Needles can stick it to pain

Acupuncture, the ancient Chinese practice of sticking needles into a patient at specific points to relieve pain and treat other conditions, seems to alleviate pain just barely better than sticking needles into nonspecified parts of the body, a new analysis shows.

Researchers in Denmark came to this conclusion, which they report in the Feb. 7 British Medical Journal, after analyzing 13 studies in which people received real acupuncture, sham acupuncture or standard pain treatments such as drugs.

The studies enrolled 3,025 people in all. In each, the participants were randomly assigned to get one of the three therapies. Decreases in pain, if any, were recorded using standard pain scales.

On average, people getting acupuncture or sham acupuncture — in which needles are stuck into body areas not targeted by acupuncturists — sensed a clear decrease in pain, whereas those getting standard care sensed considerably less improvement. People getting real acupuncture reported a little more pain relief than those getting the sham needle sticks, but this slight difference was insignificant from a clinical perspective, says study coauthor Asbjørn Hróbjartsson, a physician and epidemiologist at Rigshospitalet in Copenhagen.

The value of acupuncture in this meta-analysis might have been diluted somewhat by the study design, says physician Adrian White of the University of Plymouth in England. For example, some of the studies in this analysis centered on sore backs and knee pain from osteoarthritis, areas in which acupuncture has a positive track record, he says. But the overall value of acupuncture for pain might have been lessened by the inclusion of studies of people with headaches, a group in which acupuncture hasn’t performed well, he says.

Of course, he concedes, “this was done because acupuncturists argue they can treat any kind of condition.”

Acupuncture purports to hit key spots along channels called meridians that run throughout the body. But the narrow difference in the findings of sham needle sticks and real acupuncture raises the question of how acupuncture works.

The placebo effect, in which patients get some benefit from a fake treatment because they assume it is real, probably plays a role in acupuncture and may explain some of the sham acupuncture benefit, says Andrea Furlan, a physician and pain researcher at the University of Toronto and the Institute for Work & Health, also in Toronto. But the placebo effect is unlikely to account for all the pain reduction, she says. “There might be physiological changes” brought on as needle sticks affect the nervous system, she says.

The experience of undergoing the ritual of acupuncture also influences the therapy’s effectiveness, she says. “Belief is a big part of this,” says Furlan, a trained acupuncturist who no longer practices.

Only a few decades ago, most Western doctors had little regard for acupuncture. Now, that viewpoint is more mixed. Insurance companies in some countries even reimburse for its costs — for certain health problems.

“Complimentary or alternative therapies often provoke a division into believers and nonbelievers,” says Hróbjartsson. “That is also the case with acupuncture, though in acupuncture, in my view, a strict division is too simplistic. There are moderate skeptics and moderate believers.”