Acupuncture: Small risks versus no benefithttp://scienceblogs.com/insolence/2013/07/08/acupuncture-small-risks-versus-no-benefit/
When a massage therapist tried to treat the headaches she suffered after a 2006 car crash with acupuncture, however, he set off a cascade of health problems that would shatter Ms. Ribble-Orrs sports-centred life and raise questions about the popular needle therapy.
The therapist accidentally pierced Ms. Ribble-Orrs left lung during acupuncture treatment that was later deemed unnecessary and ill-advised, causing the organ to collapse and leaving it permanently damaged. An Ontario court has just upheld the one-year disciplinary suspension imposed on therapist Scott Spurrell, rejecting his appeal in a case that highlights a rare but well-documented side effect of acupuncture.
Mr. Spurrell, who learned the ancient Chinese art on weekends at a local university, had no reason to stick the needle in his patients chest, and had wrongly advised Ms. Ribble-Orr that the chest pain and other symptoms she reported later were likely just from a muscle spasm, a discipline tribunal ruled.
Ribble-Orr had suffered many injuries due to her competition, including a dislocated elbow and shoulder, a broken hand, head injuries and repeated knee injuries. She had overcome them all to compete again, but appears unable to overcome this one. Basically, what happened is that in 2006, Ribble-Or was trying to get into mixed martial arts competition and was eying a job as a police officer. However, she was also recovering from injuries suffered in an auto collision and seeing Scott Spurrell, a massage therapist who had learned acupuncture during a weekend course at a local university. She was suffering from pounding headaches, and Spurrell convinced her that he could relieve those headaches by inserting a two inch needle, according to the disciplinary ruling, into a muscle located between the clavicle bone and ribs. From the description, its not clear to me exactly which muscle they meant, although it could conceivably have been the scalenes, the sternocleidomastoid, or perhaps even just the pectoralis major. Whatever muscle Spurrell was targeting, going between the clavicle and the ribs is basically where surgeons stick the needle when trying to place central venous catheter into the subclavian vein, and, yes, a pneumothorax is a known potential complication of placing such lines. What also puzzles me is how on earth Spurrell could have stuck the needle in deep enough to cause a pneumothorax? It would be one thing if Ribble-Orr were a fragile little old lady, but she wasnt. She was an athlete, presumably with well-developed musculature. It would take a lot to get a needle through all of that muscle to get to the pleural cavity.
All medicine is a risk-benefit analysis. All effective treatments have risks, and those risks have to be weighed against the potential benefits. When the benefits are significant (e.g., saving life), then greater risks are tolerable. When the potential benefits are minimal, then even minor risks might not be acceptable. When the potential benefits are none, no risk is acceptable. That is the case for acupuncture. It does not work, no matter how much acupuncturists try to prove it does.
How the fuck could someone believe that sticking a needle into the chest could relieve headaches?
The needles are ultra thin and, in fact, go in only about 1/8 of an inch, if that. Maybe he was using an ice pick.
I think her lung collapsed due to some of her other, pre existing injuries. Like maybe the car accident.
Please note, this is not a promotion for accupunture. It is simply a statement of fact about accupunture needles.
The court found that the collapsed lung was caused by the use of a 2" accupuncture needle.
But they don't go in that far. They are flexible and it would be really hard to push it up to the "hilt," so to speak.
additional certification in acupuncture. If you go to someone who knows nothing about human anatomy (or animal anatomy in the case of veterinary care) this is a risk.
But, Sid, you really do need to read some reputable peer review articles on the appropriate use of acupuncture and the science behind it (not the bastardized interpretations of Chinese philosophy behind it). You seem only to read the woo--which exists to one degree or another for every aspect and every domain of medicine.
that the treatment for headaches is to put a needle into the chest?
How does one affect the other?
placement of the needles is pretty much random from one practitioner to the next.
There are 100s of treatment points all over the body and different practitioners can use different point combinations to achieve a goal. A point in the chest could impact headaches via a certain central meridian, but a more commonly used treatment point is in the hand. What looks random still has theory behind it.
He said the only reason it worked is he felt like a damned fool for spending several hundred dollars on something that didn't work, and he would have felt worse had he not quit smoking.
It's supposed to be related to acupressure points. Maybe it's all in our minds, but not one of us has gone back to smoking after 6 years.
I think there are a lot of psychological impacts on health which we don't really understand.
no business treating his client with needles unsupervised until he had become fully accredited. Acupuncture wasn't the problem, HE was.
These quack modalities have plenty of research which demonstrate lack of efficacy. This Blog does a great job of analyzing this research.
For Google fans, "SBM" in the search usually gets to entries in this Blog.
E.G., Google: acupuncture research SBM
Orac, the author of this piece, is actually David Gorski, who uses his real name at SBM. Both sites are on my regular reading list, and I've decided to make an effort to bring interesting, science-based articles from both sites to DU.
DU looks like woo central sometimes, with crap from naturalnews, mercola and whale.to posted as credible information. Gotta get some actual science-based information up here to combat the nonsense.
One would assume it is also a bad idea to get surgery or prescriptions from a massage therapist or a barber, not because antibiotics are bad but because a massage therapist does not know what they are doing. 'This guy I know, he had his appendix removed at the nail salon and got an infection, so never let a surgeon touch your appendix' is not logic that flies with me.
A 2 inch needle? A massage therapist? Good lord, the crazy tales some will tell.
A recent NCCAM-funded study, employing individual patient data meta-analyses and published in the Archives of Internal Medicine, provides the most rigorous evidence to date that acupuncture may be helpful for chronic pain. In addition, results from the study provide robust evidence that the effects of acupuncture on pain are attributable to two components. The larger component includes factors such as the patients belief that treatment will be effective, as well as placebo and other context effects. A smaller acupuncture-specific component involves such issues as the locations of specific needling points or depth of needling.
