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Gimme Some of that Placebo Acupuncture Because My Back Is Killing Me
A new study suggests that
acupuncture--even fake acupuncture--does a better job of curing
back problems than "conventional therapy":
Dr. Michael Haake of the University of Regensburg in Germany looked at 1,162 patients who had experienced chronic low back pain for an average of eight years. They ruled out people with back pain caused by spinal fractures, tumours, scoliosis or pregnancy.
On[e] third of the patients underwent twice a week 30-minute sessions of real acupuncture; another third received fake acupuncture; and the final third received conventional therapy.
The real acupuncture was based on Chinese medicine that targets traditional acupuncture points or meridians. In the fake acupuncture, the needles were not placed as deeply as the real thing and avoided meridian points. Those getting conventional therapy were prescribed a combination of medication, physical therapy and exercise.
After six months, patients were asked about their pain and functional ability. In the real acupuncture group, 47.6 per cent of patients said their condition improved. In the sham acupuncture group, 44.2 per cent did. In the conventional care group, 27.4 per cent described experiencing relief.
Some caveats: It's not clear what "conventional care" consisted of and there doesn't seem to have been a control group that received no treatment either.
reason looked at Harvard's attempts to legitimate complementary and alternative medicine here. and we looked at the bloody crossroads where chiropractors and the Federal Trade Commission collided here.
Edward|9.25.07 @ 3:02PM|#
Stone Age medicine is Stone Age medicine. People are taken in by that naturally wise look the Chinese have.
VM|9.25.07 @ 3:03PM|#
Some caveats: It's not clear what "conventional care" consisted
of and there doesn't seem to have been a control group that
received no treatment either.
nuff said.
|9.25.07 @ 3:07PM|#
The real acupuncture was based on Chinese medicine that
targets traditional acupuncture points or meridians.
And of course that makes it real.
It would have made a much more interesting study if some of the
subjects got "real" accupuncture and the others got Calgon.
Episiarch|9.25.07 @ 3:11PM|#
If somebody's gonna stick needles in me to relieve pain, all I can say is there better be morphine in them.
shecky|9.25.07 @ 3:16PM|#
Back pain (and pain management in general) can be notoriously nebulous malady to treat. Placebos and interestingly enough, outright quacks, often have good records for treatment. Unfortunately, this doesn't make it any better science.
|9.25.07 @ 3:16PM|#
As one who has found relief from debilitating back pain, I have
just two words:
Sleep Number
|9.25.07 @ 3:16PM|#
And yet, almost half the participants reported that it
worked.
This suggests to me that much of the back pain people have has a
psychological, rather than biological, cause.
Episiarch|9.25.07 @ 3:22PM|#
This suggests to me that much of the back pain people have
has a psychological, rather than biological, cause.
Possibly stress related. I know that when I get tense, my neck can
bother me a lot, and my lower back. Chilling out tends to make it
better. Morphine is even better.
|9.25.07 @ 3:22PM|#
As one wise doctor said, "All treatments ride to glory on the
innate healing power of the body."
What often happens is that the body gets better on its own, while
the treatments are taking place., so they get credit for helping,
and the healing professional gets paid.
Without a healthy dose of "after that, therefore because of that"
logic, the healing arts might well take in a lot less
revenue.
There is actually a method of injecting small amounts of pain
killer into the meridian points that is said to be effective.
|9.25.07 @ 3:22PM|#
The best money I ever spent (and it was a lot!) was for a
Tempurpedic 10" mattress and the funky pillows.
With that kind of endorsement, I think I deserve some sort of quid
pro quo from them. A Swedish bikini model would do nicely.
|9.25.07 @ 3:25PM|#
It's not surprising that poking people with needles provides
relief from pain... It feels so good when you stop.
I'll be here all week.
|9.25.07 @ 3:41PM|#
In the real acupuncture group, 47.6 per cent of patients
said their condition improved. In the sham acupuncture group, 44.2
per cent did. In the conventional care group, 27.4 per cent
described experiencing relief.
In related news, chiropracters are still in business!
|9.25.07 @ 3:43PM|#
Chilling out tends to make it better. Morphine is even
better.
Episiarch, for almost anything, morphine is better.
Episiarch|9.25.07 @ 3:46PM|#
Episiarch, for almost anything, morphine is
better.
Morphine. With a Demerol chaser.
|9.25.07 @ 3:51PM|#
Isn't that George Harrison? Does acupuncture also give one Beatles-like wealth? Hmmmm.
I am the Walrus|9.25.07 @ 3:57PM|#
Pro-Libertate, yes, but all that wealth is hidden in an Octopus's Garden.
