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Headaches? Stick Yourself With Needles… Or, Not

by Kirsten Sanford, Jan 23 2009

I ran across a press release on this week that piqued my interest.

“Acupuncture Stops Headaches, But ‘Faked’ Treatments Work Almost As Well”

Really? Interesting headline, I thought to myself, and proceeded to ingest the release. I have a love-hate relationship with acupuncture, you see. I don’t believe that it actually works. The evidence certainly hasn’t piled up in acupuncture’s clinical favor.  Yet, I have a friend or two (who I love dearly) who attend acupuncture school, and plan to make the craft their careers. So, I had to read on… maybe there is proof to my friends’ claims.

The release discussed two clinical reviews: one related to acupuncture and migraines, the other to acupuncture and tension headaches. The criteria for inclusion of trials in the review seemed fair enough. The reviewers looked at all randomized studies with at least two month long observation periods comparing acupuncture treatment to control, sham treatment or another intervening treatment, like massage or relaxation.

The review of studies related to tension headaches found that acupuncture was better than treatment for acute headaches or simple routine care, and that real acupuncture was better (marginally) than sham acupuncture. Interestingly, studies involving other treatments were considered too flawed to allow any conclusions to be drawn. I find this unfortunate because one of the main questions related to acupuncture is whether the relaxation and skin palpation that takes place during the process of acupuncture might have something to do with the perceived results.

The migraine review concluded that acupuncture was helpful to migraine sufferers, but that real acupuncture was no better than sham acupuncture. It is even questionable whether needle placement is important for positive results. This suggests that there are other processes at work in the migraine mitigation.

Overall, the suggestion of the authors is that acupuncture is a useful addition to any migraine or tension headache treatment regime. Alright, I thought, at least it doesn’t appear to have any negative effects (according to the reviews), and it might be better than dealing with the side-effects of drug-treatments.

Then I checked the authors’ declaration of interest:

“This review includes trials in which some of the reviewers were involved, as follows: Allais 2002 – Gianni Allais; Jena 2008 – Benno Brinkhaus; Linde K 2005 – Benno Brinkhaus and Klaus Linde; Streng 2006 – Klaus Linde; and Vickers 2004 – Andrew Vickers. These trials were reviewed by at least two other members of the review team. Gianni Allais, Benno Brinkhaus and Adrian White use acupuncture in their clinical work. Gianni Allais receives fees for teaching acupuncture in private schools. Klaus Linde has received travel reimbursement and, in two cases, fees from acupuncture societies (British, German and Spanish Medical Acupuncture Societies; Society of Acupuncture Research) for speaking about research at conferences. Eric Manheimer and Andrew Vickers both received an honorarium for preparing and delivering presentations on acupuncture research at the 2007 meeting of the Society for Acupuncture Research. Adrian White is employed by the British Medical Acupuncture Society as journal editor and has received fees and travel reimbursements for lecturing on acupuncture on several occasions. Benno Brinkhaus has received travel reimbursement and fees for presenting research findings at meetings of acupuncture societies (British, German and Spanish Medical Acupuncture Societies).”

Heh. They’ve all got a vested interest in the outcome of these reviews. However, who better to review acupuncture research than acupuncturists? The experts in the field.

In my view, there is a conflict of interest here, which should be better conveyed to the public. What do you think?

17 Responses to “Headaches? Stick Yourself With Needles… Or, Not”

  1. MadScientist says:

    Wow – I never knew there was such a thing as ‘sham acupuncture’!

    Of course ‘real is slightly better than sham’ really means ‘real = sham’. You should have heard my dad scream at anyone who would suggest acupuncture; as a physician he had absolutely no tolerance of health scams. Unfortunately my dad’s long gone, but acupuncture is here to stay.

    Any zookeepers around? Bring over some porcupines and let’s have a masochistic love-in! It’s almost as good for headaches as real acupuncture!

  2. Max says:

    Whenever I stick myself with needles, I forget all about my headaches, at least until the bleeding stops.

