Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
Pinning Down the Effectiveness of Acupuncture
Acupuncture made its way into Western consciousness in the early 1970s. Since that time, almost 500 randomized, controlled trials (RCTs) have attempted to validate (or invalidate) the effectiveness of acupuncture. Findings from these RCTs have been collected in numerous analyses—reviews that examine many studies related to a specific topic and draw conclusions based on collected findings. A study published in the March 2002 issue of theAnnals of Internal Medicine attempts to bring many of these analyses together in one place.
The following table presents the study's findings—31 analyses were included. The first column is the condition the meta-analysis covered; the second column is the number of RCTs included in that particular meta-analysis; the third column is the findings of the meta-analysis.
| Condition | RCTs | Findings |
|---|---|---|
| Pain-related conditions | ||
| Chronic pain | 14 | Potential bias, but most results were not positive |
| Chronic pain | 51 | Highly contradictory evidence |
| Chronic pain | 51 | Inconclusive evidence |
| Chronic neck and back pain | 13 | No convincing evidence |
| Back pain | 12 | Insufficient evidence to conclude if better than placebo |
| Low back pain | 11 | Effectiveness remains unclear |
| Osteoarthritis | 13 | Highly contradictory evidence |
| Osteoarthritis of the knee | 7 | May play a role—additional research needed |
| Acute dental pain | 16 | Acupuncture can alleviate dental pain |
| Neck pain | 14 | Insufficient evidence |
| Fibromyalgia | 3 | May be effective—more trials needed |
| Headache | 8 | Too few trials and contradictory evidence |
| Headache | 22 | Trend in favor of acupuncture, evidence not fully convincing |
| Conditions other than pain | ||
| Asthma | 13 | Trials not well done |
| Pulmonary disease | 16 | Safe and potentially effective for asthma and COPD |
| Asthma | 15 | Insufficient data |
| Chronic asthma | 7 | Insufficient evidence |
| Addiction | 13 | Claims not supported by sound trials |
| Weight reduction | 4 | Contradictory evidence |
| Smoking cessation | 8 | Little or no effect |
| Smoking cessation | 14 | Not better than placebo |
| Stroke | 5 | Evidence encouraging but not compelling |
| Stroke | 9 | No compelling evidence |
| Dentistry (mainly TMJ) | 15 | Seems effective for TMJ and facial pain |
| TMJ disorder | 3 | Studies need more rigorous methods |
| Vomiting | 33 | Acupuncture point P6 seems to be effective |
| Vomiting | 12 | Acupressure can be used as an antiemetic |
| Nausea and vomiting of pregnancy | 7 | Acupuncture benefits many women but evidence not equivocal |
| Postoperative nausea and vomiting | 19 | Similar to antiemetics in preventing early vomiting and late vomiting in adults |
| Nausea and vomiting of pregnancy | 4 | Clear evidence for beneficial effect but results remain equivocal |
| Tinnitus (ringing in the ears) | 6 | Not demonstrated to be effective |
Adapted from Annals of Internal Medicine, Volume 136, Number 5, pp 377-78.
The table indicates that the majority of the studies found little, no, contradictory, or inconclusive evidence to support acupuncture as a treatment for most of the conditions studied. However, there were four exceptions where the data was more conclusive—RCTs for vomiting and dental pain have been predominately positive and RCTs for addictions and tinnitus have been primarily negative.
This information may seem incompatible with what you may have heard from friends or family, or even from your own experience. Americans are spending more than $500 million a year on acupuncture, and many feel that they are getting the results they desire.
So, why are the majority of the trials inconclusive? A lot of the problems lie in the methodologies of the studies. Many trials had too small a sample size, poorly defined illnesses, imprecise measurements of outcomes, high drop-out rates, and inadequate follow-up—problems that plague many RCTs, not just those focused on acupuncture. In addition, an important aspect of a clinical trial is that it is "double blind." This means that the treatment being studied is compared to something else (usually a placebo) and that neither the clinician nor study participant knows which is being administered. This is much more difficult with acupuncture.
Another aspect of acupuncture that is hard to quantify in a clinical trial is the patient-physician relationship. The author of the study points out that "Historically, acupuncturists consider the patient-physician relationship and therapeutic encounter itself to be inherently ‘potent' and sufficient to promote healing." During an office visit, an acupuncturist employs several hands-on techniques, including needle insertion and massage. In addition, lifestyle counseling in areas such as mental health, diet, and exercise is often a part of acupuncture care. All these components may work together to bring about personally positive outcomes.
As this study shows, acupuncture's efficacy in numerous treatment areas has not been substantiated scientifically. But, acupuncture has produced an enormous number of favorable anecdotal experiences. If you decide to try acupuncture, discuss it with your doctor. He or she should be aware of any health-related activities you plan to undertake and may be able to refer you to a competent acupuncturist in your area. While acupuncture is generally considered safe, it is always important to check any practitioner's credentials.
Last reviewed: February 2004 by Richard Glickman-Simon, MD.
- National Center for Complementary and Alternative Medicine
www.nccam.nih.gov