Acupuncture better than standard treatments for chronic back pain

[Guest guest]

See http://www.chinesemedicinetimes.com/forum/showthread.php?t=552

[Guest guest]

Thank you for posting this study. These results are similar to what I have seen

in other studies: Random insertion works as well as targeted interventions. This

brings up a lot of questions that might shape the future of the profession: If

technique and point selection is irrelevant, what is actually the value of our

education?

It also brings up one of my soap box causes: Specific techniques, such as Tan,

may not offer any advantages, over standard treatments, and we are wasting our

money attending those seminars and buying the books.

 

Regards,

Angela Pfaffenberger, Ph.D.

 

angelapfa

 

www.InnerhealthSalem.com

 

Phone: 503 364 3022

-

Chinese Medicine

Wednesday, January 21, 2009 10:18 AM

Acupuncture better than standard treatments for chronic back

pain

 

 

See http://www.chinesemedicinetimes.com/forum/showthread.php?t=552

 

 

 

 

 

 

[Guest guest]

Wow! I have been thinking about the same thing lately. I have even

experimented on a few pt's, just popping needles in wherever vs. Dr

Tans Method. In my experience most people get a 60-100% decrease in

pain during or for a couple hours post treatment regardless of distal

style. Long term effects are really not that good, at least with the

distal approaches.

 

Its seems distal offers systemic pain relief for a short period, but

local trigger point and motor needling get better longterm results.

Its nice to combine.

 

I'm interested in other practitioners thoughts on this. Especially

Angela's statement:

" It also brings up one of my soap box causes: Specific techniques,

such as Tan, may not offer any advantages, over standard treatments,

and we are wasting our money attending those seminars and buying the

books. "

 

Sincerely,

David Vitello

 

 

Chinese Medicine , " Angela

Pfaffenberger, PH.D. " <angelapfa wrote:

>

> Thank you for posting this study. These results are similar to what

I have seen in other studies: Random insertion works as well as

targeted interventions. This brings up a lot of questions that might

shape the future of the profession: If technique and point selection

is irrelevant, what is actually the value of our education?

> It also brings up one of my soap box causes: Specific techniques,

such as Tan, may not offer any advantages, over standard treatments,

and we are wasting our money attending those seminars and buying the

books.

>

> Regards,

> Angela Pfaffenberger, Ph.D.

>

> angelapfa

>

> www.InnerhealthSalem.com

>

> Phone: 503 364 3022

> -

>

> Chinese Medicine

> Wednesday, January 21, 2009 10:18 AM

> Acupuncture better than standard treatments for

chronic back pain

>

>

> See http://www.chinesemedicinetimes.com/forum/showthread.php?t=552

>

>

>

>

>

>

[Guest guest]

Chinese Medicine , " Angela

Pfaffenberger, PH.D. " <angelapfa wrote:

>

" ...Random insertion works as well as targeted interventions. This

brings up a lot of questions that might shape the future of the

profession: If technique and point selection is irrelevant, what is

actually the value of our education?

It also brings up one of my soap box causes: Specific techniques ...

may not offer any advantages, over standard treatments ... "

 

 

Hi Angela, and all others

 

just when one study using 'active' and 'sham' shows similar results,

another pops up which challenges us all over again.

I'll post the abstract in its entirety ... below.

 

Once you've read it, perhaps the value of our education may present

itself!

 

In this study, it appears 'active' acupuncture - a technique developed

for this specific group of oncology patients - resulted in higher pain

scores than the 'sham'; the acupuncture Rx were neither empirical

[standard], nor administered to address individual TCM diagnoses.

The trial did not compare acupuncture as an adjunct to standard

alopathic pain management, ie by using a second control group.

The lack of a no-acupuncture group, and the absence of true TCM DDs &

Rx in this study, gives it little external validity.

 

Why do TCM-trained acupuncturists participate in trials devoid of TCM?

This is a worrying trend.

