acupuncture
Suffering from ‘burnout’? Mindfulness, yoga, and acupuncture are just three of a plethora of practices that are said to improve ‘burnout’. While there is growing interest in these practices, many employers remain sceptical about their benefits and are hesitant to invest resources in implementing them.
This meta-analysis examined the impact of these practices on burnout and explored potential moderators. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to ensure comprehensive and transparent reporting in the identification of eligible studies. Overall, 21 studies were included (8 on mindfulness, 7 on yoga, and 6 on acupuncture), all involving independent samples, with a total of 1,364 participants.
The meta-analytic results showed that all three therapeutic practices have consistent and beneficial effects on reducing burnout. Furthermore, moderation analyses indicated that mindfulness interventions conducted within the work schedule have a significant reduction in burnout, while acupuncture interventions with between 4 or 8 weeks (the more weeks, the better) also reduced burnout. However, no significant moderation effect was observed for yoga interventions.
The authors concluded that overall, the findings provide insights into the effectiveness of these complementary practices in reducing burnout and highlight the need for further research in this area.
As a co-author of the ‘PRISMA’ guidelines, I can assure you that this review did not follow them. I can also assure you that the primary studies are mostly of poor quality and that therefore the evidence for the three therapies is far from conclusive.
But this is not what I want to dwell upon today. I prefer to focus on the diagnosis of ‘burnout‘.
‘Burnout’ may be popular (Medline listed ~300 articles on the subject in the year 2000, while last year the figure had increased to well over 3 000), but it is not a formal diagnosis in clinical frameworks like the DSM-5 or ICD-10. Despite this undeniable fact, ‘burnout’ is now widely used as a psychological and occupational syndrome. ‘Burnout’ is characterized by emotional exhaustion, depersonalization and reduced personal accomplishment, often related to chronic workplace stress. The WHO includes ‘burnout’ in the ICD-11 (code QD85) as an occupational phenomenon, not a medical condition. It is supposed to be quantifiable through tools like the Maslach Burnout Inventory (MBI). ‘Burnout’ overlaps with conditions like depression, anxiety, or adjustment disorders.
‘Burnout’ might thus not even be a distinct entity; symptoms like fatigue or low motivation are certainly not unique. Often ‘burnout’ seems merely to be a buzzword for dysstress. Its validity hinges on self-reporting and clinician judgment and there is no way to confirm anyone’s subjective notion of suffering from ‘burnout’.In other words, people who are a bit stressed and fed up with their work situation can self-diagnose to be ‘burnout’ victims, and nobody can prove them to be wrong.
In view of all this, I ask myself, who would be surprised that mindfulness, yoga, and acupuncture can be shown (in studies of dubious methodological quality) to be effective for ‘burnout’?
It is not hard to predict that many more studies will follow and show that virtually every so-called alternative medicine (SCAM) under the sun is helpful for ‘burnout’ (already, Medline lists ~700 papers on ‘alternative medicine for burnout’). After all, nothing is easier to cure than a condition that did not exist in the first place!
Traditional Chinese Medicine (TCM) tends to prioritize inherent general immunity instead of vaccination, thereby contributing to widespread vaccine hesitancy or refusal amidst the general public. The objective of this investigation was to furnish evidence regarding the profiles and drivers of seasonal influenza vaccine hesitancy (IVH) among TCM clinicians. Between January and May 2022, the Chinese researchers conducted a nationwide survey in China with embedded an influenza vaccine hesitancy scale to 3085 registered clinicians (1013 TCM and 2072 Western medicine (WM) clinicians).
The results suggest that TCM clinicians exhibit lower possibility of influenza vaccine uptake and are less likely to recommend the immunisation to the patients. 58.3 % TCM clinicians and 52.3 % WM clinicians were categorized as being influenza vaccine hesitant. Compared to WM clinicians, TCM clinicians have lower confidence in vaccine (p < 0.001) and are less inclined to accept others’ vaccination recommendation (p < 0.001). Higher educational attainment in TCM (postgraduate: OR = 1.98, 95 %CI,1.30–3.02; doctor: OR = 2.20, 95 %CI, 1.28–3.77) and ignorance of influenza vaccination cost policy (OR = 1.76, 95 %CI, 1.18–2.63) are significantly associated with increased influenza vaccine hesitancy.