Timothy|9.25.07 @ 3:58PM|#
Acupuncture makes you die before that asshat Paul McCartney, so what good can it be?
|9.25.07 @ 3:58PM|#
Caption Contest!
"Hey, gimme a glass of water. I know a trick!"
"OOOOOOOWWWWWWWW!"
|9.25.07 @ 4:18PM|#
My ad hoc, intuitive, unscientific explanation is that while the
"conventional" patients had to do some work (exercise, therapy)
whereas placebo patients were getting Magic, compliance with
therapy was less than 100% and that caused a real and imagined
decrease in results (people who cheated knew who they were).
Magic has no compliance problems.
Shannon Love|9.25.07 @ 4:20PM|#
The key finding to this study is not that acupuncture works
better than conventional treatments but that real-acupuncture only
produces better results than fake-acupuncture in 3.4% of the cases.
That means that only 7% of those reporting improvement following
any acupuncture could be attributed to real-acupuncture, the
remaining 93% of those reporting improvement is attributed to the
placebo effect.
So if we took these findings literally, we could expect that off
every 100 patients treated by acupuncture 7 would experience
improvement due to something altered in their bodies, 44 would
experience improvement due to placebo effect and 49 would
experience no improvement at all. Its easy to see why acupuncturist
stay in business: 51 out of every 100 customers walks away feeling
better.
Conventional therapies by contrast can't count their success due to
placebo effect. Most conventional therapies won't be accepted
unless they show an effect at least 2 times as strong as the
placebo (so a placebo would help say 10 people out of 100 and the
therapy would help 20+).
So, according to this report, this study actually shows that
conventional therapy is at least twice as effective as
real-acupuncture.
Science reporting sucks.
Paul|9.25.07 @ 4:28PM|#
What pisses me off (and this is the second time the media has
done this on two...TWO separate acupuncture studies) is that the
headline brays: "Study: Acupuncture works!!!"
Then in the first goddamned paragraph, they demurely report that
lying on a table, listening to Windham Hill cd's and having needles
stuck in your body-- anywhere in your body, screw traditional
meridian points-- does wonders for hard-to-pin-down maladies such
as neck or back pain, or smoking cessation.
Sorry for the cheap-assed plug, but it's been covered before.
|9.25.07 @ 4:54PM|#
Caption Contest
And whatever you do, never sneak up behind a porcupine and go
BUBBUBBUBBUB!
|9.25.07 @ 4:57PM|#
So, since acupuncture is basically just a fancy placebo, would
the healing effect drop off for people who realized it was a
placebo? That it was in effect faith that made them feel
better?
Would it be too much of a threadjack to correlate this to biblical
accounts of healing based on faith?
Urkobold™|9.25.07 @ 5:07PM|#
PROLEFEED,
THREADJACK? NOT AT ALL. MORTAL SIN? YES! BURN IN ETERNAL PAIN IN
THE HELL OF FACIAL NEEDLES!
|9.25.07 @ 5:15PM|#
There is a lot of interesting research on the Placebo effect
that might weaken Shannon Love's interpretation of the results
here...an example...
BMJ 2005;330:1202-1205 (21 May),
doi:10.1136/bmj.330.7501.1202
Education and debate
Characteristic and incidental (placebo) effects in complex
interventions such as acupuncture
Charlotte Paterson,
Paul Dieppe
The specific effects of non-pharmaceutical treatments are not
always divisible from placebo effects and may be missed in
randomised trials
The first 150 words of the full text of this article appear
below.
Introduction
The randomised double blind controlled trial has proved an
invaluable tool for testing the efficacy of new drugs. However, it
is now used to evaluate complex non-pharmaceutical interventions,
many of which are based on different therapeutic theories. For
example, randomised controlled trials are used to test
physiotherapy, a complex intervention with a basis in biomedical
theory, and acupuncture, which is often based on Chinese medicine.
In order to use a placebo or sham controlled design, an
intervention has to be divided into characteristic (specific) and
incidental (placebo, non-specific) elements. However, recent
research suggests that it is not meaningful to split complex
interventions into characteristic and incidental elements. Elements
that are categorised as incidental in drug trials may be integral
to non-pharmaceutical interventions. If this is true, the use of
placebo or sham controlled trial designs in evaluating complex
non-pharmaceutical interventions may generate false negative
results.
Another interesting article
Placebo-Induced Changes in fMRI in the Anticipation and Experience
of Pain
Tor D. Wager,1*{dagger} James K. Rilling,2 Edward E. Smith,1 Alex
Sokolik,3 Kenneth L. Casey,3 Richard J. Davidson,4 Stephen M.
