How Researchers Reached The Flawed Conclusion That Acupuncture Doesn’t Help With Knee Pain

Recommended by HealthPAIN RELIEF from http://www.prevention.com/health/health-concerns/acupunctures-effect-knee-pain
How Researchers Reached The Flawed Conclusion That Acupuncture Doesn’t Help With Knee Pain By MARYGRACE TAYLOR SEPTEMBER 30, 2014
The effects of acupuncture on knee pain

Picture this scenario: An adult plagued with chronic headaches seeks relief by popping ibuprofen a few times a week. The meds help. Then she decides to stop taking them. And when she does, the pain creeps back.

Surprised? Not exactly. The last thing you’d deduce from this imaginary experiment is that ibuprofen doesn’t help with headaches. But that’s basically what researchers suggested about needle and laser acupuncture’s effect on chronic knee pain in a new JAMA study.

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In the clinical trial, 282 adults age 50 and older with chronic knee pain were randomly assigned to needle or laser acupuncture treatments or a sham laser acupuncture treatment. After 12 weeks, participants who received the acupuncture reported modest improvements in pain. Then the treatments stopped, and nine months later, the participants had knee pain again. This, weirdly, led the researchers to conclude that acupuncture just doesn’t offer relief from chronic knee pain.

Sounds confusing, right? Save for undergoing surgery, most chronic pain problems can never really be permanently solved. Even for treatments that make the discomfort vanish, it tends to come back once said treatment stops. That’s sort of a given. “Acupuncture can be used as pain management, but it doesn’t necessarily heal the pain permanently,” says Michelle Goebel-Angel, licensed acupuncturist at Chicago’s Raby Institute for Integrative Medicine at Northwestern.

There’s more. The researchers of this small study posit that having a larger sample size might have yielded more significant results. Which is exactly what experts uncovered in 2012 meta-analysis of nearly 18,000 patients, which found that needle acupuncture does help with osteoarthritis, as well as other types of chronic pain.

Still, like many treatments, acupuncture doesn’t have the same effect on everyone. But it’s absolutely worth trying, and tends to be the type of thing where the benefits accumulate over time (as in, longer than 12 weeks). “When patients feel the relief, they believe it,” says Goebel-Angel. “And that opens a new level of healing—the spiritual aspect of healing.”

MORE: 12 Odd Pain Relief Tricks That Work

Tags: NEWSDOCTORS & MEDICINEHEALTH HABITS & MISTAKES

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Chinese-Doctors-Poke-Holes-in-Australian-Study

AcupunctureToday.com Interview Chinese-Doctors-Poke-Holes-in-Australian-Study 063015

http://www.acupuncturetoday.com/mpacms/at/article.php?id=33043

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Acupuncture for knee osteoarthritis: reply by Hinman et al still denies real benefits for patients

• Adrian R White, Honorary University Fellow ; Mike Cummings,Plymouth University

http://acupmed.bmjjournals.com/content/33/1/86/reply

We thank Hinman and her colleagues for their considered reply to our letter. We accept that our approach was more informal than their response, but in our defence, we were writing originally for the audience of a general journal, rather than for methodologist and statisticians.

The main point we wished to make concerns the decision to power a study without any reference to previous literature or pilot data within the setting adopted. Of course it seems superficially justified to adopt a minimum change that you wish to measure (in this case a difference over sham of 1.8 on a 10 point scale), but if this difference has never been achieved in previous research it seems odd to invest so much unless the intention was to provide evidence of a lack of effect for acupuncture and laser acupuncture. More….http://acupmed.bmjjournals.com/content/33/1/86/reply

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The methodology flaws in Hinman’s acupuncture clinical trial, Part III: Sample size calculation

The methodology flaws in Hinman’s acupuncture clinical trial, Part III: Sample size calculation

April 6, 2015 | Arthur Yin Fan | J Integr Med 2015; 13 (4) : 209–211

doi: 10.1016/S2095-4964(15)60184-4

ABSTRACT | FULL TEXT | PDF |

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A patient’s comments on JAMA report- Hinman’s Acupuncture trial in Australia for chronic knee pain

1. POSTED OCTOBER 13TH, 2014 AT 7:07 PM 
   From Harvard medical school-Harvard Health Publications.
   http://www.health.harvard.edu/blog/acupuncture-knee-arthritis-fails-one-test-may-still-worth-try-201410017470

   Quick Care Walk-In Medical Clinic
   Although acupuncture is indeed not endorsed by the medical community, some of our patients do report successful treatments. Thank you for an informative article.
   • POSTED OCTOBER 15TH, 2014 AT 2:23 AM

     Kino
     This is silly! many doctors ‘work’ with Acupuncture, Kinesiology, Chiropractic and more. Many in the medical profession are disillusioned by the ‘a pill for every ill and hide the symptoms’ attitude to disease which the AMA forces them to work with.
     In an editorial in the highly esteemed ‘British Medical Journal’, titled ‘Where is the Wisdom? The Poverty of Medical Evidence, BMJ’s editor Dr. Richard Smith recounts a lecture he attended with renowned health policy consultant Dr. David Eddy.Eddy found, after doing significant research, that only about 13% of medical interventions are supported by solid scientific evidence and that only 1% of the articles in medical journals are scientifically sound.Why is that? Because most of those articles quote from other articles which make unsupported and unfounded claims.