 

One can argue that the active acupuncture in the trial below, is also

a sham. This is consistent with a comment made by a presenter [from a

different institution] at the recent Society of Integrative Oncology

congress. The methodology of the RCT, may result in 'true' acupuncture

treatments which are more sham, than true, and sham treatments which

are more true than sham.

 

 

J Thorac Cardiovasc Surg. 2008 Dec;136(6):1464-9.

 

Randomized controlled trial of a special acupuncture technique for

pain after thoracotomy.

 

Deng G, Rusch V, Vickers A, Malhotra V, Ginex P, Downey R, Bains M,

Park B, Rizk N, Flores R, Yeung S, Cassiletha B.

 

Integrative Medicine Service, Department of Medicine, Memorial

Sloan-Kettering Cancer Center, New York, New York 10021, USA.

dengg

 

OBJECTIVE: We sought to determine whether an acupuncture technique

specially developed for a surgical oncology population (intervention)

reduces pain or analgesic use after thoracotomy compared with a sham

acupuncture technique (control). METHODS: One hundred sixty-two

patients with cancer undergoing thoracotomy were randomized to group A

(preoperative implantation of small intradermal needles that were

retained for 4 weeks) or group B (preoperative placement of sham

needles at the same schedule). The numeric rating scale of pain and

total opioid use was evaluated during the in-patient stay, and the

Brief Pain Inventory and Medication Quantification Scale were

evaluated after discharge up to 3 months after the operation. RESULTS:

The principal analysis, a comparison of Brief Pain Inventory pain

intensity scores at the 30-day follow-up, showed no significant

difference between the intervention and control groups. Pain scores

were marginally higher in the intervention group (0.05; 95% confidence

interval, 0.74 to -0.64; P = .9). There were also no statistically

significant differences between groups for secondary end points,

including chronic pain assessments at 60 and 90 days, in-patient pain,

and medication use in the hospital and after discharge. CONCLUSION: A

special acupuncture technique, as provided in this study, did not

reduce pain or use of pain medication after thoracotomy more than a

sham technique.

 

PMID: 19114190 [PubMed - in process]

[Guest guest]

yeah, I am with you. Right now none of the acupuncture schools offer a doctorate

that teaches research skills, and TCM practitioners with traditional training

tend to be excluded from most research study designs.

Here is my favorite research idea:

It's multi-site, we recruit practitioners that affiliate with a very clear

tradition such a 5 element, TCM, or Tan, and we recruit clients with newspaper

ads that have a specific condition, then we randomly assign. The practitioner is

obliged to use the tradition they feel affiliated with, but there are no other

rules, other than not to exceed a certain number of tretament sessions. Then we

hire a group of unrelated students, and they interview the clients, they obtain

pain scores, satisfaction, etc. Then we see if any particular school of thought

outperforms another, AND we include a MedicalAcupuncture person, and offer a

sham. it should not be hard or overly expensive. What bothers me is that none of

the current research really helps us as practitioners nor does it help us argue

our cause with the establishment.

 

Regards,

Angela Pfaffenberger, Ph.D.

 

angelapfa

 

www.InnerhealthSalem.com

 

Phone: 503 364 3022

-

margi.macdonald

Chinese Medicine

Wednesday, January 21, 2009 3:30 PM

Re: Acupuncture better than standard treatments for chronic

back pain

 

 

Chinese Medicine , " Angela

Pfaffenberger, PH.D. " <angelapfa wrote:

>

" ...Random insertion works as well as targeted interventions. This

brings up a lot of questions that might shape the future of the

profession: If technique and point selection is irrelevant, what is

actually the value of our education?

It also brings up one of my soap box causes: Specific techniques ...

may not offer any advantages, over standard treatments ... "

 

Hi Angela, and all others

 

just when one study using 'active' and 'sham' shows similar results,

another pops up which challenges us all over again.

I'll post the abstract in its entirety ... below.

 

Once you've read it, perhaps the value of our education may present

itself!