Kosslyn,5 Robert M. Rose,6 Jonathan D. Cohen2,7
The experience of pain arises from both physiological and
psychological factors, including one's beliefs and expectations.
Thus, placebo treatments that have no intrinsic pharmacological
effects may produce analgesia by altering expectations. However,
controversy exists regarding whether placebos alter sensory pain
transmission, pain affect, or simply produce compliance with the
suggestions of investigators. In two functional magnetic resonance
imaging (fMRI) experiments, we found that placebo analgesia was
related to decreased brain activity in pain-sensitive brain
regions, including the thalamus, insula, and anterior cingulate
cortex, and was associated with increased activity during
anticipation of pain in the prefrontal cortex, providing evidence
that placebos alter the experience of pain.
|9.25.07 @ 5:29PM|#
I don't think "fake acupuncture" is a placebo. I'm fairly sure sticking needles in your flesh will stimulate the release of endorphins. My guess is it is more effective than sugar pills.
|9.25.07 @ 5:32PM|#
There is a reason the randomized double blind controlled study is the gold standard. It tells you what you need to know. Absent that set of criteria or, in a nod to Kerry's piece from last month, something sufficiently statistically rigorous, you have nothing. Witchcraft.
|9.25.07 @ 5:33PM|#
That's a good question, prolefeed.
The know that, in a blind study, there was a 3% greater effect for
real acupuncture.
They could do another test where they tell people that they're
getting fake acupuncture, and measure exactly how much the reports
of success drop.
Or, they could tell half the control group they were getting fake
acupuncture, and tell the other half that the previous study showed
that accupuncture worked even withjout poking the the pressure
points, and see how much the two groups differ.
|9.25.07 @ 5:34PM|#
I had to go to an acupuncturist last year. It did wonders for my out-of-balance humours. The follow-up treatment with leaches help stabilize the situation.
|9.25.07 @ 5:43PM|#
If Chinese acupuncture works so well, how about Scottish ach-u-puncture? It uses swords instead of needles.
Paul|9.25.07 @ 5:52PM|#
Elements that are categorised as incidental in drug trials
may be integral to non-pharmaceutical interventions.
Preeeeeeeecisely, Neu Mejican.
Lying on a table, relaxing, listening to Windham Hill cd's, for
instance IS probably effective in reducing one's back pain. The
fact that needles are being stuck in your body is merely incidental
to the treatment.
Unfortunately, it is the acupuncturis who is hoisted by his own
petard on this study. Acupuncturists go to school for
years to stick needs in the correct points.
A true believer of acupuncture believes that you could "make the
cats really big, or something" if you hit the wrong points. See
where I'm going with this?
Paul|9.25.07 @ 6:02PM|#
If Chinese acupuncture works so well, how about Scottish
ach-u-puncture? It uses swords instead of needles.
According to a loose reading of the study, yes.
Here's the subtext of an older NPR story on a different acupuncture
study that had similar findings:
A medical study conducted in Germany shows that acupuncture might help with joint pain -- but it's not necessarily the needles that do the work. [emphasis mine]
It's an audio story found here.
|9.25.07 @ 6:19PM|#
Ah, och-u-puncture. That's analogous to Scottish ach-u-puncture. Except the Germans use hundreds of pickelhaubes, rather than swords or needles.
SIV|9.25.07 @ 6:38PM|#
In related news, chiropracters are still in business!
Well you can't get a health insurance policy in most(all?) States
that doesn't pay them.
Placebos and interestingly enough, outright quacks, often have
good records for treatment. Unfortunately, this doesn't make it any
better science.
Medicine is not science. Patients should be free to chose whatever
treatment they want regardless of whether it passes the "peer
reviewed, controlled double-blind study test".
I should also be free to not pay into an insurance pool(or
socialized medecine scheme) that covers crap I don't want.
The Wine Commonsewer|9.25.07 @ 6:40PM|#
Holy Crap, we just had a big fargin' earthquake and I lost my entire comment. I bet that was a 5 and it was near here. My dogs ran like crazy. Fortuantely, my house foundation is attached to granite with rebar held in place with expoxy.
The Wine Commonsewer|9.25.07 @ 6:44PM|#
A study conducted at my house concluded that judicious consumption of red wine can help manage joint pain better than aspirin or motrin.
