I’ve never seen any convincing evidence of the effectiveness of acupuncture for treating pain.
Edzard Ernst, emeritus professor in Complementary Medicine at Exeter University, and the UK’s preeminent expert, goes further, saying: “Doctors should not recommend acupuncture for pain because there is insufficient evidence it is clinically worthwhile.”
Cochrane Reviews are the gold standard for proving medical effectiveness. There have been 12 of them on acupuncture for pain and not one of them has shown an effect beyond placebo in a raft of conditions.
These include lower back pain, rheumatoid arthritis, cancer pain, dysmenorrhoea, lateral elbow pain, endometriosis, peripheral joint osteoarthritis, prevention of migraine and tension type headache, shoulder pain, fibromyalgia, and pain in labour.
The reviews on back pain, migraine, and tension headache considered acupuncture as a possible treatment but were based mostly on trials with non-blinded patients.
This weakens the results because patients knew they were receiving acupuncture which itself has a placebo effect. Effects beyond placebo were “small”.
Many trials are weak, that is, given to error. Patient blinding, crucial for meaningful results, is often inadequate in acupuncture trials resulting in small to moderate false positives.
As Professor Ernst explains in the British Medical Journal, acupuncture is often regarded as harmless. Needling, however, may cause side effects such as pain, haemorrhages, infection, pneumothorax (rupture of the lung) and even death.
In Denmark, for instance, four cases of pneumothorax, one fatal, were revealed in 2017. Such complications might be rare, but gathering exact numbers is stymied by unreliable information.
In robust trials side effects are noted meticulously but in acupuncture trials under-reporting of harm is extensive.
For example, in a review of back pain, only 14 of 35 trials reported on harms (5% of patients receiving acupuncture and none of those receiving placebo).
The cost of acupuncture to the NHS isn’t peanuts, sessions range from £25 to £70. The total cost to the NHS may be £25million a year, though reliable figures are hard to come by.
Health services funded by taxpayers should use their limited resources for treatments that are proven.
Even now no one is certain of how acupuncture might work. Theories of nerve stimulation and endorphin production have never been proven.
Professor Ernst’s conclusion, after decades of research, is: “We still have no clear mechanism of action, insufficient evidence for clinically worthwhile benefit, and possible harms. Therefore, doctors should not recommend acupuncture for pain.”