 

In this study, it appears 'active' acupuncture - a technique developed

for this specific group of oncology patients - resulted in higher pain

scores than the 'sham'; the acupuncture Rx were neither empirical

[standard], nor administered to address individual TCM diagnoses.

The trial did not compare acupuncture as an adjunct to standard

alopathic pain management, ie by using a second control group.

The lack of a no-acupuncture group, and the absence of true TCM DDs &

Rx in this study, gives it little external validity.

 

Why do TCM-trained acupuncturists participate in trials devoid of TCM?

This is a worrying trend.

 

One can argue that the active acupuncture in the trial below, is also

a sham. This is consistent with a comment made by a presenter [from a

different institution] at the recent Society of Integrative Oncology

congress. The methodology of the RCT, may result in 'true' acupuncture

treatments which are more sham, than true, and sham treatments which

are more true than sham.

 

J Thorac Cardiovasc Surg. 2008 Dec;136(6):1464-9.

 

Randomized controlled trial of a special acupuncture technique for

pain after thoracotomy.

 

Deng G, Rusch V, Vickers A, Malhotra V, Ginex P, Downey R, Bains M,

Park B, Rizk N, Flores R, Yeung S, Cassiletha B.

 

Integrative Medicine Service, Department of Medicine, Memorial

Sloan-Kettering Cancer Center, New York, New York 10021, USA.

dengg

 

OBJECTIVE: We sought to determine whether an acupuncture technique

specially developed for a surgical oncology population (intervention)

reduces pain or analgesic use after thoracotomy compared with a sham

acupuncture technique (control). METHODS: One hundred sixty-two

patients with cancer undergoing thoracotomy were randomized to group A

(preoperative implantation of small intradermal needles that were

retained for 4 weeks) or group B (preoperative placement of sham

needles at the same schedule). The numeric rating scale of pain and

total opioid use was evaluated during the in-patient stay, and the

Brief Pain Inventory and Medication Quantification Scale were

evaluated after discharge up to 3 months after the operation. RESULTS:

The principal analysis, a comparison of Brief Pain Inventory pain

intensity scores at the 30-day follow-up, showed no significant

difference between the intervention and control groups. Pain scores

were marginally higher in the intervention group (0.05; 95% confidence

interval, 0.74 to -0.64; P = .9). There were also no statistically

significant differences between groups for secondary end points,

including chronic pain assessments at 60 and 90 days, in-patient pain,

and medication use in the hospital and after discharge. CONCLUSION: A

special acupuncture technique, as provided in this study, did not

reduce pain or use of pain medication after thoracotomy more than a

sham technique.

 

PMID: 19114190 [PubMed - in process]

 

 

 

 

 

 

[Guest guest]

Hi everybody,

 

My apologies but I've got to come out swinging on this one. This is a very

important topic to me (an dI believe should be for all of us) because of its

potential impact. What these organisations put out are what governments are

going to make pronouncements on. I believe we should work harder to be savvy on

these topics. It is not only our personal livelihoood at stake, but our ethical

obligation to *not* allow a perfectly good and _needed_ system of medicine to be

dismantled and scattered.

When we believe or swallow results from research into CM, positive or negative,

we weaken our profession. Study what has happened in China over the past 50

years, and you'll hear many many people calling for a cease-and-desist on

research into CM because it is destroying itself.

We should not be interested in reinventing the wheel. Just because modern

science has an obsessive-compulsive's ability to grind anything into meal,

doesn't mean that we should do the same. The research has been done, and we have

system to show for it, already.

It is not our job to re-do and rebuild the system, simply to illuminate it.

Later, once we've had a lot of illumination, we may want to rebuild. But right

now, " scientifically " , we are scrabbling in the dark, not knowing where we are,

and yet making pronouncements as if we Knew What Was Going On.

Remember, we do research because we are IGNORANT.