    Is there a conflict of interests whenever experts in a field review studies in that field? That’s easy to fix: Have pharmacologists review acupuncture studies, and have acupuncturists review drug studies. Wait, then the conflict of interests just gets flipped. All right, mix them all up, yeah that’s it.

  3. Dr. Dave says:

    It’s interesting that they use “sham acupuncture” in their “sham research”. It’s completely inadmissible as true research because of their conflicts of interest. Did they even bother to use a double blind?

    I’ve resorted to acupuncture for chronic pain relief, and it did nothing for me. At least the acupuncturist (a fully-trained MD) admitted it was not working after six treatments, and was not going to work. Yes, I realize that this is just anecdotal. I just wanted to get MY biases out on the table: I had high hopes for acupuncture, but it did not work for me and I just have not seen compelling research for its efficacy.

    • pamela says:

      MDs who practice acupuncture more often than not study “medical acupuncture” which is an anatomically based system and it is usually taught as a series of weekend courses. Trained acupuncturists complete four years of training on top of their undergrad studies. They utilize a completely different system, have a much broader knowledge of how to use acupuncture and have many more “tools under their belt”. You did not specify what kind of training he had in actual acupuncture, that is Traditional Chinese Medicine. If he did just take the weekend training, I recommend that you seek a qualified acupuncturist and utilize the herbs as an adjunct – you might be happier with the results.

  4. James Severin says:

    For those interested:

    I recently came across a book called “The Healthy Skeptic: Cutting Through the Hype About Your Health” by Robert J. Davis. Which had a very interesting chapter about the link between people who are paid to conduct studies and their tendency to find results in favor of the people who are paying them.

    A good read for any person skeptic or not.

  5. Mike Beavington says:

    It’s another one of those ‘death by anecdotes’. To be clear cut rational is not in people’s nature. I appreciate your friends thinking that it works and that they can really help people; I’ve got the same problems with one of my motorcycling friends who showed me some of the needles they use. OMG. No wonder punctured lungs can be a problem.

    I like to fall back on Elliot Aronson’s The Social Animal university text for understanding why people think the way they do. It explains a lot.

  6. FYI – I have two posts on this study:

    I am a bit more harsh than Kirsten.

  7. Sion Hughes says:

    I wrote to the BBC to comment on their coverage of this topic

    “So acupuncture is no better than fake acupuncture and is
    simply a placebo effect. Well, I couldn’t agree more. But I’m wondering how this becomes (to quote your article) an, “endorsement by the Cochrane Collaboration.” More like a damning expose, I would have said.
    Sion Hughes, UK”

    I soon received the following reply which made me hang my head in despair:

    “Many thanks for your message, and interest in the site.
    The term “sham” or “fake” acupuncture, although widely used, can be a
    touch misleading, as, rather than being a true control treatment,
    needles are still inserted with the aim of active treatment. It’s simply a term for an acupuncture technique which doesn’t focus on the
    traditional ‘acupuncture points’. Effectively you’re comparing two
    different types of acupuncture, rather than comparing acupuncture to no acupuncture.
    The outcome of the reviews were positive in favour of acupuncture
    generally as a technique comparing them to conventional drugs – hence
    the term “endorsement”. No conclusions were drawn about whether
    successful acupuncture depends on using the traditional points – the
    lead reviewer said that it suggested that the precise location of the
    needles was not necessarily important.
    So while it certainly doesn’t offer any evidence supporting the
    traditional “meridian” explanation, it rules in favour of acupuncture

    I hope this helps.
    Kind regards,
    Richard Warry
    Health editor
    BBC News website”

  8. Mastriani says:

    This is exactly the same as the CP article in Skeptic magazine, Vol. 14, No. 2, 2008, pgs. 42-47; with a complete set of verifiable case and meta-analyzes reference, which is page 47 completely.

    Acupuncture is purely placebo, and all the “usable” studies show that its efficacy is directly in-line with mathematical chance, and nothing more.

