UBC SBM

Acupuncture

UBC Students for Science Based Medicine

What I’ll Cover

• Acupuncture– History, Definition, and Basis in Traditional Chinese Medicine

• What does the research say about acupuncture for …– Nausea?

– Pain?

– Infertility?

– Asthma?

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History: UnclearUBC SBM

History UBC SBM

1000 CE• Professionalized

1600 CE• Circulatory system fully

described• Reproduction not

understood.

1800 CE

• Connection between electricity and nerves made

What is acupuncture?

BC Health Professions Act:

Traditional Chinese Medicine Practitioners and Acupuncturists Regulation

Acupuncture

is an act of stimulation, by means of needles, of specific sites on the skin, to promote, maintain, restore or improve health, to prevent a disorder, disease or to alleviate pain and includes

A. Needles: mechanical, thermal, electrical

B. Lasers & magnets

C. Burning dried leaves (moxibustion)

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What is Acupuncture?

College of TCM Practitioners and Acupuncturists of BC• Acupuncture is a procedure in Traditional Chinese

Medicine.

• TCM grows out of Daoism (religion/philosophy):– Yin/Yang (bright/dark)– Five Elements

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What is Acupuncture?UBC SBM

Acupuncture Basics

• Scientists in China divided on whether meridian system is relevant

• Current research does not strongly support the idea that there is something unique about acupuncture points or that meridians exist

1) Sampson, WI (September/October 1996). "Traditional Medicine and Pseudoscience in China: A Report of the Second CSICOP Delegation (Part 2)". Skeptical Inquirer 20 (5).

2) Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. THE ANATOMICAL RECORD (NEW ANAT.), 269, 257-265. Retrieved from http://www.uvm.edu/annb/faculty/PDFs/257.pdf

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Research

• There’s a lot of research outthere

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Levels of Research

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Why reviews have different results

• Reasons why reviews come up with different conclusions:

– No one likes publishing negative studies, so positive studies are overrepresented

– Different statistical formulas

– Different studies

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Nausea

Abraham, J. (2008). "Acupressure and acupuncture in preventing and managing postoperative nausea and vomiting in adults". Journal of perioperative practice 18 (12): 543–551.

Lee A, Fan, LTY (2009). Lee, Anna. ed. "Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting". Cochrane Database of Systematic Reviews (Online) (2): CD003281.

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2008(10 studies)

2009(40 studies)

Acupuncture

Nausea: Conclusion

• Acupuncture at wrist helps with nausea after surgery

• But– No difference between needles and pressure– Not better than present medication– Only tested nausea after surgery

• Not food poisoning or motion sickness

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PainUBC SBM

Somewhat unclear

Conflicting Evidence

PainUBC SBM

Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews." Pain 152 (4): 755–764.

Individual Studies

Review 1 Review 2 Review 3 Review 4 Review 5

Review of reviews

Pain: Review of reviewsUBC SBM

Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews." Pain 152 (4): 755–764.

• Migraines• Tension Headaches• Rheumatoid Arthritis• Cancer Pain• Fibromyalgia (long term body wide pain)• Muscular-skeletal Pain• Shoulder Pain• During Surgery Pain

• After Surgery Pain• Jaw Joint Pain• Sciatica (leg pain)

• Neck Pain• Low Back Pain• Osteoarthritis

Pain: Chronic Low-Back Pain

• But– Short term only (3 months)– Not better than conventional therapies

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0

20

40

People who experienced pain reduction

Furlan, Andrea D; Van Tulder, Maurits W; Cherkin, Dan; Tsukayama, Hiroshi; Lao, Lixing; Koes, Bart W; Berman, Brian M (2005). Furlan, Andrea D. ed. "Acupuncture and dry-needling for low back pain" (PDF). Cochrane Database Syst Rev (1): CD001351.

Pain: Review of reviewsUBC SBM

Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews." Pain 152 (4): 755–764.

