Does acupuncture work? It's a prickly subject

JOE SCHWARCZ
Freelance

http://www.canada.com/montreal/montrealgazette/columnists/story.html?
id=131cd74b-7934-45c2-98eb-33724452a975

Sunday, May 09, 2004





Last week, I left you sitting on pins and needles waiting to hear
about the scientific evidence for acupuncture.

I described how researchers in Germany had developed a device that
allowed an acupuncture needle to retract into the handle, giving the
appearance it had been inserted into the skin. They used this "sham"
procedure to investigate the value of acupuncture in controlling
post-operative nausea and vomiting. Anecdotal evidence, along with
some previous nonplacebo controlled studies had suggested the nausea
commonly experienced after general anesthesia could be reduced
through acupuncture. More than 200 women undergoing breast or
gynecologic surgery were in the study, with half receiving the sham
treatment and half having real needles inserted into an acupuncture
point on their forearm. Stimulation of this "Pericardium 6" point is
traditionally believed to control nausea.

In this experiment, it didn't. There was no significant difference
in postoperative nausea between the two groups but the patients who
had undergone acupuncture did have less of a tendency to vomit.
Acupuncturists argue the results would have been different if
several more points had been stimulated. Perhaps.

Since the 1970s, more than 500 studies of acupuncture have been
published in peer-reviewed scientific journals. Conditions ranging
from asthma, drug addiction and weight reduction to smoking
cessation, stroke and tinnitus (ringing in the ear) have been
examined. One would think so many studies should be able to clarify
what acupuncture can and cannot do. Alas, such is not the case.
There is much contradictory and inconclusive evidence, as is obvious
from an excellent recent review published in the Annals of Internal
Medicine, a highly respected journal. Ted Kaptchuck of Harvard
Medical School surveyed the literature for the best controlled
trials and categorized these in terms of the conditions they
attempted to treat and the results they found. Kaptchuk holds a
degree in Oriental Medicine and uses acupuncture, so he certainly is
not biased against the technique.

"Good" evidence was found for alleviation of dental pain, reduced
vomiting after surgery or chemotherapy and nausea associated with
pregnancy. For chronic pain, headaches, back pain, asthma and
smoking cessation the evidence was contradictory, while for
addiction and tinnitus it was negative. A British study just
released has, however, shown weekly acupuncture in combination with
appropriate medication can reduce the number of days migraine
patients suffer a headache more than medication alone. How do we
explain the contradictory evidence for the treatment of pain? How
can it be that some studies show significant positive results but
others come up empty? As with other treatments, the expertise of the
therapist is undoubtedly important.

Physicians who are trained in acupuncture are the most likely to
select the best candidates for treatment, and, of course, are also
adept at diagnosing conditions that require a more orthodox approach.

In other words, you have to know when to reach for the antibiotic or
the scalpel, and when to reach for the acupuncture needles. The
specific nature of the acupuncture technique is also important. Many
of the positive results are seen when electrical stimulation is
applied through the needles.

Given that acupuncture can in some cases produce positive results,
we are saddled with the question of "how?"

One explanation involves the production of pain-killing substances
by the body when stimulated by acupuncture. These "endorphins" are
also produced in times of stress and could explain why soldiers
often don't feel wounds until after the heat of the battle. Some
studies have shown that naloxone, a drug which blocks the activity
of the endorphins, can also negate the benefits of acupuncture.

Professor Ronald Melzack of McGill University, regarded as one of
the top experts on pain in the world, points out acupuncture is not
some magical process, but is just one of many methods that can
relieve pain by sensory hyperstimulation.

Flood the body with sensory input, he suggests, and there will be
pain relief. And I believe him. Many years ago, I had the pleasure
of listening to one of Professor Melzack's lectures in which he
described how rubbing an ice cube on the skin between the thumb and
forefinger can alleviate a toothache. "Hmmmm," skeptical me thought
at the time. Then it happened. I woke up one night with a terrible
toothache. I took Aspirin, I applied oil of cloves to my gums, but
nothing helped. Out of desperation I reached for an ice cube and
(feeling somewhat foolish) began to massage my hand. Within minutes
there was blessed relief! Endorphin release? Opening up of "qi"
channels? Placebo effect? Who cares! The pain was gone.

The answer to what happened may eventually come from functional
magnetic resonance imaging (fMRI) studies of the brain. Scans of
this type have already revealed when subjects' fingers are immersed
in hot water, certain areas of the brain are activated and the
activity is reduced with acupuncture. But whether the needles are
inserted along "meridians," or elsewhere, seems to make no
difference.

What then are we to conclude from all this? That acupuncture works
in the hands of some practitioners, for some conditions, for some
patients, some of the time. This may not sound too optimistic, but
the same can be said about a number of "orthodox" medical
treatments. The best bets for acupuncture seem to be in the areas of
dental pain, nausea and migraine. Risks are minor; they are the ones
associated with any needle use. So, as you can see, the facts don't
pop the acupuncture balloon, but perhaps they do deflate it somewhat.

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Joe Schwarcz is director of McGill University's Office for Science
and \Society (www.OSS.McGill.ca). He can be heard every Sunday from
3-4 p.m. on CJAD. joe.schwarcz@...