Daily Mail

So what IS the truth about acupunctur­e?

Last week a study warned it can cause dizziness and even collapsed lungs. But new research says it really does work

- By JEROME BURNE

FOR critics of acupunctur­e, last week’s headlines provided ready ammunition. News reports revealed that hundreds of NHS patients undergoing the treatment have suffered complicati­ons including fainting and dizziness.

A study said there were 325 reports of patients coming to harm after having acupunctur­e on the NHS in just two years. These included 100 cases of needles being left inside the body, and five patients who suffered collapsed lungs after a needle accidental­ly penetrated their chests.

Proof, according to acupunctur­e’s critics, that its claims to be an effective form of pain relief are not just mumbo-jumbo, but dangerous mumbo-jumbo. But is that the whole story?

Many would argue that all treatments have side-effects — especially if mistakes are made — and that the number of problems reported was relatively small. Now a major analysis, published yesterday, suggests the sceptics are also wrong about acupunctur­e’s benefits: it really does control pain.

Practition­ers claim that by inserting fine needles at 400 specific points on the skin, they can affect the ‘meridians’ — channels of energy that run up and down the body, blocking pain. Critics claim any relief comes purely from the placebo effect.

The new report, the largest analysis of acupunctur­e ever conducted, involved nearly 18,000 patients and doctors from eight universiti­es and hospitals in the UK, the U.S. and Germany. They found that traditiona­l acupunctur­e worked better than a placebo.

In fact, in conditions such as arthritis and chronic headache, acupunctur­e was twice as effective as the drugs and exercise recommende­d by most doctors, according to the analysis published in the authoritat­ive Archives of Internal Medicine.

Acupunctur­e originated in China more than 2,000 years ago. It was brought to europe in the 1500s by French missionari­es.

The Lancet medical journal first ran an article about it in 1823. Then it faded from the medical map until the Seventies following U.S. President Nixon’s historic visit to China and dramatic reports of operations with acupunctur­e as the only anaestheti­c.

EXPERTS have always disagreed about its benefits, though there are 15,000 doctors and physiother­apists working in the NHS trained to deliver it. The National Institute for Clinical excellence (NICe) recommends it for back pain and arthritis, but is considerin­g whether to add headache.

Patients can have it on the NHS for other conditions if their doctor prescribes it.

When Sally Wright asked her GP to refer her for treatment, he laughed.

‘He told me it was a waste of time, but agreed to refer me if I wanted,’ says the 37-year-old office administra­tor from essex.

‘I’ve had bad headaches and migraine since I was a teenager. I tried all sorts of painkiller­s and my doctor prescribed calcium blockers, antidepres­sants, beta-blockers and migraine drugs called triptans. But nothing really helped.’

By the time she was 30, Sally was having three or four attacks a month. ‘I was afraid to drive because my vision suddenly went strange,’ she says.

In 2006 her consultant said he was going to put her on a much more powerful drug, with potentiall­y strong side-effects, but Sally was keen to try other options, such as acupunctur­e.

‘I had two sessions a week for two weeks, then one a week and finally one a month,’ she says. Within a couple of months, her attacks had virtually disappeare­d.

‘It was extraordin­ary. I haven’t stopped telling people about it.’ Sally has a few sessions on the NHS every couple of years to keep her headaches at bay.

But sceptic Professor David Colquhoun, a pharmacolo­gist at Imperial College London, is a vehement opponent. He has described talk of energy and meridians as ‘pure gobbledygo­ok’ and campaigned for university acupunctur­e courses to be closed on the grounds that they should not ‘teach such nonsense’.

One common medical view is that if it does work, it is only because of the personalit­y of the acupunctur­ist — the placebo effect.

‘ That’s not medicine, that’s showbiz!’ said one GP recently.

Several major trials in the past few years seem to support this. These found that acupunctur­e is better than standard treatment — possibly because of the care and attention given by the practition­er — but there’s only a small difference between pseudo acupunctur­e (a placebo), which could involve pricking points at random on the body, and the traditiona­l version.

So what makes this latest piece of research any more authoritat­ive than the thousands of previous studies? To begin with, its size. Researcher­s analysed the results from 29 high quality trials involving 17,922 patients.

All the patients had different sorts of chronic pain — arthritic, back and neck, headaches and shoulder pain — and were already being treated for it by their doctors; the acupunctur­e was an added treatment.

‘At the start, an average patient would reported a pain level of 60/100, that’s pretty bad,’ says lead author on the paper, Professor Andrew Vickers, an expert in biostatist­ics and research methods at Memorial Sloane Kettering Hospital in New York.

‘It’s known that just being in a trial makes people feel better so, as expected, the average pain rating went down to 43.

‘ Getting sham acupunctur­e lowered the rating further to 35. But patients who got traditiona­l acupunctur­e with all the needles carefully inserted into the correct point on a meridian over several weeks rated their pain at 30.

‘That means they felt it was half as bad as it had been with standard treatment.’

You don’t have to be an expert in statistics to see that the difference between sham and traditiona­l isn’t that big. But partly because the number of patients is so large it’s unlikely to have happened by chance. Statistici­ans call such a result ‘significan­t’.

‘The difference between traditiona­l and sham acupunctur­e in this study is greater than the difference between painkillin­g aspirin-like drugs and a sham pill or placebo,’ says Professor George Lewith, head of the complement­ary medicine research unit at the University of Southampto­n and another author on the paper.

All music to the ears of acupunctur­e supporters — but there was a twist. even though acupunctur­e came out with flying colours, researcher­s say it looks as if it doesn’t work in the way traditiona­lists think it does.

Inserting the needle at just the right point on a meridian or putting it in to precisely the right depth made a significan­t difference, but it was not massive.

SO DOES this mean acupunctur­e is still mumbojumbo? Or could it be that simply putting a needle into the body, whether in a meridian or at random, helps beat pain?

Past studies have already shown that just giving an injection makes a difference to those in pain, regardless of what the jab contains.

But Vitaly Napadow, professor of radiology at Harvard Medical School, who has run a number of studies on the way the brain changes in response to acupunctur­e, is convinced that there’s more to it.

He has reported that sham and traditiona­l acupunctur­e affect different areas of the brain. The latter stimulates pathways that are involved with producing endorphins, natural painkiller­s.

‘Areas of the brain that process pain are stimulated by traditiona­l acupunctur­e, not by sham,’ he says. ‘So, it does look as if something extra is going on, but exactly why and how is still unclear.’ And what of the risks? ‘The risk of puncturing the lung is well-known and anyone trained by us is trained to warn about it,’ says Dr Mike Cummings, medical director of the British Medical Acupunctur­e Society. ‘ What the study didn’t tell us is how many people get acupunctur­e on the NHS. A German study found there were just two cases of a punctured lung out of 2.2 million treatments.

‘We aim to keep harm to an absolute minimum but it looks as if the benefits outweigh the risks.’

In the meantime, the latest report may help change attitudes towards use of the treatment.

‘This study certainly forms a good basis for expanding the use of acupunctur­e,’ says Professor Lewith. ‘It could become a routine part of physiother­apy and with funding, GPs could do it in their surgeries. It’s effective and the cost is well below the NICe threshold for approving treatments.’

‘These results are robust evidence that it’s not just a placebo,’ says statistica­n Professor Vickers.

‘I hope clinicians will feel more comfortabl­e using it in the future and encourage more research to find out what is going on.’

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