The authors concluded that the concerns and doubts towards influenza vaccine is highly prevalent in the Chinese clinicians, especially those practicing TCM. High TCM educational degrees and ignorance of influenza vaccination cost policies are two primary risk factors for developing influenza vaccine hesitancy.
The findings are, I think, far from surprising. There is plenty of evidence about the negative stance towards influenza and other vaccination that practitioners or proponents of so-called alternative medicine (SCAM) display, e.g.:
- Do views about so-called alternative medicine (SCAM), nature and god influence people’s vaccination intentions?
- Use of so-called alternative medicine (SCAM) and its association with SARS-CoV-2 vaccination status
- Chiropractors Aren’t The Solution To The Primary Care Shortage: the thorny issue of vaccination
- An osteopath and anti-vaccination activist received a well-deserved and long-overdue indefinite suspension
- Prison sentence for a German HEILPRAKTIKER who issued false vaccination certificates
- Interest in so-called alternative medicine is linked to vaccination coverage
- Naturopath jailed for selling fraudulent vaccination documents
- Vaccination rates of Canadian healthcare professionals: those of chiropractors and naturopaths are at the lowest
- A Professor for Integrative and Anthroposophical Medicine claims that severe adverse effects of COVID vaccinations are 40 times more frequent than officially recognized
- Preference of so-called alternative medicine predicts negative attitudes to vaccination
- Intelligence, Religiosity, SCAM, Vaccination Hesitancy – are there links?
- A well-known opponent of vaccination has died of COVID after self-treatment with MMS
- The International Chiropractors Association’s Statement on Vaccination
- A naturopath promoting fake news about COVID vaccinations
- More information on homeopaths’ and anthroposophic doctors’ attitude towards vaccinations
- The UK Society of Homeopaths, a hub of anti-vaccination activists?
- HOMEOPATHY = “the complete alternative to vaccination” ?!?!
- Are anthroposophy-enthusiasts for or against vaccinations?
- Far too many chiropractors believe that vaccinations do not have a positive effect on public health
- Naturopaths’ counselling against vaccinations could be criminally negligent
- HOMEOPATHS AGAINST VACCINATION: “The decision to vaccinate and how you implement that decision is yours and yours alone”
- Use of alternative medicine is associated with low vaccination rates
- Integrative medicine physicians tend to harbour anti-vaccination views
- Vaccination: chiropractors “espouse views which aren’t evidence based”
With so much evidence and unquestionable serious harm being caused by these SCAM anti-vaxxers, the obvious question is this:
WHY IS SO LITTLE BEING DONE ABOUT IT?
This cross-sectional meta-epidemiological study investigated the patient-reported acupuncture-related adverse events (A-AEs) in acupuncture randomised controlled trials (RCTs). All RCTs were included that used acupuncture as the intervention group to obtain the efficacy and/or safety of acupuncture therapy and that based the acupuncture therapy on Traditional Medicine theory.
The researchers assessed
- (1) the general characteristics of acupuncture RCTs;
- (2) the general characteristics of PROs;
- (3) the reporting scores of PROs by the Extension of Consolidated Standards of Reporting Trials of Patient-Reported Outcomes (CONSORT PRO Extension);
- (4) the general characteristic of A-AEs; (5) the incidence of A-AEs.
They included 476 RCTs; 296 (62.2%) used PROs as study outcomes, 272 (57.1%) reported safety outcomes. The Visual Analogue Scale (149, 23.7%) and the Pittsburgh Sleep Quality Index (42, 6.7%) were the most common PROs reported. The reporting of PROs was incomplete, with sufficiently reporting scores ranging from 2.7% to 97.6% across the CONSORT PRO Extension.
