Recently on the show, we had a discussion about what separates that which is science from that which is not. Science, that is.
This was sparked by a claim that was made to Stuart that the benefit of acupuncture could be “proved” by feeling better sometime after seeing an acupuncturist. Now, this observation clearly falls into the “not science” category. But what does science actually say?
For an answer, we turn as we always do to the Cochrane Library of systematic reviews. And what do we find? That it’s a bit more complicated than that…
You see, the Cochrane Collaboration tend to study the efficacy of specific treatments for specific conditions. So there’s no one simple answer for whether acupuncture is effective; it depends on what condition you’re trying to treat.
But in the interest of giving some sort of answer, after the break are the first 25 of 96 results in a search for Cochrane reviews on “acupuncture”:
- Peripheral joint osteoarthritis – Acupuncture may lead to small improvements in pain and physical function after 8 weeks and 26 weeks, but we often do not have precise information about side effects and complications.
- Migraine prophylaxis – Collectively, 22 trials suggest that migraine patients benefit from acupuncture, although the correct placement of needles seems to be less relevant than is usually thought by acupuncturists.
- Tension-type headache – The available evidence suggests that acupuncture could be a valuable option for patients suffering from frequent tension-type headache.
- Depression – Thirty trials, and 2812 participants were included in the review and meta-analysis, however there was insufficient evidence that acupuncture can assist with the management of depression.
- Shoulder pain – There is not enough evidence to say whether acupuncture works to treat shoulder pain or whether it is harmful, although from the little evidence that there is, acupuncture may improve pain and function over the short term (2 to 4 weeks).
- Neck disorders – Individuals with chronic neck pain who received acupuncture reported, on average, better pain relief immediately after treatment and in the short-term than those who received sham treatments, while those with chronic neck pain with symptoms radiating to the arms who received acupuncture reported, on average, better pain relief in the short-term than those who were on a waiting list.
- Cancer pain in adults – Only three studies met the review criteria, but still provided insufficient evidence to judge whether acupuncture is effective in relieving cancer-related pain in adults.
- Insomnia – Currently there is a lack of high quality clinical evidence supporting the treatment of people with insomnia using acupuncture, because it is mainly evaluated in observational and uncontrolled studies, and randomised controlled trials are scarce and of poor methodological quality.
- Schizophrenia – Although some trials favoured acupuncture when combined with antipsychotics, the results came from small studies, and further, more comprehensive trials are needed.
- Irritable bowel syndrome – Some randomised controlled trials showed no clear evidence in support of acupuncture as an effective treatment for irritable bowel syndrome, although other poor quality trials showed beneficial effects; but overall there is no evidence to support the use of acupuncture for the treatment of IBS.
- Rheumatoid arthritis – From the little evidence that there is, acupuncture and electroacupuncture do not appear to improve the symptoms of rheumatoid arthritis.
- Acute stroke – Evidence from randomised controlled trials showed no clear effect of acupuncture on either the number of patients who died from acute stroke, or were left needing help with everyday activities.
- Cocaine dependence – There is no evidence that any form of auricular acupuncture (inserting needles into a number, usually five, of specific points in the ear) is effective for treating cocaine dependence.
- Traumatic brain injury – The small number of studies together with their low methodological quality means that they are inadequate to allow any conclusion to be drawn about the efficacy and safety of acupuncture in the treatment of traumatic brain injury.
- Restless legs syndrome – Based on two trials with 170 patients, the review did not find consistent evidence to determine whether acupuncture is effective and safe in the treatment of restless legs syndrome.
- Assisted conception – The data from this meta-analysis suggests that acupuncture does increase the live birth rate with in vitro fertilisation (IVF) treatment when performed around the time of embryo transfer, but this could be due to placebo effect and the small number of trials, and acupuncture may in fact have potential harmful effects in early pregnancy.
- Smoking cessation – The review did not find consistent evidence that active acupuncture or related techniques increased the number of people who could successfully quit smoking, however it may be better than doing nothing, at least in the short term.
- Chronic asthma – There is insufficient evidence to make recommendations about the value of acupuncture as a treatment for asthma, and future research should concentrate on establishing whether there is a non-specific component of acupuncture which benefits recipients of treatment, and assess not only placebo treatment, but ‘no treatment’ as well.
- Low back pain – There is insufficient evidence to make any recommendations about acupuncture or dry-needling for acute low-back pain, but in the short term it is more effective than no treatment for chronic low-back pain. And although acupuncture is not more effective than other conventional and “alternative” treatments, when used as an adjunct it relieves pain and improves function better than the conventional therapies alone.
- Bell’s palsy – Poor quality caused by flaws in study design or reporting (including uncertain method of randomisation, allocation concealment and blinding) and clinical differences between trials prevented reliable conclusions about the efficacy of acupuncture.
- Dysphagia in acute stroke – Only one small randomised controlled trial was identified, involving 66 participants, which did not provide clear evidence of benefit from adding acupuncture to standard Western medical treatment for swallowing difficulties in patients with stroke.
- Stroke rehabilitation – Five randomised trials were identified, but all were of poor quality and no definite conclusions could be drawn about the effects of acupuncture in patients who had a stroke more than one month previously.
- Attention Deficit Hyperactivity Disorder (ADHD) in children and adolescents – No trials were included in this review, so no conclusions could be drawn about the efficacy or safety of acupuncture for ADHD in children and adolescents; there is an urgent need for further large scale, multicenter, randomised, controlled, double-blinded studies of acupuncture with standardised evaluation of outcomes.
- Lateral elbow pain – Acupuncture might be able to provide short-term relief from tennis elbow, but more research is needed.
- Uterine fibroids – There is no reliable proof of effectiveness of acupuncture for uterine fibroids (benign growths within the uterine muscle) due to lack of randomised controlled trials up to now.
So there you go – that’s what we call “mixed results”. The general conclusion seems to be that there aren’t enough high quality, randomised controlled trials to really decide whether acupuncture is effective. Which doesn’t mean it’s been proven to not be effective, but it certainly hasn’t been proven.