'As Good As Medication': Australian Study Shows Acupuncture Relieves Pain

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The world's largest randomised controlled trial of the use of acupuncture in emergency departments has found the treatment is a safe and effective alternative to pain-relieving drugs for some patients.

Led by RMIT University, the study found acupuncture was as effective as pain medicine in providing long-term relief for patients who came to emergency in considerable pain.

But the trial, conducted in the emergency departments of four Melbourne hospitals, showed pain management remains a critical issue, with neither treatment providing adequate immediate relief.

Lead investigator Professor Marc Cohen, from RMIT's School of Health and Biomedical Sciences, said pain was the most common reason people came to emergency, but was often inadequately managed.

"While acupuncture is widely used by practitioners in community settings for treating pain, it is rarely used in hospital emergency departments," Cohen said. "Emergency nurses and doctors need a variety of pain-relieving options when treating patients, given the concerns around opioids such as morphine, which carry the risk of addiction when used long-term."

Cohen said the study has shown acupuncture is a viable alternative, and would be especially beneficial for patients who are unable to take standard pain-relieving drugs because of other medical conditions. But it's clear we need more research overall to develop better medical approaches to pain management, as the study also showed patients initially remained in some pain, no matter what treatment they received.

The study, published in the Medical Journal of Australia and funded by a grant from the National Health and Medical Research Council, involved 528 patients with acute low back pain, migraine or ankle sprains who presented at the emergency departments of the Alfred Hospital, Cabrini Malvern, Epworth Hospital and Northern Hospital between January 2010 and December 2011.

Patients who identified their level of pain as at least 4 on a 10-point scale randomly received one of three types of treatment: acupuncture alone, acupuncture plus medication or medication alone.

One hour after treatment, less than 40 per cent of patients across all three groups felt any significant pain reduction (2 or more pain points), while more than 80 per cent continued to have a pain rating of at least 4. But 48 hours later, the vast majority found their treatment acceptable, with 82.8 per cent of acupuncture-only patients saying they would probably or definitely repeat their treatment, compared with 80.8 per cent in the combined group, and 78.2 per cent in the medication-only group.

"Some Australian emergency departments already offer acupuncture when trained staff are available but further studies are needed on ways to improve pain management overall in emergency departments, and the potential role for acupuncture in this," Cohen said.

"We need to determine the conditions that are most responsive to acupuncture, the feasibility of including the treatment in emergency settings, and the training needed for doctors or allied health personnel."

[MJA]

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Comments

    with 82.8 per cent of acupuncture-only patients saying they would probably or definitely repeat their treatment, compared with 80.8 per cent in the combined group, and 78.2 per cent in the medication-only group.

    So, your headline could also read

    *Pain medication reduces acupuntures effects!*

    If they can show a reason for acupunture reducing pain other than channeling chi (or prove chi either or really), I'd be interested.

      According to the guy who did acupuncture to me the healing is promoted by creating an inflammatory response using sterile needles. The body senses the foreign intruder (the needle) and you get increased white blood cells in that spot. But because it's sterile they don't have an infection to fight so they work on whatever your other problem is.

      Whether that's true or hokum I have no idea. But that's what I was told. And like I said, it didn't help me - so I lean more towards the hokum side :P

    I've only had acupuncture once but I don't really think it's worthwhile. It didn't relieve the pain for me, and in fact one the needles hurt like hell when they put it in. Must have hit a nerve or something.

    Out of all the non-drug related treatments I think massage and relaxation therapy holds most promise for chronic pain sufferers. Massage and physiotherapy helps (me at least) much more than acupuncture or minor painkillers (like panadol).

    Where is the control with "fake" acupuncture? This has been proven in studies to have the same affect as "real" acupuncture.

    ive had acupuncture on a badly sprained ankle.
    the physio doing it explained its a way of reconnecting signals from the brain to the injured area (in my case of treatment anyways). when there is heavy muscle and ligament trauma, the swelling can block the signals the nerves a trying to send effectively.
    he also said there was a case where they did brain surgery on someone using soley acupuncture for pain management and the guy was awake and talking and they would get him to play guitar when they fiddled with certain parts of his brain to make sure they werent effecting his motor functions. kinda interesting stuff.