164 studies reported A-AEs, of which 141 reported specific details. The OR for the incidence of AEs in the acupuncture group compared to the control group was 1.434 (95% CI 1.148 to 1.793). The researchers identified 1277 reports of A-AEs, predominantly tissue injury (eg, haematoma, bleeding), irritation (eg, pain, post-acupuncture discomfort), with no reports of serious A-AEs. The reporting of A-AEs lacked details on the acquisition methods (15.5%), occurrence time (5.5%), A-AEs’ treatment (18.1%) and A-AEs’ recovery (19.7%). Studies that reported funding, registry information, acupuncturist qualifications and non-significant primary outcomes were associated with the A-AEs’ reporting, and the difference was statistically significant (p≤0.05).
The authors concluded that their study found that the reporting of PROs and A-AEs was insufficient in acupuncture RCTs. Future studies should clarify the clinical significance of using PROs as outcomes and report AEs comprehensively to provide patients with sufficient information on the benefits and harms of acupuncture treatments.
If you have followed my blog for any length of time, you will have seen numerous studies that show how poor the reporting of AEs is in trials of acupuncture and other forms of so-called alternative medicine (SCAM). This is not just regrettable, it is unethical, dangerous and amounts to scientific misconduct.
Based on such flawed evidence SCAM promoters claim that their treatments are quite safe. But because of the very inadequate reporting this assumption might well be wrong. Thus consumers are systematically being misled into making wrong, and in a worst case scenaario fatal, therapeutic decisions.
Imagine what scandal it would generate, if we found that studies of pharmaceuticals were systematically hiding AEs by simply not monitoring and reporting them!
This “randomized controlled clinical trial” (has anyone ever seen a randomized trial without a control group? – No, therefore, the correct term is “ramdomized clinical trial (RCT)”) aimed to compare the effectiveness of wet cupping therapy (WCT) and Acupuncture in treating migraine patients. It was conducted between 01.03.2022 and 01.10.2023 in a Traditional and Complementary Medicine Center of a tertiary hospital. Patients diagnosed with migraine were included in the study and randomized into three groups.
- The WCT group received wet cupping 3 times, once a month.
- The acupuncture group received 10 sessions of acupuncture once a week.
- The waiting list group served as the control group.
VAS and MIDAS scales were used for all groups at the beginning and the end of the treatment, and the results were compared.
Initially, 168 patients were enrolled. However, there were some dropouts throughout the study period. In the acupuncture group, 11 patients did not attend subsequent sessions, with one dropout occurring due to adverse effects. In the wet cupping (WCT) group, three patients discontinued their participation following the initial treatment. Ultimately, a total of 153 patients were included.
The findings show that all three groups were similar regarding age and sex. Migraine Disability Assessment Scale (MIDAS) and Visual Analogue Scale (VAS) pain scores decreased significantly in both treatment groups after the applications, while they remained similar for the same period in the control group. Additionally, the post-treatment values of MIDAS and VAS in both the WCT and acupuncture groups were significantly lower compared to controls, while they were similar when compared in between.
The authors concluded that both of these applications were found to be similarly effective in improving disability status and pain intensity in patients with migraine.
I beg to differ!
Apart from all other flaws of this trial, it did not control for placebo effects. Both WCT and acupuncture are invasive treatments that are bound to cause sizeable placebo responses. The waiting list control might account for the natural history of the disease and for regression towards the mean, but it is not a method for allowing for placebo effects. In view of this fundamental limitation of the study, its conclusions should be re-written as follows:
Both of these applications were similarly effective in producing sizeable placebo effects which in turn improved disability status and pain intensity in patients with migraine.
For migraine patients, this means that neither of these therapies are likely to be the best available option.
The aim of this recent review was to investigate the efficacy of non-surgical and non-interventional treatments for adults with low back pain compared with placebo. It included all randomised controlled trials evaluating non-surgical and non-interventional treatments compared with placebo or sham in adults (≥18 years) suffering from non-specific low back pain.
