Evidence based acupuncture

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Evidence based acupuncture

 What is evidence based medicine:

“The application of the best available (i.e., most reliable) evidence gained from the scientific method to guide clinical decision-making. The most rigorous evidence comes from meta-analysis of multiple double-blinded, placebo-controlled clinical trials.”

What is the Evidence for Acupuncture?

As of June 2017 there have been over 8000 trials for acupuncture – more than both physiotherapy and chiropractic combined. In fact, the growth in Acupuncture research is double that for the rest of bio-medicine. Research in acupuncture is not only increasing in quantity but also in terms of the quality of medical journals in which it appears.

McDonald and Janz (both Australian practitioners) have published a comparative literature review of all systematic reviews of every condition for which there is acupuncture research and found the following:

  • Strong evidence of acupuncture effectiveness for 8 separate conditions
  • Moderate evidence of effectiveness for 38 separate conditions
  • Weak positive evidence for 71 conditions
  • Little or no evidence for 5 conditions

A previous report indicated there was strong evidence for only 3 conditions indicating that the strength of the evidence continues to increase over time due to both the quality and quantity of research/trials conducted.

The Strong evidence for acupuncture effectiveness included the following

  • Migraine prevention
  • Headache
  • Low back pain
  • Knee/osteo arthritis
  • Allergic rhinitis
  • Chemotherapy induced nausea and vomiting
  • Post operative nausea and vomiting
  • Post operative pain

It is no longer possible to say that the effectiveness of acupuncture is attributed to the placebo effect or that it is useful only for musculoskeletal pain.

An ongoing search by the European journal of integrative medicine, had found over 870 recommendations [for acupuncture by November 2015] for over 100 conditions from multiple international groups and over 30 countries. As of June 2017 that number is now over 1000

“In an analysis of patient-level data from 29 high quality Randomized Controlled Trials, including 17 922 patients, we found statistically significant differences between both acupuncture versus sham and acupuncture versus no acupuncture control for all pain types studied.” Vickers et al 2012

They found the effects are persistent for over 12 months in treating pain:

  • 30% of patients had a reduction with no acupuncture,
  • 5% of patients had a reduction with sham acupuncture
  • 50% of patients had a reduction with acupuncture

In the USA a 2 year retroactive study of 89000 patients conducted by American Speciality Health Incorporated indicated that 93% of respondents said that acupuncture was effective in treating their primary condition indicating that real world data was for more positive towards acupuncture than the trial data. Furthermore in a Network Meta analysis, comparing different treatments for sciatica, acupuncture comes in second behind biological agents and ahead of other treatments including manipulation, surgery, intra operative interventions and non opioids/opioids.

Safety of alternatives to acupuncture for pain:

Opioids

Opioids for low back pain (Shaheed 2016):

“Irrespective of study design, the predominant causes for drop-out were adverse events or lack of efficacy, with half of trials having 50% of participants drop out owing to these 2 reasons.”

For people with chronic low back pain who tolerate the medicine, opioid analgesics provide modest short-term pain relief but the effect is not likely to be clinically important within guideline recommended doses

According to the CDC: “From 1999 to 2015, more than 183,000 people have died

In the U.S. from overdoses related to prescription opioids.” More than the number who died from taking heroin and cocaine combined in the same period. The annual death rate from opioids in the US is greater than that from motor vehicle accidents

NSAIDs:

“The adverse cardiovascular profile of NSAIDs includes risk of atherothrombotic events like myocardial infarction (MI) and stroke, which can be fatal. The increased cardiovascular risk has

been observed both in people with a prior high risk of cardiovascular disease and in previously healthy individuals and this risk appears to be dose dependent”

Apart from rofecoxib, diclofenac is the agent most associated with an increased risk of cardiovascular events: a 40%–60% higher relative risk of serious cardiovascular events, compared to non-use of NSAIDs, has been reported.” Reddy et al, 2013

According to a report in the British medical journal into the risk of acute myocardial infarction with NSAIDs in real world use based on a cohort of 446763 individuals including 61460 with acute myocardial infarction was acquired found that taking any dose of NSAIDs for one week, one month, or more than a month was associated with an increased risk of myocardial infarction.

It was found that all NSAIDs were associated with an increased risk of acute myocardial infarction. The risk was greatest during the first month and with higher doses. Onset risk occurred in the first week

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5423546/

First line treatment for migraines

  • Topiramate – anti-convulsant
  • Propanalol – beta-blocker
  • Amitriptyline – tricyclic antidepressant

Indicating that migraine treatment with these medications is off label meaning there may be no specific clinical evidence for the efficacy in treating migraines.

 “A large body of research indicates that acupuncture is more effective than usual care for many conditions. It also significantly outperforms sham acupuncture demonstrating specific effects”