Comparative efficacy of acupressure and magnetic therapy vs. diclofenac sodium for pain management in upper urinary tract calculi

This study compared the analgesic efficacy of acupressure and magnetic therapy (AMT) versus diclofenac sodium (DFS) in acute renal colic. A total of 138 patients with acute renal colic (visual analog scale [VAS] score ≥ 7) were randomized to AMT or DFS treatment. Primary endpoints included changes in VAS scores at baseline, 1-, 10-, 30-, and 120-min post-intervention, along with analgesic duration. Multiple linear regression evaluated the influence of treatment modality, gender, white blood cell (WBC) count, and other covariates on VAS scores at 10 min. Interaction effect analysis was additionally used to assess how these factors modified treatment efficacy.

The AMT group demonstrated rapid onset, achieving an 86 % VAS reduction at 1-min post-intervention (vs. baseline, P < 0.001), though pain rebound occurred after 30 min. The DFS group exhibited slower onset but significantly prolonged analgesic duration compared to AMT (23.6 ± 2.2 h vs. 2.4 ± 1.0 h, P < 0.001). Multiple linear regression revealed that AMT had the best analgesic effect (B = -6.22, P < 0.001). Male gender (B = 0.78, P = 0.026) and lower baseline WBC counts (B = -0.16, P = 0.026) were associated with higher VAS scores. Interaction analysis indicated enhanced AMT efficacy in male patients and those with lower WBC counts.

The authors concluded that AMT and DFS exhibit complementary “rapid-sustained” analgesic profiles in renal colic management, with gender and WBC levels significantly modulating treatment efficacy. A stratified analgesia protocol based on these factors may optimize patient outcomes.

Apart from the fact that, as an equivalence trial, the study is hopelessly underpowered and its results therefore less than reliable, I have a further reason for not trusting its findings.

A renal colic is an acute and severe loin pain caused by a urinary stone moving from the kidney downwards into the ureter. The pain is often resistant to DFS or other conventional pain-killers and might require opioids. The pain usually peaks sharply, lasts for 20 to 60 minutes, and then subsides into a dull ache before the next “wave” begins. These waves are caused by the ureter’s peristalsis—the tube’s rhythmic muscular contractions—as it tries to squeeze the stone toward the bladder.

So, all I need to do to fake the effectivenesss of a so-called alternative medicine (SCAM) like AMT is to start treating patients when a wave is subsiding. This can easily appear as though AMT had a remarkable effect of 86%. Subsequently, the pain will recur. And this is probably what happened in this study! What I am trying to convey is that I am not convinced that AMT did much at all.

Moreover, I find it daft to conduct a trial where two SCAMs are tested together in one single treatment arm. Even if one would be convinced of the value of AMT – which I am not! – one would need to ask: was it the acupressure or the magnetic therapy that did the trick?

My conclusion is therefore yet again: if you design a silly study, you get a silly result.