run on a type of living biological electricity which the Chinese called qi (pronounced ‘chi’). When this gets stuck, weak or moves incorrectly we can get health problems. This can be corrected by skilled acupuncture and this is why it is so powerful and yet so gentle.

      After treatment you may feel pleasantly ‘spacey’. If you have pain then the pain is almost always improved – in fact if there is no improvement then your next treatment is on us. As well as this patients often report better sleep, less pain, less stiffness and a general sense of feeling better.

      Dr Daniel Keown has treated patients for almost thirty years and is dual qualified as an Emergency doctor (MCEM) and acupuncturist (Lic. Ac.). He finds acupuncture so effective that he has left Emergency medicine to concentrate on acupuncture. Dr Keown has treated a wide variety of illnesses. Acupuncture is especially good for any pain. He has also had great success with:

      • gynaecological problems and women’s health;
      • back pain;
      • headaches;
      • facial issues such as Bell’s palsy and trigeminal neuralgia; and,
      • digestive issues.
      Then I had a look at one of your videos [https://drdankeown.com/blog1/2023/1/7/the-miracle-of-ivermectin]
      Subsequently, I felt that you are too dangerous to let you near patients.
      So, thank you for the invite – but no thanks.

      • Thought so.

        I presume you will be referring me to the relevant authorities if you believe I am ‘too dangerous to see patients’ because I can confirm I am currently seeing patients… Who pay me and hence are, by nature, happy with my treatment.
        Never had a single untoward event from treatment (apart from bruising). Never even had a significant event in 20 years of Emergency medicine. I am the polar opposite of dangerous in medicine.
        It is your duty to refer onwards if you think I am dangerous. To who and for what I’m not sure.

        If you didn’t, the logical conclusion would be that you are using a slanderous slur to back out of a challenge. You may wish to consider removing that slander. And even if you do refer the slander will still persist.

        • “… you are using a slanderous slur to back out of a challenge.”
          There is no slanderous slur in stating that I feel your video is dangerous. The only slander came from you.
          “… You may wish to consider removing that slander.”
          I have no intention to remove anything.

        • Accusing Prof Ernst of being a quack is libelous, Daniel. Those who live in glass houses should be careful when throwing stones.

          • You’re misunderstanding: its’ an affectionate nickname for a Professor of what he agrees are all scams or quackery.
            He should be proud of it.

        • It sounds like your qi is getting a little stuck, Dan.
          Perhaps you need to have a calming cup of tea and a lie down in a quiet, darkened room.

          • Hilarious 😂

            Or we could just do a study of acupuncture Vs standard therapy in a chronic pain clinic?

            I thought you were all scientists? Why soscared of a little scientific enquiry 😉

          • have you ever heard of the fact that HE WHO MAKES A CLAIM OWS US THE PROOF?
            please do the study, publish it, and then come back to us.

          • Agree completely with this. Furthermore, the more dangerous the procedure the higher the standard of proof.
            Given that acupuncture is phenomenally safe (Ernst et al) then it requires a very low burder of proof. Given that current pain management is both terrible and incredibly dangerous (a generation of opioid addicts) – high burden of proof.
            Hence why a simple comparison trial is warranted and cost effective way of showing which is efficacious.

            There really is no good argument not to do it. Why do you resist? Oh yeah, you think I am… sorry, my videos are ‘dangerous’. 🙄

            Ps where does this burden of proof thing leave surgery… whoooah!

          • acupuncture is phenomenally safe
            NOT REALLY: https://pubmed.ncbi.nlm.nih.gov/21801529/

            it requires a very low burder of proof
            NOT TRUE

            current pain management is both terrible and incredibly dangerous
            NOT TRUE

            a simple comparison trial is warranted and cost effective way of showing which is efficacious
            IF YOU THINK SO, THEN DO IT

            There really is no good argument not to do it
            ONCE YOU TRY, YOU WILL FIND MANY SUCH ARGUMENTS

            Why do you resist
            I HAVE STOPPED DOING TRIALS WHEN I RETIRED ~10 YEARS AGO

            where does this burden of proof thing leave surgery?
            328,421 = THE NUMBER OF CLINICAL TRIALS OF SURGERY LISTED IN MEDLINE TODAY

          • I for one would very much like to see the evidence for the existence of qi and meridians. And oh, evidence for this most egregious Big Pharma conspiracy would also be in order.

