Although acupuncture has long been used to treat chronic pain, its effectiveness remains a controversial topic among physicians and scientists. This is largely because no biological mechanism has been identified to explain how the insertion and stimulation of specialized needles at specific points on the body generates lasting effects, such as decreased pain many months after a treatment.

Now, in an extensive analysis of data from nearly 18,000 individuals involved in 29 high-quality clinical trials, Memorial Sloan-Kettering health outcomes researcher Andrew Vickers and colleagues have determined that acupuncture is an effective treatment for chronic back and neck pain, osteoarthritis, shoulder pain, and headaches.

Clinical Trial and Patient Data Examined

The review article, published in the September 10 issue of the Archives of Internal Medicine, was based on an evaluation of clinical trials conducted in the United States, Germany, Spain, and Sweden. The analysis included data from only the highest-quality trials: those that determined at random whether a patient would receive acupuncture.

In the studies, patients were randomly assigned to actual acupuncture, sham acupuncture (in which needles are inserted superficially or at nontraditional sites), or standard care without acupuncture. After selecting the trials, Dr. Vickers and colleagues requested the original patient data from the study investigators to use in their analysis.

“There have been many clinical trials of acupuncture for chronic pain,” Dr. Vickers says, “but the quality of these studies has been questionable. In our study, we only used data from trials that were very carefully designed to avoid bias. And by obtaining the original data, we could make sure that the statistical analyses were as accurate as possible.”

Implications for Patients and Doctors

An estimated three million Americans have acupuncture treatments each year, in most cases to address conditions causing chronic pain. Dr. Vickers explains that several factors likely contribute to the benefits that patients report.

“People receiving acupuncture for pain experience a benefit beyond that gained from the correct insertion of needles,” he says. “There is probably some benefit to needle insertion regardless of whether it is at a correct acupuncture point. And of course there is often an effect related to believing that the treatment will be helpful.”

According to the Archives study, acupuncture does result in a pain relief benefit over sham acupuncture for chronic back and neck pain, osteoarthritis, shoulder pain, and headache — and its effectiveness over standard treatment without acupuncture is much greater.

“This has major implications for clinical practice,” Dr. Vickers says. “Our findings provide the most-robust evidence to date that doctors are justified in making referrals to acupuncture for their patients with chronic pain. I hope that our findings help inform future clinical and policy decisions for acupuncture.”

Source: MSKCC.