The Wine Commonsewer|9.25.07 @ 6:57PM|#
A former love of my life ultimately became a practicing
acupuncturist (I wasn't surprised). She was a sweet young thing and
one of few nice looking libertarian babes (they were rare back
then). Also a Christian who believed in reincarnation (not snakes
come back as cats but you keep recycling til you are good enough to
stay upstairs), so you see why I wasn't surprised at the
acupuncture connection.
She once dragged me off to this rickety old woman who read my hand
and predicted I'd marry Mrs TWC. I don't even buy that stuff but
she was surprisingly prescient with compelling details including
the two blond kids.
Naturally, I figured she meant Miss Debbie the future acupuncturist
so when we split I chalked it up to psychic fraud.
Then 15 years later I met Mrs TWC and said, whoa......But we
weren't planning any kids except ten years later we had the blond
kids, in the order predicted with the same age spread. There was
more.
Cue Rod
Surly courtesy of NoStar
Janis Siegel has got to be a libertarian. Dude, she's wearing a
tinfoil hat.
The Wine Commonsewer|9.25.07 @ 7:01PM|#
The earthquake was only a 3.9 but it was only about ten miles from here. About a block from my sister Mo's house.
Paul|9.25.07 @ 7:19PM|#
My dogs ran like crazy.
I have some sharp, pointy things that can get their chi back in
order.
The Wine Commonsewer|9.25.07 @ 7:23PM|#
And speaking of my sister Mo, Our Mo jumps out of aircraft down there by my sister Mo's house.
Mrs TWC|9.25.07 @ 7:27PM|#
FIFTEEN YEARS LATER? You're not that old sweetheart. But, Debbie is OLDER than I am by considerable. :-)
|9.25.07 @ 8:03PM|#
Sometimes George sang songs with out needles stuck in his face.
Here he is singing "I'm Happy Just To Dance With You" with his good
friends, the other Beatles!
http://www.youtube.com/watch?v=6l1mtTxLHBs
|9.25.07 @ 8:05PM|#
Actually what this study shows is that sticking needles in your flesh can ease back pain. In both the real and fake acupuncture they were sticking needles into the patients, it's just the details that varied.
penxv|9.25.07 @ 8:37PM|#
I don't know what constitutes "conventional therapy" but I have
had my lower back realigned by a therapist using the McKenzie
Method and not only did it help with pain, but I am much more
flexible as a result.
http://www.mckenziemdt.org/
It is basically a series of intense stretches that a good therapist
can use to diagnose and then get your back into proper
alignment.
|9.25.07 @ 10:00PM|#
One aspect this study does not take into account is the *degree*
of relief that was found.
Purely anecdotal but what the heck. Acupuncture has worked for me
for some maladies and for others, not at all, and for some
conditions just a little. If only the placebo effect was at work
shouldn't I have experienced the same results each time?
Additionally, I think I read another study that found that
acupuncture was only effective for a select group of
conditions.
Paul|9.25.07 @ 10:44PM|#
Actually what this study shows is that sticking needles in
your flesh can ease back pain. In both the real and fake
acupuncture they were sticking needles into the patients, it's just
the details that varied.
True... depending on how you define "details". In a study on heart
disease, drug x reduced the liklihood of heart attack by 18%, those
with sugar pills saw a 15% reduction in probability.
If we ever saw a study like this, we'd immediately start asking
"what else was going on in the control group"?
And besides, sticking needles in the wrong place is
something that people who spent a lot of money and years of their
life studying at Bastyr
University would tell you is a little bit more than just
"details".
the needle:
If only the placebo effect was at work shouldn't I have
experienced the same results each time?
No. Different maladies will respond to psychological factors
differently. Neck pain, for instance will respond differently than
smoking cessation, two things that acupunture has shown to help
with in studies.
For instance, some people might respond to a sugar pill for a birth
control study. Does that mean the sugar pill should be used for
birth control?
half serious question: What do they give diabetics in the placebo
group?
votejoe|9.25.07 @ 10:55PM|#
Boy, for a bunch of libertarians, you sure are against people having their pain aleviated by a mathod you don't like.
Thomas Paine\'s Goiter|9.25.07 @ 11:01PM|#
You guys are annoying. The acupuncture works for someone -- if it feels good, do it.
edna|9.25.07 @ 11:07PM|#
in a blind study, there was a 3% greater effect for real
acupuncture.
error bars not calculated. probably an insignificant
difference.
Mrs TWC|9.25.07 @ 11:29PM|#
half serious question: What do they give diabetics in the
placebo group?
That's a thread winner. Or at least worth a chortle.