            So far, all I saw was some rather outlandish claims, supported by fanaticism, belligerence and arrogance – things that are not considered to be much good in the way of evidence.

        • “I am the polar opposite of dangerous in medicine.”

          Ah, only dangerous in non-medicine, presumably.

    • Dr Keown,
      Have you done any acupuncture study with double-blind needles?

      • did he publish any acupuncture studies at all?

      • No. And I’ll answer further on the basis this question is asked in good faith.

        The question all clinicians want to know is whether a treatment is better than the current standard of care.

        This is why I challenged Prof Quack (to be fair – I did believe that he’d have no interest in the answer so wouldn’t take it up).

        Almost no medicine has absolute proof, instead almost all studies done are against current standard of care.

        This is, therefore, a completely reasonable place to start a study. And, why I want to do one.

        Let’s do it, heh? Pain clinic standard of care vs acupuncture. Acupuncture will definitely be cheaper and safer, so if we can show it’s better too then its a slam-dunk.

  • Richard Rasker

    Presuming you ask in good faith

    Here is qi https://youtu.be/ndFe5CaDTlI

    ‘Meridians’ don’t exist. 😉

    • @Dan Keown
      Sorry, but I don’t accept YouTube videos as evidence. Please refer to for instance scientific/medical textbooks, which should at least feature the following:
      – The nature of qi
      – The source or origin of qi
      – Ways to objectively measure or at least detect qi; as it is claimed to be influenced by simple steel needles, there should be an interaction with metal that should be trivial to detect
      – How qi can be manipulated or used
      – A theoretical framework describing the interactions between qi, organisms and the aforementioned ways to influence and measure it.
      – References to scientists who researched qi.

      The problem is that there appears to be no scientific literature at all as described above – and in all my 30+ years of working in biomedical electronics, dealing with the interactions between electromagnetic phenomena and biological mechanisms on a regular basis, qi never played a role; for all intents and purposes, it simply doesn’t exist.

      Another general problem is that any form of medicine based on qi does not appear to perform any better than other, non-qi-based forms of medicine. All traditional forms of medicine were (and still are) completely useless at best, and many were brutal and often lethal – including, I may add, traditional acupuncture as it was really practised in China up until the early 1900s. From Dugald Christie’s book Thirty Years in Moukden:

      “Chinese doctors own that they know nothing at all of surgery. They cannot tie an artery, amputate a finger or perform the simplest operation. The only mode of treatment in vogue which might be called surgical is acupuncture, practised for all kinds of ailments. The needles are of nine forms, and are frequently used red-hot, and occasionally left in the body for days. Having no practical knowledge of anatomy, the practitioners often pass needles into large blood vessels and important organs, and immediate death has sometimes resulted. A little child was carried to the dispensary presenting a pitiable spectacle. The doctor had told the parents that there was an excess of fire in its body, to let out which he must use cold needles, so he had pierced the abdomen deeply in several places. The poor little sufferer died shortly afterwards. For cholera the needling is in the arms. For some children’s diseases, especially convulsions, the needles are inserted under the nails. For eye diseases they are often driven into the back between the shoulders to a depth of several inches. Patients have come to us with large surfaces on their backs sloughing by reason of excessive treatment of this kind with instruments none too clean.”

      So excuse me for not being impressed with ‘Traditional Chinese Medicine’ at all. It really wasn’t any better than our western medicine in medieval times – and general health, life expectancy and infant mortality in China only improved significantly with the introduction of western-style medicine on a larger scale, from the 1960s onward. The only improvement achieved in TCM/acupuncture was abandoning most of the really harmful stuff, so we’re now left with just another placebo treatment. Yes, a pretty good placebo as placebos go (which also explains why it sometimes helps relieve pain and discomfort somewhat), but still a placebo. Most people I know who tried acupuncture experienced only brief and infrequent effects, which were usually most pronounced at the first session. As the novelty of the treatment wore off, so did any effects.