Although millions of Americans use acupuncture each year, often for chronic pain, there has been considerable controversy surrounding its value as a therapy and whether it is anything more than an elaborate placebo. Research exploring a number of possible mechanisms for acupunctures pain-relieving effects is ongoing.
Researchers from the Acupuncture Trialists Collaboration, a group that was established to synthesize data from high-quality randomized trials on acupuncture for chronic pain, conducted an analysis of individual patient data from 29 high-quality randomized controlled trials, including a total of 17,922 people. These trials investigated the use of acupuncture for back and neck pain, osteoarthritis, shoulder pain, or chronic headache.
For all pain types studied, the researchers found modest but statistically significant differences between acupuncture versus simulated acupuncture approaches (i.e., specific effects), and larger differences between acupuncture versus a no-acupuncture controls (i.e., non-specific effects). (In traditional acupuncture, needles are inserted at specific points on the body. Simulated acupuncture includes a variety of approaches which mimic this procedure; some approaches do not pierce the skin or use specific points on the body.) The sizes of the effects were generally similar across all pain conditions studied.
The authors noted that these findings suggest that the total effects of acupuncture, as experienced by patients in clinical practice, are clinically relevant. They also noted that their study provides the most robust evidence to date that acupuncture is more than just placebo and a reasonable referral option for patients with chronic pain.
Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: individual patient data meta-analysis. Archives of Internal Medicine. September 10, 2012; Epub ahead of print.
Edited to add NIH direct link:
but then again, NCCAM is a great example of politics over science.
I don't promote woo, but neither do I promote disproven dogma. Both are harmful.
Here is a peer review article about a study that indicates that Acupuncture is effective with chronic pain:
Background Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.
Methods We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.
Results In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.
Conclusions Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.
So is Science a process of peer review double blind studies or simply "whatever Sid thinks?"
CRPS RSD is ranked as the most painful form of chronic pain that exists today by the McGill Pain Index.
Complex Regional Pain Syndrome, or CRPS, formerly known as RSD or Reflex Sympathetic Dystrophy is a progressive disease of the Autonomic Nervous System, and more specifically, the Sympathetic Nervous System. The pain is characterized as constant, extremely intense, and out of proportion to the original injury. The pain is typically accompanied by swelling, skin changes, extreme sensitivity, and can often be debilitating. It usually affects one or more of the four limbs but can occur in any part of the body and in over 70% of the victims it spreads to additional areas.
(I don't know about out of proportion to the original injury; I still have nightmare about pull myself up the dirt road with my tibia having ruptured the skin, to get help)
In any case, I've tried an enormous array of therapies from sympathetic nerve blocks in the spinal column, to fentanyl patches, morphine, lyrica, gabapentin, percocet, physical therapy, etc. And I have found acupuncture to help some. No, it's not a cure, but it does provide me with some relief- more than the nerve blocks and it's not painful and intrusive.
Everything follows from that.
right therapist. It is not always about believing and it helps acupuncture to work since I also used acupuncture on my dog and I don't think she believed it was going to work and this is what helped her. She had a pinched nerve in her neck and after three treatments I had my old pup back again. I have also used acupuncture to treat back pain and after a rear end collision used acupuncture to treat and again was successful. It may not help all but for me the pain went away immediately.
but one of nation's leading chronic pain specialists. Sid read a blog, plus he's in Canada which has very different rules about such things, this link offers the Oregon State licensing rules
happens with every profession.
My wife is a Tradition Chinese Medicine practitioner from a family line of TCM doctors. The theory behind the application of the needles is time tested and rather complex. Normally, the use of needles is combined with herbal treatments and powerful massage techniques from a system called Tui Na.
Since TCM is not a uniform field of study and has developed over centuries by families and handed down from teacher to student, there exist many variations of treatment for any particular health problem. Over thousands of years of practice, treatments that fail fall into disuse while effective methods gain traction, spread and endure.
A great deal of research is now being done in modern Universities in China and elsewhere in order to establish the science behind the tradition. If the story above is accurate, I'd say the therapist was blindingly incompetent and this cautionary tale is being trotted out for use as propaganda.
And if it had, that would only speak to its prescientific origins. In other words, to the fact that they just made stuff up, for the most part.
Chairman Mao: The real inventor of traditional Chinese medicine
I used to think it worked, too.
A lot of "traditional medicine" is still woo.
Chriropractic is based on an outdated belief that the brain sends "energy" to the body.
Homeopathy is based on an outdated belief that water retains some kind of magic.
Acupuncture is based on the same blind belief chiropractic came from.
and I've managed to keep almost all of it off for several years.
What happened to that poor woman sounds awful. It sounds like she had acupuncture from someone with inadequate training. I believe that well-trained, experienced acupuncturists can treat a variety of conditions.
Acupuncture helped my lower back considerably. I used to need at least two cortisone injections in my lower spine every year. The orthopedist said he didn't recommend surgery because it could cause additional problems.
I found a reputable acupuncturist through my health insurance company -- it wasn't covered but she gave discounts to those who had this insurance. She worked on me for a couple of weeks, two to three sessions a week, and it genuinely helped. I have not needed a single cortisone injection in the five years since the treatment.
She also encouraged me to try weight loss treatment with acupuncture since it would help my back. It worked very well, and I wasn't even dieting. The weight came off at the rate of 1 to 2 pounds a week. I was very much impressed with how well it worked.
From what I've been told or have read, acupuncture relies on knowing the lines or meridians in the body where energy flows. restricted. Placing needles on the correct points helps release blocked energy and restore well-being. There are points on the body that can release blocked energy in a seemingly unrelated part of the body.
Chairman Mao: The real inventor of traditional Chinese medicine
I used to think it worked, too.