Random effects meta-analysis was used to estimate pooled effects and corresponding 95% confidence intervals on outcome pain intensity (0 to 100 scale) at first assessment post-treatment for each treatment type and by duration of low back pain—(sub)acute (<12 weeks) and chronic (≥12 weeks). Certainty of the evidence was assessed using the Grading of Recommendations Assessment (GRADE) approach.
A total of 301 trials (377 comparisons) provided data on 56 different treatments or treatment combinations. One treatment for acute low back pain: (non-steroidal anti-inflammatory drugs (NSAIDs)), and five treatments for chronic low back pain:
- exercise,
- spinal manipulative therapy,
- taping,
- antidepressants,
- transient receptor potential vanilloid 1 (TRPV1) agonists)
were found to be efficacious. However, effect sizes were small and of moderate certainty. Three treatments for acute low back pain (exercise, glucocorticoid injections, paracetamol), and two treatments for chronic low back pain (antibiotics, anaesthetics) were not efficacious and are unlikely to be suitable treatment options; moderate certainty evidence. Evidence is inconclusive for remaining treatments due to small samples, imprecision, or low and very low certainty evidence.
The authors concluded that the current evidence shows that one in 10 non-surgical and non-interventional treatments for low back pain are efficacious, providing only small analgesic effects beyond placebo. The efficacy for the majority of treatments is uncertain due to the limited number of randomised participants and poor study quality. Further high-quality, placebo-controlled trials are warranted to address the remaining uncertainty in treatment efficacy along with greater consideration for placebo-control design of non-surgical and non-interventional treatments.
This is an important analysis, not least because of the fact that the research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. The methodology is sound and the results thus seem reliable.
The findings are in keeping with what we have been discussing at nauseam here: no treatment works really well for back pain. For acute symptoms no so-called alternative medicine (SCAM) at all is efficacious. For chronic pain, spinal manipulation therapy (SMT) have small effects. As SMT is neither cheap nor free of risks, excercise is much preferable.
Considering that most SCAMs are heavily promoted for low back pain (e.g. acupuncture, Alexander technique, cupping, Gua Sha, herbal medicine, homeopathy, massage, mind-body therapies, reflexology, Reiki, yoga), this verdict is sobering indeed!
Constipation is characterized by persistent difficulty in defecating. It is a common disorder in the community particularly affecting the elderly and those with intellectual disabilities and neuropsychiatric disorders. It can also be caused by numerous medications including analgesic, antidepressant, antihypertensive and anticholinergic agents. It may be asymptomatic or it may produce abdominal pain/cramps, bloating, nausea and anorexia progressing to urinary incontinence and fecal impaction, or paradoxical diarrhea due to overflow.
This review demonstrated that constipation may also kill you. A wide range of mechanisms associated with constipation may result in death including:
- bowel obstruction,
- stercoral colitis with ulceration,
- perforation and peritonitis,
- respiratory compromise,
- abdominal compartment syndrome,
- venous thrombosis with pulmonary thromboembolism.
Moreover, constipation may exacerbate pre-existing diseases and treatments such as laxative and enemas may be lethal. The autopsy examination of a case with constipation and megacolon should take into account all of the pre-existing conditions, as well as the possibility of underlying disorders such as Hirschprung disease. Review of the decedent’s medical and drug history and level of supportive care will be important. Toxicological evaluations may be useful.
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Constipation is defined as having fewer than three bowel movements per week or experiencing difficulty in passing stool. The condition is common and often difficult to treat. WebMD recommends diet and lifestyle changes, such as:
- Drink an extra two to four glasses of water a day, unless your doctor tells you to limit fluids for another reason.
- Try warm liquids, especially in the morning.
- Add fruits and vegetables to your diet.
- Eat prunes and bran cereal.
- Exercise most days of the week. When you move your body, the muscles in your intestines are more active, too.
- Don’t ignore the urge to poop. Listen to your body when it’s telling you it’s time to go.
- Eat foods with probiotics such as yogurt and kefir.
- Skip processed meats, fried foods, and refined carbs such as white bread, pasta, and potatoes. You can eat lean meats such as poultry and low-fat dairy products.
