Re: Acupuncture for Headaches

On Jul 25, 9:20 pm, "Peter Moran" <pmo...@xxxxxxxxxxxxxxxx> wrote:
"The One True Zhen Jue" <Andrew_King...@xxxxxxxxx> wrote in messagenews:1185400267.903810.55210@xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
I doubt if headache meets Richard Schultz's classification as a
disease. Regardless, its a condition that can be debilitating.
Often, headache sufferers will use OTC's & Rx meds with varying or
little success.

Once again, for the reading comprehension impaired, people who seek
out Acupuncture have a long history of headaches. They have tried
mainstream methods. IF they had simple to treat headaches, they would
not be seeking treatment, they'd be living pain free and going on with
their lives. For those who suffer from the most difficult to treat
headaches, Acupuncture may well be their alternative to suffering.

I've cited a couple of studies done recently and in a first-world
medical system. These are not anecdotes from the Forbidden City!

<snip the interesting studies>

PM These are largely predictable results from the addition of any kind of
medical attention to routine care. I would expect similar results with
sham acupuncture, with therapeutic touch, or massage, or connection to a
magical mystical machine, or neck manipulation. (In fact similar results
have been reported with the latter but the small risk of stroke makes it an
unsuitable treatment for a condition likely to require recurrent
interventions.) .

Three questions arise. 1. What is the true scientific implication of these
studies? For all we know they may merely reflect patient reporting biases
i.e. the patients were not blinded as to how they are being managed, and may
be simply expressing gratitude for the additional medical attentions, or
resentment if they discovered they were not being offered it. Or, they may
reflect a true placebo reaction to the extra medical attention. Or, lying
down in a relaxed nurturing environment for half an hour a week may be
enough to help stress-related headaches in some , or allow for
introspective re-evaluation of maladaptive illness behaviour in others. Or
perhaps acupuncture has some kind of residual counterirritant effect --
needle sites are bound to sometimes be sore for a while from bruising.

I'll accept that patients may respond to treatment for reasons other
than the actual nature of the treatment itself. That happens even
with meds that have proven efficacy. That happens even with surgical
procedures that have proven efficacy. So, proven efficacy and placebo
are not mutally exclusive. What is much different about the average
acupuncture patient is that they have usually tried everything in
conventional medicine. They have had their condition for years, often
decades. It is fair to say that their condtions are very enduring and
not very susceptible to mainstream therapies. The fact the these most
difficult cases respond so well is often remarkable.

If, on the other hand, we were mostly treating the low-hanging fruit
that shows up in many private medical practices, you could make that
argument. Almost by definition, people enrolled in acupuncture
studies have the most enduring & resistant conditions. After all,
what asymptomatic person would be enrolled in such a study?

Yes, it is much harder to evaluate Acupuncture than most other
therapies. One of the main problems is that experimental design
usually has every patient get the same treatment and for the same
length of time. That is NOT how its done in the real world. Unlike
medical experimenters, Acupuncturists differentially diagnose patients
and choose the points based on that presentation of symptoms and the
characteristics of the individual patient.

http://consensus.nih.gov/1997/1997Acupuncture107html.htm


2. What the studies don't do is provide any support for the precepts of TCM
or the existence of meridia, acupuncture points or chi..

This isn't what the experiments are designed to test. Even so, the
fact that you don't understand TCM terms in their context does not in
any way mean that are less valid than medical terms like immune
system. BTW, have you ever seen an immune system? No, because there
is NO such separate entity, its just a term to describe a wide variety
of tissues, humoral secretions, etc that may protect the organism.
Have you ever seen, touched, or treated "anger"? Does anger not exist
because you can't isolate it from the body or is it a term with
contextual value? I think you'll agree that anger is real and the
effects thereof are also real. Qi is an abstraction, one with great
contextual value.

If you disagree, then tell me, is HIV a deficiency in the skin? No?
Does it mean that their saliva is deficient? No? Well, according to
the accepted definition of the immune system, skin & saliva are parts
of it. I guess you'll say that I'm using the term improperly or out
of context.


3. The third question is a somewhat independent one of whether such results
support acunpuncture as a cost effective element in the management of
headache, whatever the basis of the reported benefits. Answering that
question might need a longer term impartial re-evaluation of these patients
to determine whether there has been any lasting improvement in health
status.


Acupuncture is not only cost-effective, its down right cheap! While
Richard thinks Duke University is offering it because of the money, he
neglects the fact that acupuncture is about the least expensive
procedure you can get there. I _think_ its $75 per treatment, not a
lot of money considering the University hospital setting and the
effects.

"The study suggests that acupuncture leads to persisting, clinically
relevant benefits for primary care patients with chronic headache,
particularly migraine. It is relatively cost-effective compared with a
number of other interventions provided by the NHS."

http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=15527670&ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum

Acupuncture of chronic headache disorders in primary care: randomised
controlled trial and economic analysis.Vickers AJ, Rees RW, Zollman
CE, McCarney R, Smith CM, Ellis N, Fisher P, Van Haselen R, Wonderling
D, Grieve R.
Integrative Medicine Service, Biostatistics Service, Memorial Sloan-
Kettering Cancer Center, New York, USA.

OBJECTIVES: To determine the effects of a policy of using acupuncture,
compared with a policy of avoiding acupuncture, on headache in primary
care patients with chronic headache disorders. The effects of
acupuncture on medication use, quality of life, resource use and days
off sick in this population and the cost-effectiveness of acupuncture
were also examined. DESIGN: Randomised, controlled trial. SETTING:
General practices in England and Wales. PARTICIPANTS: The study
included 401 patients with chronic headache disorder, predominantly
migraine. INTERVENTIONS: Patients were randomly allocated to receive
up to 12 acupuncture treatments over 3 months or to a control
intervention offering usual care. MAIN OUTCOME MEASURES: Outcome
measures included headache score; assessment of Short Form 36 (SF-36)
health status and use of medication at baseline, 3 months and 12
months; assessment of use of resources every 3 months; and assessment
of incremental cost per quality-adjusted life-year (QALY) gained.
RESULTS: Headache score at 12 months, the primary end-point, was lower
in the acupuncture group than in controls. The adjusted difference
between means was 4.6. This result was robust to sensitivity analysis
incorporating imputation for missing data. Patients in the acupuncture
group experienced the equivalent of 22 fewer days of headache per
year. SF-36 data favoured acupuncture, although differences reached
significance only for physical role functioning, energy and change in
health. Compared with controls, patients randomised to acupuncture
used 15% less medication, made 25% fewer visits to GPs and took 15%
fewer days off sick. Total costs during the 1-year period of the study
were on average higher for the acupuncture group than for controls
because of the acupuncture practitioners' costs. The mean health gain
from acupuncture during the year of the trial was 0.021 QALYs, leading
to a base-case estimate of GBP9180 per QALY gained. This result was
robust to sensitivity analysis. Cost per QALY dropped substantially
when the analysis incorporated likely QALY differences for the years
after the trial. CONCLUSIONS: The study suggests that acupuncture
leads to persisting, clinically relevant benefits for primary care
patients with chronic headache, particularly migraine. It is
relatively cost-effective compared with a number of other
interventions provided by the NHS. Further studies could examine the
duration of acupuncture effects beyond 1 year and the relative benefit
to patients with migraine with compared to tension-type headache.
Trials are also warranted examining the effectiveness and cost-
effectiveness of acupuncture in patients with headache receiving more
aggressive pharmacological management.

PMID: 15527670 [PubMed - indexed for MEDLINE]


Peter Moran


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