     The High Risks of the Medical Approach

     Dr. Lucian Leape, researcher at the Harvard Medical School of Public Health, also states that only 13% of medical procedures have ever been tested for appropriateness by randomized trials.
     He noted that adverse events occurred in 3.7 percent of all hospitalizations. Worse yet, 13.6 percent of those adverse events led to death!
     He is quoted as saying, “Medicine is now a high risk industry, like aviation.
     But, the chance of dying in an aviation accident is one in 2 million, while the risk of dying from a medical accident is one in 200!”
     I think I’ll take acupuncture anytime!

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The methodology flaws in Hinman’s acupuncture clinical trial, Part II: Zelen design and effectiveness dilutions

The methodology flaws in Hinman’s acupuncture clinical trial, Part II: Zelen design and effectiveness dilutions.

Click to access S2095-4964(15)60172-8.pdf

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Rana Hinman’s Acupuncture Clinical Trial has too many methodology flaws (IV)-The sham laser acupuncture is not a valid negative control for acupuncture

Rana Hinman’s Acupuncture Clinical Trial has too many methodology flaws (IV)-The sham laser acupuncture is not a valid negative control for acupuncture.

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Rana Hinman’s Acupuncture Clinical Trial has too many methodology Flaws (III)-There is a crucial mistake in interpreting the Hypothesis testing – What means? if P>0.05.

Rana Hinman’s Acupuncture Clinical Trial has too many methodology Flaws (III)-There is a crucial mistake in interpreting the Hypothesis testing – What means? if P>0.05..

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The methodology flaws in Hinman’s acupuncture clinical trial, Part I: Design and results interpretation. J Integr Med 2015; 13 (2) : 65–68

The methodology flaws in Hinman’s acupuncture clinical trial, Part I: Design and results interpretation. J Integr Med 2015; 13 (2) : 65–68.

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Letters to JAMA Exposing Acupuncture Research Flaws Applauded by TCMAAA (from http://www.marketwatch.com)

Letters to JAMA Exposing Acupuncture Research Flaws Applauded by TCMAAA

http://www.marketwatch.com/story/letters-to-jama-exposing-acupuncture-research-flaws-applauded-by-tcmaaa-2015-02-19

Published: Feb 19, 2015 8:01 a.m. ET

TCMAAA calls for stricter adherence to research ethics and well-designed acupuncture studies among the integrative medicine community

TAMPA, Fla., Feb 19, 2015 (BUSINESS WIRE) — In five letters to the editor published in the latest issue of JAMA, the Journal of the American Medical Association, acupuncture clinicians and researchers around the world point to key flaws that call into question the validity and research methods used in a randomized clinical trial published in JAMA in October of 2014. The Australian study, Acupuncture for chronic knee pain: a randomized clinical trial, by Hinman, et al., concluded, “In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function. Our findings do not support acupuncture for these patients.” Many American acupuncturists were outraged when the October 2014 article was published in JAMA and have called for a review of the study’s design and protocols.

Yong Ming Li, MD, Ph.D., of New Jersey challenges that the researchers altered the aims and hypotheses of the study after the data was collected and the trial was closed. According to the original aims and hypotheses submitted to the official clinical trials registry in 2009 the objective of the study was not to evaluate the effectiveness of traditional needle acupuncture against sham laser acupuncture, but to evaluate laser acupuncture against sham laser acupuncture with needle acupuncture serving as a positive control for laser acupuncture. Protocols originally filed with the registry as well as the authors’ baseline publication do not describe sham laser acupuncture as being a control for needle acupuncture. Dr. Li’s letter furthermore debates the validity of using sham laser acupuncture as a control for needle acupuncture, as it is not generally accepted as a valid control for needle acupuncture.

Hongjian He, AP, Ph.D., of Florida also questions design choices: she specifically points to the use of non-standardized point selection for chronic knee pain. Also some patients received treatments once a week, while others got treated twice a week. This lack of consistency throws into question the validity of the statistics extrapolated from the data collected during the study.

David Baxter, TD, DPhil, MBA, and Steve Tumilty, Ph.D., questioned in their letters why the researchers chose to use laser dosages below the threshold necessary to have a therapeutic effect and why they failed to specify wavelength used in the study and why those levels were chosen.

Lixing Lao, Ph.D., MB, and Dr. Wing-Fai Yeung, BCM, Ph.D., point out in their letter that patients were assessed after 12 weeks and then again after one year, but that without treatment for chronic knee pain after one year, the condition naturally will deteriorate, so that the findings after a year are irrelevant. With these key flaws revealed the conclusion of this randomized clinical trial is clearly undermined.

No group has been more involved in this issue than the Traditional Chinese Medicine American Alumni Association (TCMAAA). Through its broad social media in the USA and around the world, TCMAAA has orchestrated a series of professional forums and discussions on research ethics and design for acupuncture studies after the Australian study was published in JAMA.

“This collection of letters represents a merging of licensed acupuncturists and integrative medicine practitioners who demand the same gold standards of ethics and design quality for clinical acupuncture research as conventional medical studies,” stated Haihe Tian, Ph.D., AP., the President of TCMAAA.

Even with the challenges acupuncture poses in gold-standard randomized clinical trials this valuable treatment method should not be overlooked. With properly designed and well-thought-out studies acupuncture can be evaluated fairly and thoroughly, with conclusions founded upon careful reasoning, accepted controls, and irrefutable evidence.

About TCMAAA:

Registered in Florida, TCMAAA (website: http://www.tcmaaa.org) is a nonprofit organization with one thousand members of licensed acupuncture practitioners formally trained in accredited medical education institutions in China. As a leading organization among Chinese Medicine practitioners, TCMAAA continues to support its members’ professional growth across the United States.

SOURCE: TCMAAA

For TCMAAA
Selene Hausman, L.Ac., 480-510-2259
seleneph@gmail.com

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