      Brain surgery is done without anaesthesia anyway when doctors need patient feedback. Check out 'awake brain surgery' with a search or two. No acupuncture required.

        urgh, could you imagine the sound of them cutting your skull open and you sitting there feeling AND hearing it. think i'd throw up. blech.

          They'd numb the area so you probably wouldn't feel the cutting. And I don't think the brain has a lot of nerves for feeling them poking around in there.

            yeah i figured they'd numb it, but the sound. oh man the sound would be the sickening part i reckon.

    'Worlds largest'?
    528 patients, self reporting pain levels across 3 Melborne hospitals is hardly a large or conclusive study of anything and nothing about what they did or found warrants head lines that include the word proves.

    Only thing this study proves is how flimsy acupuncture studies are even after decades of research.

    Acupuncture belongs in the same basket as homeopathy. Stop wasting resources studying it. And stop wasting headlines promoting it.

      That said - 'self reporting' is pretty much all we have for pain. Physiological markers (sympathetic response) aren't necessarily reflective of what the patient feels. Pain is totally subjective and there's no real way to get an idea of pain except self-reporting.

      Decisions around emergency analgesia are a pain in the arse and debated constantly. "Did she really need that fentanyl?" "Well, she said 8/10 pain..." "Oh fuck off, her obs are normal..." The fact that it used self-reported pain levels isn't exactly unusual. Until someone comes up with a foolproof objective measure of pain, we haven't got too much else to work with!

        You're right, pain is poorly understood. A doctor mate is all excited because he read about people incapable of feeling pain, so they are hoping to discover what the cause of that is to develop better anesthesia and pain relief. He went on to mention that these people also have little to no fear as they don't have the learned "I won't do x because it might hurt" response, which presents interesting survival problems.

        Granted, pain is ultimately a subjective opinion when it comes to level or intensity. Probably impossible to objectively measure. All the more reason why this study is garbage.

        As someone who suffers chronic migraines and cluster headaches I'd love to see an external, impartial pain evaluation. The neurologist kinda looked at me funny when he asked what the worst was on a 10 scale and I said 11 or 12. Can't stand, vomiting from pain, shaking (and the shaking hurts), light and sound hurt, would happily have asked someone to shoot me to stop the pain level bad. That neurologist wrote it off as stress, I never went back to him.

        I clearly remember something my old GP told me, nearly 30 years ago. That pain, like anything is a learned thing. And the more we experience it, and allow ourselves to experience it the stronger the neural pathways get. And the easier it is to trigger pain. I'd like to know whether that's something that's being studied or whether it's just a pet theory he had.

      I think you are mixing up cray cray movie style acupuncture and one that is a proven pain reliever called "dry needling".

      The evidence base for acupuncture or dry needling in various areas of physiotherapy has increased substantially over the past decade. In particular, research has grown to provide evidence-based support for the treatment of acute and chronic back pain, chronic neck pain, tension-type and migraine headaches, pelvic girdle pain, knee osteoarthritis, lateral elbow pain and shoulder conditions.

      A good read here as well.
      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117383/

    One hour after treatment, less than 40 per cent of patients across all three groups felt any significant pain reduction (2 or more pain points), while more than 80 per cent continued to have a pain rating of at least 4. But 48 hours later, the vast majority found their treatment acceptable,

    No placebos for the drugs or the acupuncture. It is quite feasible that 48hours later many people's pain would have reduced to acceptable levels with no treatment at all.
    Interesting study, but too flawed to say acupuncture works better than just resting for pain reduction.

    Okay lets get right into this sad excuse for a scientific study.

    This study has serious flaws that you have absolutely failed to address as you regurgitate the press release that they threw at you, and maybe there shouldn't be reporting of these kinds of pilot studies unless it is done by a scientifically literate journalist.

    First of all, this study did not include a sham acupuncture arm or a, and this is vital to there is existing good evidence that it doesn’t matter where you put the needles, or whether you use needles at all.

    “a significant association was found between the genuine and sham acupuncture treatments, implying that the non-specific effects of acupuncture may contribute to the analgesic effect observed in genuine acupuncture analgesia.”

    Kong, J et al. (2013). Are all placebo effects equal? Placebo pills, sham acupuncture, cue conditioning and their association. PLoS One, 8(7), e67485.
    http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0067485

    Importantly, this article neglects to emphasize the most important finding of the actual study, which was that all the modalities that were compared for treatment of ankle strain, back pain and migraine led to UNDER-TREATMENT of the pain. None of the modalities they compared led to significant improvement in pain:

    “Across the three arms, fewer than 40% of participants experienced a reduction in pain of two points or more at 1 hour after the intervention, and more than 80% of patients still had a pain rating above four.

