Earlier this year, new official guidance said that patients with persistent lower back pain should be offered acupuncture on the NHS. The recommendation, from the NHS rationing body NICE, said that the scientific evidence now showed that acupuncture was not only effective at treating back pain, but also cost effective when other treatments, such as painkillers, were found not to be working.

Up to now, the scientific rationalists among us would have had grounds for pooh-poohing all this as unproved, pricey pampering. But that’s all changed. Science has suddenly — and very publicly — taken a turn in favour of the needle.

The new guidance came from a report from the influential medical research review body ‘the Cochrane Collaboration’, saying that headache and migraine sufferers clearly fared better with acupuncture than painkillers. In addition, a large scientific review found that women undergoing fertility treatment were more likely to give birth successfully if they had acupuncture.

Not everyone believes it works

The short answer is that Acupuncture does work — for head and back pain. But for everything else, it depends on whom you talk to. And many Doctors are still sceptic.

Professor Edzard Ernst, chair of complementary therapy at Exeter and Plymouth universities, is doubtful. He says that you need to study the effects on thousands of people before you can say “this works” or recommend that people should pay for a treatment. In addition, he doesn’t buy the supposed evidence on fertility.

One of his worries is whether acupuncture actually has any effect on the body, or whether it’s simply a glorified “placebo” — a treatment that makes us feel better simply because we expect to be made better. If it is just a trick of the light, should the NHS — or anyone — be paying for it?

The evidence that it works is there but sham acupuncture works as well
In fact, pretty strong evidence that acupuncture kills pain and helps nausea sufferers.

At the same time , administering “sham” acupuncture — where needles are inserted into the wrong place, or aren’t pushed in properly, or toothpicks are applied to the skin instead — often seem to have the same effect. To the sceptics, this suggests that acupuncture doesn’t actually have a curative effect: it just cons people into feeling well.

The concept behind the needles
Acupuncture brings a real neurophysiological response, which is more than placebo. Touching, pressure, pointing to where the pain is all have an effect, and you can measure their effects in the nervous system.

The idea of energy in acupuncture is a huge concept. But basically inserting a needle provokes an electrical and biochemical response which promotes communication between cells. It’s been shown that it ignites the brain with electrical lights.

It’s all about costs
So why did the NHS introduce Acunpucture ? Better it’s cost effective. First, not everyone will be able to get treatment. Second the costs to the NHS would be minimal – in the order of £77,000 – because they are offset by the savings in terms of reducing future disability and healthcare needs and moving away from treatments with little supportive evidence.

The guidelines, which apply to England and Wales, say doctors should no longer offer spinal x-rays or MRI scans or injections of therapeutic substances into the back for non-specific low back pain.

The Chartered Society of Physiotherapy welcomed the guidelines, as did Dr Dries Hettinga of the charity BackCare. He said: “This offers a real choice for patients.
“This guideline will help patients understand what treatment and care can help them with their back pain and shows that there can be a positive outlook for treating this condition.”

Conclusion
Proof is a hard thing to come by for any treatment, and acupuncture is going to take longer than most to crack. In the meantime, spending your painkiller cash on a relaxing acupuncture session doesn’t seem such a stupid move. Try it !

I read an article published in the New York times and published yesterday. In the article a doctor named Colin Fernandes tells of the inadequacy of drugs offered to treat some diseases notably trauma and back pain.

As an example, the author describe the case of young veterans, frequently in their 20s, coming back from combat. They mostly have chronic pain and traumatic brain injury, untreated post-traumatic stress disorder, and sleep and mood disorders.

The challenge he faces if to find a balance between pain relief and side effects; For example the only treatment available for these problems is giving opioid painkillers (Percocet or Vicodin). But these drugs affect mood and sleep and he finds himself in the unenviable position of limiting access to pain medications if their use will lead to functional decline.

He he is sobered by the fact that the only study of efficacy of these drugs is a 16 weeks test where in practice the use of these drugs are often maintained on opioids for years or decades.

Colin Fernandes also note that trials suggest that on average, patients given opioids experience an improvement of only 2 to 3 points on a pain scale of 0 to 10 [=not much compared to the side effects]. Side effects and risks are many: chronic constipation, sedation and somnolence, a worsening of mood, opioid-induced hyperalgesia (a paradoxical phenomenon in which pain medications actually increase pain), hypogonadism (impaired endocrine function) and addiction [sic]. Recent studies also suggest an adverse effect on immune function.

Colin concludes that the guiding principle learned in medical school “First do no harm” is easy to understand but as a doctor saying to your patient “There is nothing more I can offer you” is very hard.

Feel free to tell me of your experiences in comments below..