Is acupuncture evidence based?
Awareness and acceptance of acupuncture is at an all-time high and still increasing year on year. I see a wider variety of people in my clinics and I get more referrals from GPs with a growing variety of conditions. However, there can still be the perception that acupuncture is not effective, not based on evidence or just some kind of (super) elaborate placebo. So, I thought I’d compile this blog on just how well acupuncture is evidenced, because it is. More and more so, each year.
Exponential growth in research
In a study by Ma et al. (2016) research trends of acupuncture were analysed over the last 20 years. They found that acupuncture research is growing at an exponential rate with, on average, a 10.7% increase each year. To put that in context, biomedicine, as a whole, is only growing at an average rate of 4.5%. So, acupuncture research is growing twice as fast as biomedicine. They also discovered that the quality of research is improving, this was mainly seen in the proportion of randomized controlled trials compared to all trials. This went from 7.4% in 1995 to 20.3% by 2015. They also noted a wider range of journals accepting acupuncture publications. All of which points towards a better understanding of acupunctures benefits and mechanism and, as a result, its acceptance.
Better quality of evidence
Part of the increase in research has been the publication of mega studies. Studies that have thousands, or even tens of thousands of participants, instead of hundreds. These provide much more robust statistical evidence. The most notable piece is MacPherson et al. (2017) which included nearly 18,000 participants. They compared acupuncture to sham and standard medical treatments for neck and back pain, headache and migraine and osteoarthritis of the knee and concluded, ‘We found acupuncture to be more than simply a placebo as it was more effective than sham acupuncture, with sham acupuncture consisting of needling that did not penetrate the skin or needling at the wrong points. Acupuncture was also found to be better than standard medical care for all of these chronic pain conditions [my emphasis].’ This not only shows that acupuncture is effective, they also showed it was cost effective for many of the conditions studied. Research of this calibre gives a huge boost to the evidence base of acupuncture and allows health-care providers and policy makers to consider acupuncture for national health services. Something that can only be done with evidence based medicine.
As well as large pieces of research, there are more and more systematic reviews of acupuncture for certain conditions. Even the Cochrane collaboration, the most respected, and indeed conservative, research group in biomedicine, has begun to publish positive findings for acupuncture. Something they only do when the evidence base for a certain area is large enough and of a high enough quality. For migraine they state, ‘The available evidence suggests that a course of acupuncture consisting of at least six treatment sessions can be a valuable option for people with migraine.’ However, there are other areas they state the quality of the evidence is not high enough to draw definitive conclusions.
On top of all this evidence there have now been a few comprehensive reviews of acupuncture, where all data for all conditions is analysed and conclusions drawn. The first, in 1997, was conducted by The World Health Organisation and recommended acupuncture for over 100 conditions (click here to see the full list). The most recent, 2017, was conducted by the Acupuncture Evidence Project and now includes even more conditions, including many pain conditions as well as insomnia, anxiety, depression. They also note acupunctures ability to regulate female reproductive function, gastrointestinal function, bladder function and circulation. (click here to see my summary of the research).
International medical organisations recommend acupuncture
As a result of all of this high-quality evidence acupuncture is recommended for a large range of conditions by many international institutions. In Australia acupuncture has been included in clinical guidelines for a variety of pain conditions including post-operative pain and rotator cuff syndrome. In America The American College of Physicians has recently recommended acupuncture for back pain. In the UK there are clinical guidelines for headache and migraine and osteoarthritis of the knee. Indeed, in 2015 a symposium in South Korea found over 870 recommendations for over 100 conditions in 30 different countries.
To make this evidence more accessible and clear to the public evidence based acupuncture was created. This is a website with a huge resource of research and plain English summaries of the research for different areas of acupuncture, breaking them down into broad areas like the nervous system, the circulatory system, etc, which makes it even easier to access the information that is important for you. It includes the mechanisms that are being discovered and help us understand how and why acupuncture is effective for such a wider range on conditions.
The main compiler of this information, Mel Hopper Koppleman, has also put together a simple video that explains some of the best research into acupuncture.
So next time someone tries to tell you acupuncture doesn’t work or isn’t evidenced based or is even an elaborate placebo, you can let them know that, actually, it is scientifically proven to be more than placebo. It is effective for many pain conditions as well as a wide variety of other conditions. It is at least as effective as standard medical treatment, if not more, for some conditions, and it is recommended by The World Health Organisations amongst many other national and international health organisations.