    Is there conflict of interest? Definitely. Look at any study that comes out of Asia; claims of 90% effective intervention. Until you find out there are no controls in place, and the placebo effect is tied to cultural affectation.

    Acupuncture is right there with remote viewing and criminal profiling; utterly bogus when actual scientific methodology is applied. But that won’t stop it from being a “profession” that rakes in the money.

  9. There is a phenomenon of gating — where the nerve fibers can only transmit so much. By applying ice, or heat, or other stimuli it overloads the neural highway – gating the pain. That might be the best this silly process is about. There is no “energy” as the ancients thought. Acupuncture is another pseudo-science, something that didn’t pass the test of time, but comes up again, and again — never to die as long as those make money off it will be around. Acupuncture is not even scientific as “bleeding” which can be helpful in patients who have iron overload.

  10. Max says:

    If there’s one test acupuncture has passed, it’s the test of time, having been around for several thousand years.

  11. Darin says:

    Terry Simpson, thanks for brining up the phenomenon of ‘gating.’ I’ve been diagnosed with HIV-associated painful peripheral neuropathy (PPN) in my feet and lower legs since the early ’90’s. During this time, I’ve been practicing the art of gating inexpensively, safely, and effectively at home through a combination of ice packs, warm foot spas, a cheap mild O.T.C. topical ointment (active ingredients: essential oils of camphor, mint, eucalyptus, cinnamon, and clove), self-massage, stretching, and gentle exercise (walking, gardening, docenting at the local botanical garden, and staying generally productively active).

    Most of all, I’ve changed my mental and emotional perspective on chronic background and breakthrough pain. I’ve also educated myself quite extensively through quality medical sources about my condition. I’ve been under the care of a neurologist at the nearby medical school for a decade and a half. He and I have an active and enjoyable doctor+patient relationship and as advances in the scientific understanding of my medical condition have changed, we’ve worked together to keep the neuropathy portion of my medical care current and complete. I’ve also participated in some phase III, randomized, double-blind, placebo controlled clinical trials of neuropathy medications, so as a patient participant I’ve seen how knowledge is properly and correctly gained. Other than during the medication study times, I’ve taken anti-PPN symptom medications from various medication classes. I have no formal science background other than a college biology class 25 years ago, yet I do have the ability to read and understand scientific, rational, reasonable, and valid materials and know how to avoid being scammed.

    A few years ago an acquaintance repaid me for a large favor my giving me a 12-session gift certificate ($900.00 value!) at an acupuncturist. Oddly, this acquaintance was a big supporter and user of acupuncture although he also concurrently claimed severe PPN after years of treatment. After calling the acupuncturist and discovering that the certificate was non-refundable, I decided I might as well use up the sessions.

    The ‘holistic health’ center was quite lovely and after checking in, I was served a cup of green tea in a charming pottery cup and relaxed to calming newage music in the waiting hall. The accupuncturist took me into a small room with soothing sage green painted walls, a grass cloth accent screen, natural wood flooring and oriental rugs, aromatherapy candles blazing, indirect lighting, lovely Asian-themed artwork, cut flowers in a earthenware peasant vase, silk curtains nicely contrasting the pastel walls, and in the center of the room a treatment table rose up I can best describe as altar-zen-chic. I’d filled out a basic information sheet about my medical history and the smooth voiced practitioner was most interested in instilling a belief that accupunture worked better than ‘that toxic drug’ that my neurologist was prescribing. I duly used all the gift certificate treatments over a 12 week period and experienced absolutely no effect on my breakthrough peripheral neuropathy symptoms and nothing with the background pain. The accupunturist began each post-poking session with the same question, ‘How much better are you feeling?’ To which I answered, ‘Not any.’ Her: ‘Nothing?’ Me: ‘Some transient relief immediately after the treatment, but nothing after an hour or so.’ Her: ‘The longer you come for treatments, the longer each treatment will work.’ Me (to self): ‘Oh my.’ I was highly encouraged to believe in the treatment, which in my patient’s mind, confirmed the effectiveness of accupuncture as a placebo with expensive gating potential, nothing more. How I would laugh and walk out if my neurologist would advise me that I had to believe, really believe in the pills, capsules, and/or tablets he prescribed to ensure their effectiveness.

