Should Doctors Recommend Acupuncture For Pain?

Some see acupuncture as a safe alternative to drugs, while others argue there’s no convincing evidence of clinical benefit and potential for harm. So should doctors recommend acupuncture for pain? Experts debate the issue in The BMJ today.

Acupuncture is a safe alternative to drugs for chronic pain, argues Mike Cummings, Medical Director of the British Medical Acupuncture Society and Associate Editor of the journal Acupuncture in Medicine, published by BMJ.

In the US, acupuncture is recommended for back pain, but in the UK, it is no longer included in the National Institute for Health and Care Excellence’s (NICE) guidelines for low back pain, although it remains in the NICE guideline on headaches, he explains.

He acknowledges that acupuncture “seems to incur more staffing and infrastructure costs than drug based interventions, and in an era of budget restriction, cutting services is a popular short term fix.” But argues that group clinics in the community “can provide more treatment at much lower cost.”

Acupuncture enthusiasts often emphasise “pragmatic” comparisons between acupuncture and usual care. However, they argue that “unblinded pragmatic trials cannot differentiate possible true effects of acupuncture from placebo effects and bias.” To inform us reliably of any causal relation between acupuncture and effect, “we need to focus on adequately blinded “explanatory” acupuncture trials,” they say.

“If acupuncture is endorsed as a theatrical placebo we should be discussing the ethics of placebo interventions, not the elusive effect of acupuncture,” they add.

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