- Keep a food diary and make a note of any foods that constipate you.
- Adjust how you sit on the toilet. Raising your feet, leaning back, or squatting may make it easier to poop.
- Take an over-the-counter fiber supplement (Metamucil®, MiraLAX®, Citrucel® or Benefiber®). Start with a small amount at first.
- Avoid reading or using your phone or other devices while you’re trying to move your bowels.
- Drink less alcohol and caffeinated drinks, which can make you dehydrated.
- Talk to your doctor about bowel training. It can help train your body to pass stool shortly after breakfast every morning.
- Don’t rush when going to the bathroom. Give yourself time to relax, which can help your digestive muscles relax.
- Talk to your doctor about any medications that could be causing your constipation.
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Because conventional options are often not as successful as hoped, many sufferers turn to so-called alternative medicine (SCAM). But is SCAM really a solution?
A recent review found that “acupuncture or electroacupuncture and herbal medicine are effective in treating
constipation, whereas findings on massage and moxibustion are inconclusive.” Our own assessment [‘Oxford Handbook…’ (2008)] of the evidence disagrees and rated as follows:
- Beneficial: Psyllium
- Likely to be beneficial: abdominal massage, biofeedback, fibre
- Unknown effectiveness: acupuncture, aloe vera, ayurvedic medicine, meditation, Padma Lax, probiotics, herbal tea.
Whichever way we turn it, constipation is a more serious condition than many of us think, and neither conventional healthcare nor SCAM are convincingly successful in helping those who suffer from it.
Tuina, or Tui Na is based on the notion that imbalances of the life-force, qi, can cause blockages or imbalances that lead to symptoms and illness. Tuina massage is similar to acupressure in that it targets specific acupoints. Practitioners use fingers to apply pressure to stimulate these points.
Some people suggest that Tuina might benefit diabetic peripheral neuropathy (DPN), but the evidence is inconclusive. This review evaluated its clinical efficacy and safety for DPN treatment.
Ten databases were searched, covering the period from their inception to February 21, 2024. Relevant data were extracted from studies meeting the inclusion criteria, and a meta-analysis was conducted using RevMan
5.3 software.
A total of 24 randomized controlled trials (RCTs) involving 1,989 participants were included. Patients in the experimental group received Tuina in addition to routine treatments and nursing of DPN. Patients in the control group received routine treatments and nursing of DPN, including health education, dietary guidance, blood sugar control, and oral vitamin B or mecobalamin.
The meta-analysis showed that, compared to various control therapies, Tuina demonstrated a higher overall clinical efficacy rate and improved Toronto Clinical Scoring System (TCSS) scores, indicating that Chinese Tuina may provide benefits beyond conventional treatment. Furthermore, improvements were observed in the motor and sensory nerve conduction velocities (MNCV and SNCV) of certain specific nerves, such as the common peroneal nerve, sural nerve, and ulnar nerve. Although the differences in MNCV and SNCV of the tibial and median nerves were not statistically significant, the overall improvement in clinical outcome supports the notion that Tuina is superior to conventional treatment.
The authors concluded that Chinese Tuina therapy is a safe and effective treatment option for DPN. It can alleviate clinical symptoms and improve the MNCV of the common peroneal nerve as well as the SNCV of the sural and ulnar nerves. Its efficacy in the tibial and median nerves remains unconfirmed, highlighting a need for future large-scale, high-quality RCTs.
There are several reasons why I cannot accept the conclusion that Tuina is effective for DPN, e.g:
- All the RCTs were of the notorious A+B vs B design that – as discussed ad nauseam on this blog – does not control for placebo effects and thus never generate negative results.
- None of the RCTs were single or double blind which means that expectation and therapist influence would have impacted on the findings.
- All of the studes originate from China; we have often discussed why such studies are notoriously unreliable. Funding for the review was supported by the National Key Research and Development Program of China and Jilin Provincial Natural Science Foundation Project.
- Most of the studies are published in journals and/or laguages that are not accessible to non-Chinese readers.
