Acupuncture and Back Pain
Hello Magazine UK Version, Oct. 2007
Back pain costs the NHS 500 million pounds a year and the economy a staggering 10 billion pounds a year in lost working days. It`s thought that more than three quarters of us will suffer from it at some point. Many of those affected feel they got no relief from conventional medicine – but perhaps the ancient Chinese practice of acupuncture could hold at least some of the answers.
The Chinese have used needles in their medicine for thousands of years, working on the principle that there are hundreds of points on the body that link to invisible pathways for the body`s qi, or vital energy. The theory is that by stimulating the correct points, using very fine stainless steel needles, you can release blocked qi. While there is skepticism in the West about the theory, the results have impressed many doctors, and acupuncture is now available in many areas on the NHS.
Now research carried out at Ruhr and Regensburg Universities in Germany suggest that acupuncture is much more effective than traditional medicine in helping to ease back pain – BUT there`s a catch. Researchers examined 1,162 adults who were suffering from chronic back pain, dividing them into three groups – those receiving acupuncture, those having “fake” acupuncture and those given conventional treatments, including painkillers, heat and physical therapy. All the patients received about ten 30 minute sessions of their therapy.
All in the mind?
After six months of treatment, 47 per cent of patients in the real acupuncture group said they felt better, while 44 per cent improved in the fake acupuncture group and 27 per cent in the conventional care group saw an improvement.
“Patients experience not only reduced pain intensity, but also improvements in the disability that often results from back pain and therefore in their quality of life”, says Dr Heinz Endres, who led the study.
He believe that his findings are in line with a theory that pain messages to the brain can be blocked by competing stimuli – an idea that`s utilized in other pain management techniques. Because both the fake and the real acupuncture showed very similar results, he puts it down to a “superplacebo” effect – both treatements triggered a release of the body`s natural pain-relieving endorphins.
The study back up finds published in the British Medical Journal last year, which found that a short course of acupuncture could benefit patients with low back pain. “Through these controlled research findings demonstrating the effectiveness of acupuncture, we believe that both the medical health profession and members of the public will see the benefits of acupuncture as part of an integrated healthcare service”, says Mike O`Farrell of the British Acupuncture Council.
It`s estimated that around two per cent of the UK population uses acupuncture every year, but that figure could rise with the news that the Government is introducing statutory regulation of acupuncture and its practitioners some time next year.
Mike says that this is good news: “our hope it that, after regulations, the decision makers will have increased awareness and confidence to offer acupuncture more widely.”
More evidence from research
Dr Endres concluded that, real or fake, “acupuncture represents a highly promising and effective treatment option for chronic back pain”.
On the one hand, this is a nice piece on the effectiveness of acupuncture for backache. Acupuncture works! On the other hand, it reveals some profound misunderstandings about acupuncture and how it should be researched.
Why does ‘sham’ acupuncture work almost as well as ‘real’ acupuncture?
To answer this we have to look at what constitutes sham acupuncture in modern research. The idea comes from pharmaceutical research: you give half your study group a drug and the other half a placebo. It looks and tastes like a drug but it isn’t. So everyone thinks they’re taking it but only half actually are. The half who are not taking the drug, called the control group, gives you a baseline to compare with the half who are.
The idea of sham acupuncture is similar: to create a group of people who think they are having acupuncture but are not, to compare with the people who are, so you can see the effect.
In research, ‘real’ acupuncture consists of needling acupuncture points with conventional acupuncture needles, usually to a depth of half an inch to an inch. Sham acupuncture consists of using special fake needles that are retractable, a bit like the swords actors use in movies.
After the fake ‘insertion’, the needles are taped in place at the points. So the study group is split in half: some patients get an actual needle insertion but the control patients get only the look and ritual of one.
In Toyohari style acupuncture there is no insertion at all
All this seems entirely logical if you think that all acupuncture consists of is the mechanical act of inserting a needle half an inch to an inch in depth. If you are familiar with Japanese acupuncture, however, you will know that the insertion depths are extremely shallow, typically 1 – 3 mm. In Toyohari acupuncture, there is no needle insertion at all. The needle tip is simply touched to the skin or held 1mm above it. Almost exactly as in sham acupuncture.
Dr. Manaka, whose work is discussed at length on this site, researched the effects of taping needles to pieces of cardboard and holding them over the skin. Anyone can read his experiments and repeat his findings, which show that stainless steel needles affect muscular tension in the body simply by proximity to the skin and that this effect is increased or decreased by the direction in which the needle is pointing. The effects he noted are completely repeatable and reversible, the yardstick of any good research.
Sham acupuncture is acupuncture
If modern researchers were familiar with Japanese acupuncture they would realise that the sham acupuncture they are using as a control style is a dynamic intervention in its own right. This is backed up by published research in Japanese and English and by the experience of some 60,000 acupuncturists working in present-day Japan, who routinely use shallow or no insertion to treat their patients.
This research does not compare a sham technique with a real one, but two real acupuncture techniques with each other.
Oran Kivity BAc. MBAcC (overseas)