      • ‘Sorry, but I don’t accept YouTube videos as evidence.’

        This is an absurd statement. Either you’re a weird scientific puritan or you don’t know what ‘evidence’ is.

        Stopped reading after this.

        • I submit this YouTube video as evidence that Flying Spaghetti Monster exists.

          https://www.youtube.com/watch?v=vL7FcvEydqg

          All hail the all mighty FSM! Eat pasta and multiply!

        • Really, this is not absurd in the slightest. One does not need to be “a weird science puritan”, by which I take it you mean anyone with any scientific training, to know that argumentum ad youtubium (see? It even has its own term) is rarely a valid form of evidence.

          The bulk of the regulars know what constitutes evidence on the basis of our training and varying professional backgrounds. I can imagine the response if I’d tried to pull that sort of nonsense with my old head of department…

          And will you just use one name? it looks like we are dealing with at least 4 different people.

        • @Dan Keown
          The video (just 2 minutes) describes the finding that embryonic development of frogs involves turning genes on and off not just by chemical gradients in developing structures, but also by means of local intracellular electric potentials – something that was already known to happen in the healing of wounds.

          However interesting this may be (and even close to my personal area of expertise), this video clip does NOT constitute evidence for the existence of qi. Which means that my rejecting this video turns out to have been quite justified. And then YOU feel insulted?

          Several words come to mind to describe your demeanour – but as I decided some time ago to try and stay civil as much as possible, I shall leave it at this.

    • “‘Meridians’ don’t exist.”

      You name meridians “channels”.
      [https://drdankeown.com/ssoma]

      The meridian system (… also called channel network) is a concept in traditional Chinese medicine (TCM). Meridians are paths through which the life-energy known as “qi” (ch’i) flows.

      Meridians are not real anatomical structures: scientists have found no evidence that supports their existence. One historian of medicine in China says that the term is “completely unsuitable and misguided, but nonetheless it has become a standard translation.” Major proponents of their existence have not come to any consensus as to how they might work or be tested in a scientific context.
      https://en.m.wikipedia.org/wiki/Meridian_(Chinese_medicine)

      • Correct. There are channels in the body. This is the best translation of the Chinese jīng luò from which the erroneous translation ‘meridians’ was made.

        • There are plenty of “channels” which will show up under surgery, dissection and the like – veins, arteries, nerves – so where are the “meridians” and what is the “chi”/”qi” energy and how come it doesn’t show up on any available scan?

        • Reiki, qi gong and accupuncture use the concept of qi.
          https://www.holdenqigong.com/qi-gong-and-reiki-what-are-their-similarities-and-differences/

          Why do you need to poke needles when one can “cure” ailments by waving hands over the body?

        • Yes, I know it’s “correct”, otherwise I wouldn’t have posted it.

          This sentence in my Wikipedia quote

          One historian of medicine in China says that the term is “completely unsuitable and misguided, but nonetheless it has become a standard translation.”

          is referring to a work of the extraordinarily well informed historian, Paul U. Unschuld, Professor and Director of the Horst-Goertz Endowment Institute for the Theory, History, and Ethics of Chinese Life Sciences at Charité-Medical University, Berlin:

          Unschuld, Paul U. (2018). Traditional Chinese medicine: heritage and adaptation. New York: Columbia University Press. p. 125. ISBN 9780231175005.

          Using the same source, ref [10]:

          Believers in qi describe it as a vital force, the flow of which must be unimpeded for health. Qi is a pseudoscientific, unverified concept,[4][5] and is unrelated to the concept of energy used in science[6][7][8] (vital energy itself being an abandoned scientific notion).

          The historian of medicine in China Paul U. Unschuld adds that there “is no evidence of a concept of ‘energy’ — either in the strictly physical sense or even in the more colloquial sense — anywhere in Chinese medical theory.”[10]

          https://en.m.wikipedia.org/wiki/Qi

  • What a glib-tongued blogger. Forgive your ignorance.

  • Ignorant old guy

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