- None of these serious limitations are discussed by the review authors.
I REST MY CASE
It does not happen every day that the prestigeous German FRANKFURTER ALLGEMEINE ZEITUNG publishes an in-depth analysis of TCM (Traditional Chinese Medicine) and even discusses several of the themes that we, here on this blog, have often debated. Allow me, therefore, to translate a few passages from the recent FAZ article entitled “Der Fluch der alten Dinge” (The Curse of Old Things):
… TCM has countless followers in many countries. ‘TCM is a wonderful medicine that thinks ‘holistically’, that sees not just one organ but the whole person and that offers very good treatment options,’ says Dominik Irnich. He heads the German Medical Association for Acupuncture. Although there is not evidence for all indications, TCM is ‘a scientifically based option for a number of diseases, the effects of which have been proven many times over’…
Meanwhile, Beijing wants to utilise the positive image of TCM to present itself in a good light and promote exports. The current five-year plan also provides for the creation of around 20 TCM positions for epidemic prevention and control. Critics, on the other hand, see patients at risk due to insufficiently tested therapies – and medicine as a whole: many studies are hardly valid and distort the state of science…
The top leadership of the Chinese Communist Party is using the ‘old things’ to increase its global influence and utilise TCM not only in its own country, but also as an export hit. The global TCM market is estimated to be worth many billions of euros annually, but there are no reliable figures – not least because it often includes illegally traded products such as rhino horn or donkey skin, which has led to mass killings.
Officially, Beijing prosecutes illegal trade and promotes science-based medicine, but the interests are intertwined. Even under Mao, traditional methods were used in China as a favourable alternative to imported medicines, and Beijing is currently increasingly allowing them to be reimbursed. At the same time, China’s leadership is trying to anchor TCM products in healthcare worldwide, for example as part of a ‘health Silk Road’ in Africa. During the Covid-19 pandemic, the state not only used TCM products en masse in its own country, Chinese foreign representatives also distributed them to Chinese people in Europe. This included a product based on gypsum, apricot kernels and plant parts called Lianhua Qingwen. According to a report published by the consulate in Düsseldorf, this was distributed even though the sale of medicines outside of pharmacies is generally punishable by law.
Beijing has also been successful at the level of the World Health Organisation (WHO), which promotes traditional medicine from China. ‘This was part of the interests and election programme of former Chinese Director-General Margaret Chan,’ says WHO consultant Ilona Kickbusch. The WHO drew up standards for acupuncture training, including knowledge of the ‘function and interactive relationship of qi, blood, essence and fluid’, as the document states.
In 2019, the WHO member states decided to add a chapter on ‘traditional medicine’ to the standard classification of diseases. Doctors can now code alleged patterns of ‘qi stagnation’ or yang deficiency of the liver. The umbrella organisation of European science academies EASAC criticised this as a ‘significant problem’: doctors and patients could be misled and pressure could be exerted on healthcare providers to reimburse unscientific approaches. Nature magazine found: ‘The WHO’s association with drugs that have not been properly tested and could even be harmful is unacceptable for the organisation that has the greatest responsibility and power to protect human health.’ …
In general, the study situation on therapies that are categorised as TCM is extremely confusing. The evidence is ‘terrible’, says the physician Edzard Ernst, who has analysed such procedures. ‘There are thousands of studies – that’s part of the problem.’ Many studies come from China, but it is known that a large proportion are invalid or falsified. It is almost impossible to report critically on TCM there: according to media reports, a doctor was imprisoned for three months in 2018 after criticising a TCM remedy. In 2020, Beijing even considered banning criticism of TCM, but refrained from doing so after an outcry.
According to Ernst, the quality of even some of the meta-analyses from the respected Cochrane Collaboration is ‘hair-raising’ due to the inclusion of unreliable studies, and according to some Chinese researchers, acupuncture works for everything. Prof. Unschuld said at an event a year ago that he was asked in China not to address critical issues.