 

Please see my review on this topic at:

http://middlemedicine.wordpress.com/articles/ (use " save link as " on the

gerac-review link to download the pdf)

Please comment, opine and so forth,

 

Thank you my friends and colleagues,

 

Hugo

 

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies..org

 

 

 

 

 

[Guest guest]

I think what we see in the studies is the failure of TCM for specific

relief of pain. I know, like many people, I've taken Dr. Tan / Master

Tung classes out of a frustration at poor results, and my results were

impressive enough after just one class that I changed my five-year old

TCM treatment style for Tan/Tung in the course of a week and never

looked back. How do I know it's more specific, i.e. more effective?

Because 1) the improvement is instantaneous, whereas before it took

days/weeks to see any changes, 2) many more patients have improved than

before - I can treat tougher cases, and 3) the spine will align itself

in response to distal needling in a way that can be objectively measured

and that is specific to the points used (i.e. the wrong KD or SI point

does nothing, the right one will straighten out the rotated vertebra

you've palpated).

So, not suprisingly, 50 year old TCM is actually a sham, and older

traditions of acupuncture are more effective for pain. But TCM has a

monopoly on research, so I won't be surprised if such poor sham/verum

studies continue to pour out of the research communities.

 

But if you don't believe me, I will gladly take your 50% nonresponsive

patients!

 

Cheers,

Ben Hawes, L.Ac.

 

 

Re: Acupuncture better than standard treatments for chronic back

pai

 

<Chinese Medicine/message/31727;_ylc=X\

3oDMTJycWZsbnFqBF9TAzk3MzU5NzE1BGdycElkAzk0OTU5NzcEZ3Jwc3BJZAMxNzA1MDYwODE0BG1zZ\

0lkAzMxNzI3BHNlYwNkbXNnBHNsawN2bXNnBHN0aW1lAzEyMzI1NzE1NDU->

 

 

 

Posted by: " Angela Pfaffenberger, PH.D. " angelapfa

 

<angelapfa?Subject=%20Re%3A%20Acupuncture%20better%20than%20s\

tandard%20treatments%20for%20chronic%20back%20pai>

apfaffenberger <http://profiles./apfaffenberger>

 

 

Wed Jan 21, 2009 11:23 am (PST)

 

Thank you for posting this study. These results are similar to what

I have seen in other studies: Random insertion works as well as

targeted interventions. This brings up a lot of questions that might

shape the future of the profession: If technique and point selection

is irrelevant, what is actually the value of our education?

It also brings up one of my soap box causes: Specific techniques,

such as Tan, may not offer any advantages, over standard treatments,

and we are wasting our money attending those seminars and buying the

books.

 

Regards,

Angela Pfaffenberger, Ph.D.

 

angelapfa <angelapfa%40comcast.net>

 

www.InnerhealthSalem.com

 

Phone: 503 364 3022

-

Chinese Medicine

<Chinese Medicine%40>

Wednesday, January 21, 2009 10:18 AM

Acupuncture better than standard treatments for

chronic back pain

 

See http://www.chinesemedicinetimes.com/forum/showthread.php?t=552

<http://www.chinesemedicinetimes.com/forum/showthread.php?t=552>

 

[Guest guest]

Ben:

" But if you don't believe me, I will gladly take your 50% nonresponsive

patients! "

 

Can I split those with you?

 

Hugo

 

 

________________________________

Hugo Ramiro

http://middlemedicine.wordpress.com

http://www.chinesemedicaltherapies.org

 

 

 

 

 

[Guest guest]

Chinese Medicine , " Angela

Pfaffenberger, PH.D. " <angelapfa wrote:

>

....This brings up a lot of questions that might shape the future of the

profession: If technique and point selection is irrelevant, what is

actually the value of our education?

 

I think we've probably all experienced having gotten different results

from different practitioners. The reality is, no two practitioners use

exactly the same depth of insertion, types of needle stimulations, or

have the same 'qi'. Even very well designed studies may yield varying

results just depending on the factors being examined. I think that

this is just good news for acupuncture, even without showing that more

conscientious point selection makes a difference. I'm sure there will

be more and more studies that just lend more support to acupuncture's

effectiveness.

 

Marie