Some see acupuncture as a safe alternative to drugs, while others argue there's no convincing evidence of clinical benefit and potential for harm. So, should physicians recommend acupuncture for pain? Experts debate the issue in The BMJ.
Acupuncture is a safe alternative to drugs for chronic pain, argues Mike Cummings, Medical Director of the British Medical Acupuncture Society and Associate Editor of Acupuncture in Medicine, published by BMJ.
In the US, acupuncture is recommended for back pain, but in the UK, it is no longer included in the National Institute for Health and Care Excellence's (NICE) guidelines for low back pain, although it remains in the NICE guideline on headaches, he explains.
The biggest and most robust dataset for acupuncture in chronic pain comes from a review of data from 20,827 patients, showing moderate benefit for acupuncture compared with usual care, but smaller effects compared with sham acupuncture, he writes. Importantly, it also shows that 85% of the effect of acupuncture is maintained at 1 year.
Further evidence that sham acupuncture is linked to better quality of life compared with usual care for patients with chronic pain "should urge a more flexible approach from guideline developers," adds Cummings.
He acknowledges that acupuncture "seems to incur more staffing and infrastructure costs than drug based interventions, and in an era of budget restriction, cutting services is a popular short term fix." But argues that group clinics in the community "can provide more treatment at much lower cost."
Another challenge is the lack of commercial sector interest in acupuncture, he adds, meaning that it does not benefit from the lobbying seen for patented drugs and devices.
In summary, he says the pragmatic view sees acupuncture as a relatively safe and moderately effective intervention for a wide range of common chronic pain conditions.
"For those patients who choose it and who respond well, it considerably improves health related quality of life, and it has much lower long-term risk for them than non-steroidal anti-inflammatory drugs. It may be especially useful for chronic musculoskeletal pain and osteoarthritis in elderly patients, who are at particularly high risk from adverse drug reactions," he concludes.
Please click below for a contrasting view of acupuncture.
Cummings M, Hróbjartsson A, Ernst E. Head to Head: Should doctors recommend acupuncture for pain? BMJ. 2018;360:k970.
Should doctors recommend acupuncture for pain? [press release]. London, UK: BMJ Publishing Group Ltd; March 7, 2018.