‘In a country without the open and free critical culture that is common in democratic countries, the control mechanisms are missing,’ says Jutta Hübner, Professor of Integrative Oncology at Jena University Hospital. The inclusion of Chinese studies, which almost never report negative results, can create a much too positive image of TCM at a formally very high level of scientific evidence, without the results being reliable…
Instead of allowing the research to be carried out by proponents, it would be desirable ‘if the universities in particular remembered that they have the duty to be critical,’ says physician Edzard Ernst. However, some university clinics prefer to advertise TCM methods in order to attract patients and money.
We often encounter multiple systematic reviews on (almost) the same topic. This provides us with interesting comparisons and is, I think an opportunity to learn. Here is an example: two reviews of auricular acupuncture for post/peri-operative pain.
- A recent review from the Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China; Rehabilitation Medicine Center, West China Hospital, Sichuan University, Chengdu, People’s Republic of China; Department of Integrated Chinese and Western Medicine, Sichuan Cancer Hospital, Chengdu, People’s Republic of China
Purpose: We conducted a more comprehensive systematic review and meta-analysis to evaluate the effectiveness of auricular acupuncture (AA) in perioperative pain management.
Methods: Randomized controlled trials (RCTs) findings were retrieved from the Embase, Cochrane Central Register of Controlled Trials, PubMed, Web of Science, Chinese Biomedical Literature Database, Wanfang, VIP, and China National Knowledge Infrastructure databases from their inception to March 2024 using the search terms “pain”, “auriculotherapy”, and “randomized controlled trial”. The experimental group was treated with AA alone or in combination with analgesic drugs, whereas the control group was treated with sham auricular acupuncture, placebo, conventional treatment, or no treatment. The primary outcome was the perioperative pain score. The secondary outcomes were analgesic requirements, anxiety score, and adverse events (AEs). RevMan version 5.4 was used for data analysis.
Results: The analysis included a total of 21 RCTs with 1527 participants. AA was superior to the control group for reducing pain intensity (mean difference [MD]= −0.44; 95% confidence interval [CI]: −0.72 to −0.17) and analgesic requirement (standardized mean difference [SMD]= −0.88, 95% CI: −1.29 to −0.46). Perioperative anxiety improvement did not differ significantly between the AA and control groups (MD= −5.45, 95% CI: −32.99 to 22.09). Subgroup analysis showed that AA exerted a significant analgesic effect as a preoperative intervention and in orthopedic surgery. The results of the sensitivity analysis demonstrated the stability of the results of the meta-analysis. AA-related AEs were mainly nausea, vomiting, and drowsiness. None of the patients in the experimental group dropped out of the trial due to AA-related AEs.
Conclusion: Current evidence suggests that AA may be a promising treatment option for improving perioperative pain with few AEs. However, owing to the low quality of the current evidence, large-sample, high-quality RCTs are needed to prove this conclusion.
- A not so recent review from the Department of Anaesthesiology and Intensive Care Medicine, University of Greifswald, Germany and the Department of Complementary Medicine, Exeter, UK.
The number of publications on the peri-operative use of auricular acupuncture has rapidly increased within the last decade. The aim was to evaluate clinical evidence on the efficacy of auricular acupuncture for postoperative pain control. Electronic databases: Medline, MedPilot, DARE, Clinical Resource, Scopus and Biological Abstracts were searched from their inception to September 2007. All randomised clinical trials on the treatment of postoperative pain with auricular acupuncture were considered and their quality was evaluated using the Jadad scale. Pain intensity and analgesic requirements were defined as the primary outcome measures. Of 23 articles, nine fulfilled the inclusion criteria. Meta-analytic approach was not possible because of the heterogeneity of the primary studies. In eight of the trials, auricular acupuncture was superior to control conditions. Seven randomised clinical trials scored three or more points on the Jadad scale but none of them reached the maximum of 5 points. The evidence that auricular acupuncture reduces postoperative pain is promising but not compelling.
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Before you now claim that the second review, with me as senior author, is bound to be far too critical, let me tell you that its two other authors were not from my team and are known proponents of acupuncture.
