After a series of columns I wrote last year that were rather unsympathetic to the cause of alternative medicine, it was suggested to me that if I ever did find something that was alternative and worked, then I should prove myself open-minded enough to write about it.
This is not that column. It is the next best thing, though. Some of you will have seen the “news” that – and I quote from a selection of non-FT headlines – “Acupuncture is the best way to treat back pain” and “needles ‘are best for back pain’”.
For those who know that back pain is common, miserable, and, where chronic, frequently disabling to work and life, this is quite exciting. Acupuncture uses no drugs, can be administered by anyone after a short training period, and is popular. It is a long story but I have had acupuncture, rather bizarrely, very early in the morning on the floor of a kitchen on the island of Iona, and it was a very relaxing experience.
The latest study, on which the reports were based, was done in Germany, and published in the Archives of Internal Medicine. The study took more than 1,100 people who had suffered from low back pain for more than eight years. They were split into three groups. One group got the treatment typically recommended by doctors like myself – exercise, drugs and physical therapy. Another group got acupuncture twice a week, according to the principles of Chinese medicine. The last group got sham acupuncture, superficial needles placed at non-acupuncture sites.
After six months, patients were asked how they were in terms of pain and function of their backs. Of the Chinese acupuncture group, 47.6 per cent had responded to the treatment, compared with 44.2 per cent of the sham acupuncture group, and only 27.4 per cent of the conventional treatment group.
Interestingly, “real” acupuncture is no better than sham acupuncture (the difference between the two was not statistically significant). However, both are better than conventional treatment, which is really very interesting.
The British Acupuncture Council says on its website that acupuncture, as practised by its members, is a “holistic approach to health based on over 2,000 years of development and refinement in the Far East …as much about the maintenance of health as the management of disease.”
It also says that “according to traditional Chinese philosophy, our health is dependent on the body’s motivating energy – known as qi – moving in a smooth and balanced way through a series of meridians (channels) beneath the skin. The flow of qi can be disturbed by many factors, physical, mental and emotional: anxiety, stress, anger, fear or grief, poor nutrition, weather conditions, hereditary factors, infections, poisons and trauma. By inserting fine needles into the channels of energy, an acupuncturist can stimulate the body’s own healing response and help to restore its natural balance.”
The German paper used acupuncture in accordance with these beliefs, using “traditional Chinese medicine diagnosis”. While one may strongly suspect that qi does not exist – there is no evidence for it either anatomically or physiologically – what this paper tells us is that the aforementioned diagnosis has done nothing to make these people’s back pain better. The effect of the sham acupuncture, which used shallow placing of needles at sites not typically used in Chinese acupuncture, was just as positive. It was not making qi flow again that improved these people’s back pain but something else about the use of the needles.
The improvement could, for example, be something to do with the delivery of a hands-on placebo effect. The acupuncture treatment in the study, real or sham, took 30 minutes twice a week and we know that continuity of care makes a positive difference to how people’s symptoms improve. Was it the effects of knowing that “care” was going to be regularly delivered that helped to improve how people felt about their back pain?
Or maybe it was the effects of placing a needle into the skin. Does this somehow alter the perception or transmission of pain?
I don’t know, but, for once, I do find this particular development in alternative medicine quite exciting. I am not about to start recommending acupuncture, but this study should be the start of more detailed research into how to use this effect for people with chronic back pain.
Margaret McCartney is a GP in Glasgow