    Overall, only 16% of patients received "clinically relevant pain relief” at 1 hour – defined as a score less than 4.“

    In other words, all arms of the study, including acupuncture (= placebo) led to ineffective pain relief, until "rescue” pain relievers (effective doses of narcotics like morphine) were given if needed.

    If people need effective pain-relief for severe pain, it should be given as soon as practicable, in appropriate doses.

    If people have mild to moderate musculo-skeletal pain, which is tolerable, perhaps local measures like heat and mobilization are preferable to ineffective medications or needle-placebo.

    And for migraine - evidence-based specific medications should be used.

    Not all Emergency Departments use placebos for pain relief. Those who truly need a strong pain-killer for severe pain need it earlier than one hours, where this is feasible. Maybe the cost of providing a needle-magician could be diverted into providing more nursing and medical staff.

    This article should highlight the wastage of pharmaceutical resources in patients who are being unnecessarily medicated, not to promote the ridiculous ideals of alternative medicine.

      You know, you really shouldn't get all high and mighty about empirical reporting when you say things like:

      'acupuncture (= placebo)'

      Your painful level of bias clearly has interfered with your understanding of how empirical reasoning works.

      There is no solid empirical evidence that acupuncture works, as yet.

      Neither is there solid empirical evidence that it doesn't.

      There is a vast amount of anecdotal evidence indicating that it does work for many people, but no empirical information on what mechanism of action causes it to be effective in given individuals.

      Your one-eyed bias does as much damage to the 'scientific cause' as the basest peddler of homeopathic remedies.

      Rein in your personal issues and apply the scientific method if you want to actually make a positive difference.

    Perhaps the people who made this study have not heard of the placebo effect?

    I appreciate Gizmodo posting medical studies, but come on guys, this isn't high quality research. There is no meaningful conclusion to be drawn from this randomised trial, which apparently lacks a control and has fairly nebulous comparison factors. It's almost a junk article designed to excite people who love "alternative therapies" or at best the suggestion that analgesia in the acute setting should be examined. None of the conclusions that seem to be hinted at in the article can be drawn.

    I get that clinical trials and medicine aren't Giz AU's area of expertise, but if you guys report on it (and please do!), maybe get someone who is well read in the area to review articles first. Comments from the "Lead Investigator" aren't exactly great analysis.

    This study, as someone noted above, is bunk. A careful study shows it proves acupuncture does not work when real pain relief does not work but that people forget that quickly - the kind of double negative crap "complementary" medicine (that is medicine that does not work) loves.

    Rae, any chance you can link to the actual journal article or study? I'd like to send this on to the Skeptics with a K and Skeptics Guide to the Universe podcasts.

    Even without the concerns about the quality of the study raised by others, this is one study. Hundreds more have demonstrated that acupuncture has no effect beyond placebo. The toothpick study, where patients received "acupuncture" but administered using toothpicks rather than needles is probably the most famous. This was reported as "fake acupuncture works" rather than "acupuncture shown to be as effective as pretend acupuncture".

    Placebo has come to be a hand waving dismissal. One of Skeptics with a K most recent episodes, 198 or 199 from memory (here: http://www.merseysideskeptics.org.uk/podcasts/ the show notes weren't terribly specific and it is something discussed a lot, listen to both, it's a solid podcast anyway) has a brilliant breakdown of why it is misunderstood and where the misunderstanding came from. Mind over matter it's not.

    Hilarious.
    It's a crying shame this hoodoo voodoo rubbish still persists. It will never dies it seems.
    When these studies are truly controlled and "p hacking" is avoided the results are always that acupuncture is utterly ineffective. No better than placebo- as you would logically imagine due to it having no real method of action.
    There are some good explanations of the mental gymnastics advocates use to try and support it here:
    https://sciencebasedmedicine.org/reference/acupuncture/

    Rae, I'm going to be gentle.

    This isn't how science works.
    Getting published is a single step along the way to hypothesis acceptance.
    But, it *is* interesting, and you can report it very professionally, if you relax the certainty in the language a little.

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