Some notable differences between the two reviews include the following:
- Our review was published in 2008, while the Chinses review is brand-new and dates from 2025.
- The Chinese team searched several Chinese data-banks, while we only searched Western ones.
- Our review included 9 RCTs, while the new review included 21 RCTs.
- Nine studies in the Chinese review were from China, whereas only 1 study in our review originated from China.
- The authors of the Chinese review stated that large-sample, high-quality RCTs are needed to prove their conclusion, while we thought that further rigorous research and independent replications, which effectively exclude bias, seem warranted.
So, what can we learn from comparing these papers?
- Obviously, as time goes by, more studies get published.
- In the case of acupuncture, most recent studies originate from China. As we have often discussed, Chinese acupuncture trials almost invariably report (false) positive results. It follows that, in future, we will see more and more (false) positive reviews of acupuncture (and other TCM topics). At present, I see no rational way of dealing with this problem (other than not at all considering papers from Chinese authors).
- It is often easy to find indications of bias in the way authors formulate their conclusions. Impartial researchers advocate to PROVE their assumptions, while scientists want to test them in the most rigorous way possible.
The most interesting finding from this comparison is, in my view, that our 2008 conclusion would also be well-suited for the 2025 review – I would argue even better than the odd conclusions from the original authors. What the evidence suggested in 2008 is very much the same evidence as 17 years later:
The evidence that auricular acupuncture reduces peri-operative pain is promising but not compelling.
And what does this fact – that the evidence does not clearly move in a positive direction – imply? I think, it suggests that the treatment in question is hardly worth taking seriously. In other words even my re-drafted conclusion above needs to change:
The evidence that auricular acupuncture reduces peri-operative pain is not compelling!
This open-label, randomized, controlled trial was aimed to assess the effectiveness and safety of Vuong Hoat (VH) natural health supplement for reducing the negative impact of low back pain, improving the quality of life, and enhancing functional activities in patients with lumbar degenerative disc disease (LDD).
The study involved 60 patients suffering from low back pain caused by LDD. The participants were randomly assigned to:
- a study group (SG) comprising 30 subjects who received VH in conjunction with the same electro-acupuncture,
- a control group (CG) comprising 30 subjects who received treatment with electro-acupuncture.
These treatments lasted for 28 days.
The clinical progression and tolerability of both groups were compared based on seven objective measurements:
- visual analog scale index,
- Schober test,
- fingertip-to-floor distance,
- spinal flexion,
- spinal extension,
- spinal tilt,
- spinal rotation.
Already after 14 days of treatment, the SG showed a significant improvement in overall outcomes compared to the CG. Specifically, 43.3% of SG patients achieved very good results, 53.3% had good results, and 3.4% had moderate results, whereas corresponding figures for the CG were 6.7%, 76.7%, and 16.6%, respectively (P < .05).
After 28 days of treatment, both groups demonstrated a shift toward very good results, with the SG continuing to show better outcomes than the CG (P < .05). In the SG, the very good results increased to 76.7%, good results decreased to 20%, and moderate results were 3.3%. On the other hand, the CG had 46.7% very good results, 43.3% good results, and 10% moderate results. Notably, no side effects were reported from the VH treatments during the study.
The authors concluded that their findings of this study indicate that VH health supplement is a safe and effective approach for managing low back pain and limited spinal movement in patients with LDD.
I have several concerns and questions, some are trivial others are not:
- What does VH contain? I have no free access to the actual paper but even the abstract should mention this information.
- How do the investigators know that low back pain was caused by LDD? Lots of people have LDD without pain and vice versa.
- The A+B vs B design is known to produce false positive results due to its failure to control for placebo effects; why not use a placebo (which would have been very easy in this case)?
- Contrary to the authors statement, the outcome measures are NOT objective.
- It seems highly implausible that no side effects of VH occurred. Even placebos cause side-effects in ~6% of all cases.
- Conclusions about safety are NEVER warranted based on just 30 patients.
- Why does an allegedly respectable journal publish such rubbish?