• Migraines• Tension Headaches• Rheumatoid Arthritis• Cancer Pain• Fibromyalgia (long term body wide pain)• Muscular-skeletal Pain• Shoulder Pain• During Surgery Pain

• After Surgery Pain• Jaw Joint Pain• Sciatica (leg pain)

• Neck Pain• Low Back Pain• Osteoarthritis

Pain: Conclusion

1. Small pain reduction in some types of pain, no reduction in most other types

2. Little or no difference between acupuncture and fake acupuncture

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InfertilityUBC SBM

Infertility

Review 1 (2008)

Review 2 (2008)

Review 3 (2009)

Review 4 (2011)

More Pregnancies

MoreBabies

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Infertility: Conclusion

• Conclusion:– There is conflicting evidence about whether acupuncture treats

infertility

– Most reviews suggest acupuncture does not increase odds of giving birth

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Asthma

• Long term lung disease.

• Reversible breathing difficulty.

• Often, but not always, caused by allergies.

• 250,000 deaths/year worldwide (GINA, 2009)

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"Global Strategy for Asthma Management and Prevention 2010 (update)" (PDF). Global Initiative for Asthma. 2010.

Asthma• Review 1 (2002):

– “The current analysis did not find evidence of the efficacy of acupuncture in the treatment of patients with asthma”

• Review 2 (2002):– “There is not enough evidence to make recommendations about the value of

acupuncture in asthma treatment.”

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Linde K, Jobst K, Panton J. Acupuncture for chronicasthma (Cochrane Review). The Cochrane Library, Issue 2. Oxford, Update Software, 2002.

Martin J, Donaldson AN, Villarroel R, Parmar MKB, Ernst E, Higginson IJ. Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials. The European Respiratory Journal. 2002;20(4):846–852.

Placebo Effect: Does it really help?

Feeling Better Getting Better

Wechsler ME, Kelley JM, Boyd IO, Dutile S, Marigowda G, et al. (2011) Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Engl J Med 365: 119–126.

Acupuncture Conclusion:

Subjective

After Surgery Nausea– Acupuncture at wrist seems to

help– No difference between needles

and pressure

Pain– Both fake acupuncture and real

acupuncture have small effect– Mostly equal for most types of

pain– For some types of pain real

acupuncture seems to be better than fake acupuncture but there’s conflicting evidence

Objective

Infertility– Latest review says fertility does

not increase chance of having a baby

Asthma– Evidence is weak– Existing therapies prevent death

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Benefits

- Weak- Comparable to conventional

therapies- Those therapies aren’t great

to begin with

- Best evidence does not support it’s use

- Conventional therapies much better (Asthma)

- No competing therapy (IVF)- Except IVF is a therapy

itself that does help with infertility

Acupuncture Conclusion:Risks and side effects

– Bacterial and viral infections• Non sterile needling• Small risk, but still real

– Trauma• Not bleeding (surprisingly)• Pain, headache, numbness• Pneumothorax• Death

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Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review of reviews" (pdf). Pain 152 (4): 755–764.

Concluding Statements

• Acupuncture:– minor benefits, evidence generally weak– minor to major risks– has been studied for decades and still no clear effect– If acupuncture were a drug it would not make it to

market and would be abandoned

• Alternative Medicine• Controversial to recommend

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Works Cited

1. Manheimer, E., Zhang, G., Udoff, L., et al., 2008. Effects ofacupuncture on rates of pregnancy and live birth among womenundergoing in vitro fertilization: systematic review andmeta-analysis. British Medical Journal 336, 545–549.

2. El-Toukhy, T., Sunkara, S.K., Khairy, M., et al., 2008. A systematicreview and meta-analysis of acupuncture in in vitro fertilization.British Journal of Obstetrics and Gynaecology 10, 1203–1213.

3. Sunkara, S.K., Coomarasamy, A., Khalaf, Y., El-Toukhy, T., 2009.Acupuncture and in vitro fertilization: updated meta-analysis.Human Reproduction 24, 2047–2048.

4. Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X. Randomized controlled trial: effects of acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertil Steril. 2011;95:583–7. doi: 10.1016/j.fertnstert.2010.05.024

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Acupuncture

By Ratib Islam

UBC Students for Science Based Medicine