Answer: Splenda Pills
Real Answer: I dunno
Mrs TWC|9.25.07 @ 11:31PM|#
The acupuncture works for someone -- if it feels good, do
it.
Well, acupuncture certainly has less calories than red wine.
Haven't tried the needle but red wine is pretty effective at
alleviating aches and pains. Often cures the snarks as well.
The Wine Commonsewer|9.25.07 @ 11:51PM|#
The least she could have done was change my name back when she was done. [pouts]
Paul|9.26.07 @ 1:44AM|#
Boy, for a bunch of libertarians, you sure are against
people having their pain aleviated by a mathod you don't
like.
Look, think of it like public transit, I love acupuncture, but for
other people.
But seriously, as a libertarian, I don't care if someone pays out
of pocket for their sugar pills. What I don't like is fraud.
Now, I'll admit that when it comes to acupuncture, outright fraud
is a difficult charge, especially when both practitioner and
patient believe in the efficacy. But also as a libertarian, I
reserve the right to make fun of anything I want as long as it's
not a political candidate sixty days before an election lest my
speech be declared "money".
Minion of URKOBOLD|9.26.07 @ 9:28AM|#
pain alleviation via method I like:
GET OUT, VOTEJOE. GET OUT. GO AWAY!
ahhhh. much better.
seagull|9.26.07 @ 11:36AM|#
If "conventional" treatment is anything like what i've seen lately, it was probably a Tylenole every twelve hours and then half a Percocet if you're still screaming and rearing like a sea lion; I'm not surprised it does twice as much good to distract them by waving shiny gold pins at them. It can't be much worse than doing nothing, which is the approximate amount of pain treatment most patients can expect now.
|9.27.07 @ 9:38AM|#
If only the placebo effect was at work shouldn't I have
experienced the same results each time?
-No. Different maladies will respond to psychological factors
differently. Neck pain, for instance will respond differently than
smoking cessation, two things that acupunture has shown to help
with in studies.-
This assumes that the maladies I had corresponded to the maladies
supposedly more susceptible to suggestibility. Actually, one malady
I sought treatment for was bronchial colds, which I usually get in
the winter and which for me can sometimes last up to a month. But
possibly, some acupuncture treatments were able to push this out
very quickly (increasing circulation perhaps, improving immune
function). Other acupuncture treatments didn't help me a bit there.
So, I doubt suggestibility is the only thing going on.
|9.27.07 @ 4:31PM|#
It is obvious that many of you are unaware of the science of
acupuncture from the viewpoint of those who study, practice and
recieve acupuncture treatments. You believe that placebo is the
only riding factor, or that endorphins are the only acting agent
involved. Yet that does not explain the long-term results in the
treatment of patients, nor the treatments patients recieve in
regulating the menses, clearing skin diseases, helping their nerve
fibers regrow or other greater treatments unknown by the general
public. One of you stated that "placebo based blind testing is the
gold standar" but I must remind you that surgery never gets that
type of testing. Except most recently in knee surgeries where there
was still a 30% "placebo" effectiveness.
The fact that needles were inserted more shallowly (which is
actually a Japanese style of acupuncture) does not constitute
"Fake" acupuncture. The fact that points are "not traditional" does
not mean points are not on the extra network of meridian studies
practiced by Japanese, 5-Element, Toyohari or other acupuncture
professionals as proper points for treatment.
Placebo, by definition means "inactive" and therefore there is no
such thing as placebo acupuncture, because sticking needles into
someone will do SOMETHING. Especially in the light of the fact that
"western science" has absolutly no concept of why acupuncture
works. Distal points on the ankle have shown through MRI to affect
the vision, yet there is no nerve link from the ankle to the visual
cortex - how does this work? Meridian therapy explains, but western
science cannot. Just because one doesn't speak the language doesn't
mean the speaker is an idiot.
Learn more of what this science of acupuncture is from it's own
theory, ideals, mechanisms and history instead of trying to squeeze
it into your own limited minds. Quantum physics is the science of
today, but western medicine has not grasped it yet - Chinese
medicine has been practicing it for centuries.
|9.27.07 @ 4:38PM|#
I think I also need to remind the viewers that acupuncture works on animals - where is their sense of placebo?? How would they "believe" that getting stuck with needles would relieve their conditions?? Animal acupuncture is one of the finest examples of how acupuncture itself works, not a belief that it works.
|9.29.07 @ 9:26AM|#
Phranque,
It's a classic case of the tail wagging the dog. Western science
true believers declare that the only path to truth or solid
evidence for their theories is through the method they have
selected. But this is circular reasoning. They're stuck in a box
and don't know it.
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