    I know that my story is pure anecdote and should be considered only as the basis for a hypothesis, but it is my anecdote to share. Both the acupuncturist and the well-intentioned although scarily evangelical acquaintance blamed me for my failure to experience salvation through the healing powers of becoming a human pincushion. The acupuncturist went as far as to blame the failure on my refusal to cease taking my prescribed PPN anti-seizure class medication during the three months of her sticking me. I asked her how a prescription medication might prevent the effectiveness of her technique since they, um, like, sorta are based on, like, um, you know, like totally different modalities and the answer was a nonsensical mix of pseudoscience, affirmation slogans, and song lyrics (I’m not kidding, she actually quoted both a Joni Mitchell and a k.d. lang song to explain her ‘medical’ technique). If there was anything I learned, it was to trust in my own amateur critical reasoning and thinking skills and be endlessly and mildly amused at the tomfoolery that passes as alternative and complementary quackery.

  12. sonic says:

    There are numerous studies that indicate the effectiveness of acupunture for various situations.
    But the question was if the acupunturists should be doing the research on acupunture.
    This is a good question that could be asked about drugs (the drug companies fund the tests.) Or any other medical procedure. (doctors review the tests…)
    The problem as I see it is that if one must be ignorant to be unbiased, then only the ignorant will be considered to have valuable opinions. The more ignorant the more useful the opinion.
    Clearly this doesn’t work.
    A dose of doubt regarding claims might work, but it involves questioning those who are considered experts.

  13. “There are numerous studies that indicate the effectiveness of acupunture for various situations. But the question was if the acupunturists should be doing the research on acupunture.”

    Sure, if they follow proper protocols so that their results are credible.

    “This is a good question that could be asked about drugs (the drug companies fund the tests.) Or any other medical procedure. (doctors review the tests…). The problem as I see it is that if one must be ignorant to be unbiased, then only the ignorant will be considered to have valuable opinions. The more ignorant the more useful the opinion.
    Clearly this doesn’t work.”

    Your error is in assuming that only ignorance affords objectivity. Properly done research and testing controls for bias.

    “A dose of doubt regarding claims might work, but it involves questioning those who are considered experts.”

    Not so much as it involves careful review of their research and testing protocols and whether their findings have been replicated by others also employing proper protocols for research and testing.

  14. Max says:

    In theory, bias is not a matter of ignorance, but a matter of being invested in promoting or criticizing something. But in practice, nobody becomes an expert in a subject without getting invested in it.
    Bias in medical research has been studied. For example, drug studies funded by drug companies tend to conclude in favor of the drug.

  15. Darin says:

    It seems highly unlikely that a pharmaceutical company is going to fund clinical trials if they do not have compelling reasons to believe that the medication being studied has significant potential for approval and use. I’ve been a research subject in three clinical trials (Passive HyperImmune Therapy(adoptive immunotherapy), Gem91(genetic medicine), and prosaptide(HIV peripheral neuropathy) where the results were not sufficiently positive to continue with development and the approval process. After a fully conducted clinical trial in each instance, no further development and research occurred.

    There are significant numbers of investigative medications, therapies, and interventions that are shelved after investigation reveals them to be ineffective or possessing an unacceptable side-effect profile, it’s called research and development. One has to wonder what a pharmaceutical company would do with a ‘procedure’ such as acupuncture if it were investigated as a medicine or therapy which would require FDA approval. It’s quite likely that it would be shelved as ineffective or at least as effective as a placebo. R&D would relegate acupuncture to the shelf where it belongs.

  16. Mastriani says:

    Last night one of the local news stations ran a “special report” on acupuncture.

    “The experts in the field claim …”;

    Certainly, “experts” …