Author Topic: Acupuncture for low back pain  (Read 1246 times)

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Offline Fast Eddie B

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Acupuncture for low back pain
« on: February 13, 2017, 07:04:40 PM »
I was just watching tonight's CBS Nightly News.

It had a segment on new guidelines for treating back pain from the American College of Physicians.

Twice they listed acupuncture.

In part:

"For chronic low back pain, consider nondrug therapy, such as exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive-behavioral therapy, or spinal manipulation (low-quality evidence)."

Full article here: http://www.medscape.com/viewarticle/875737/

I hope the show covers this and its ramifications.
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Offline His Noodliness

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Re: Acupuncture for low back pain
« Reply #1 on: February 15, 2017, 01:16:07 PM »
I was just watching tonight's CBS Nightly News. It had a segment on new guidelines for treating back pain from the American College of Physicians.


I just logged in to start a topic on what I saw on NBC Nightly news. Exact same story. A Dr. at Mt. Saini (the hospital, not the mountain where Moses performed his gig), was shown inserting needles into a patient and said the remedy was "based in science" now.

Infuriating.

Offline Crash

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Re: Acupuncture for low back pain
« Reply #2 on: February 15, 2017, 02:20:53 PM »
  I saw the same report and thought WTF.  Because of the opiate epidemic they are grasping for any substitute no matter how idiotic.  It might be my knee jerk skepticism but why does anyone think that poking needles into imaginary points will have a healing effect?  Anyone can see that someone just made that shit up. 
  There is nothing too stupid that people won't believe.  I remember as a ten year old debating with the nuns that men must have written the bible so it could be just made up shit. As far as I knew, god did not have a pair of hands. I scoffed at the divine inspiration explanation.  I never got a real answer soI never bought it.  "You're such a cynic" the nuns would say. 

Offline HanEyeAm

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Re: Acupuncture for low back pain
« Reply #3 on: February 16, 2017, 08:39:52 PM »
The hate on acupuncture is way strong on SGU. More than deserved I think.

As I mentioned on the infant acupuncture thread, there are recent meta-analyses published in reputable journals (or at least by reputable publishers) that support acupuncture:

http://aim.bmj.com/content/early/2016/07/08/acupmed-2015-010989.abstract
http://www.nature.com/articles/srep30675
https://www.ncbi.nlm.nih.gov/pubmed/28115321
https://www.ncbi.nlm.nih.gov/pubmed/27852100
https://www.ncbi.nlm.nih.gov/pubmed/27764035

Chronic pain is a funny thing... often with no obvious etiology and always subjective. Something works, for many, and whether it is placebo, touch, kind word from the acupuncturist, an NOS body response to needles, etc., there is something worth exploring.

But, yeah, meridians are butkis.


« Last Edit: February 17, 2017, 01:01:24 AM by HanEyeAm »

Offline arthwollipot

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Re: Acupuncture for low back pain
« Reply #4 on: February 17, 2017, 01:32:41 AM »
The thing which sealed acupuncture's coffin for me was the finding that sticking the needles in the wrong places was exactly as effective as sticking them in the right places.

Offline HanEyeAm

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Re: Acupuncture for low back pain
« Reply #5 on: February 17, 2017, 02:00:38 AM »
The thing which sealed acupuncture's coffin for me was the finding that sticking the needles in the wrong places was exactly as effective as sticking them in the right places.

Doesn't that make you curious about what is making it effective?

In the context of ideopathic (unknown cause) back pain, are you really going to throw out an effective treatment because you don't understand why it works? This isn't using acupuncture to cure skin cancer (for which there is a good, evidence-based alternative and the foo treatment leads to good chance of harms). If there is nothing else that works and acupuncture does, and acupuncture has no negative side effects, and the foo of meridians is not promoted as part of the treatment, why knock it? Medical research should be able to conduct research on why (i.e., uncover mechanisms) it is effective.

Offline arthwollipot

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Re: Acupuncture for low back pain
« Reply #6 on: February 17, 2017, 02:41:18 AM »
The thing which sealed acupuncture's coffin for me was the finding that sticking the needles in the wrong places was exactly as effective as sticking them in the right places.

Doesn't that make you curious about what is making it effective?

Not really, because both are also exactly as effective as not sticking needles in at all.

Offline Fast Eddie B

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Re: Acupuncture for low back pain
« Reply #7 on: February 17, 2017, 07:40:11 AM »

Doesn't that make you curious about what is making it effective?

Not really. Placebo Effect covers it pretty nicely.

Quote
In of the treatment, why knock it? Medical research should be able to conduct research on why (i.e., uncover mechanisms) it is effective.

Medical research has been done, leading to my response above.
"And what it all boils down to is that no one's really got it figured out just yet" - Alanis Morisette
• • •
"I doubt that!" - James Randi

Offline seamas

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Re: Acupuncture for low back pain
« Reply #8 on: February 17, 2017, 10:32:56 AM »
The thing which sealed acupuncture's coffin for me was the finding that sticking the needles in the wrong places was exactly as effective as sticking them in the right places.

Doesn't that make you curious about what is making it effective?

It is a gigantic leap to claim there is something effective about the intervention.

Offline HanEyeAm

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Re: Acupuncture for low back pain
« Reply #9 on: February 17, 2017, 11:24:06 AM »

Doesn't that make you curious about what is making it effective?

Not really. Placebo Effect covers it pretty nicely.

Quote
In of the treatment, why knock it? Medical research should be able to conduct research on why (i.e., uncover mechanisms) it is effective.

Medical research has been done, leading to my response above.

"Placebo effect/repsonse" is not well understood and is a catch-all term for something we assume won't have an effect but is indistinguishable from the "real" treatment. As has been shown many times over, placebos may have real effects in many, many different ways. Studying placebo response helps us better understand what is working and what isn't working. BTW, when you find the "placebo" really has an effect, it really is  no longer a placebo.

Regarding that "medical research," I'm not sure what you are referring to. Dismissing the study of a treatment that works by calling it a placebo is not really useful to the pursuit of knowledge or improving patient care.

Offline HanEyeAm

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Re: Acupuncture for low back pain
« Reply #10 on: February 17, 2017, 11:25:44 AM »
The thing which sealed acupuncture's coffin for me was the finding that sticking the needles in the wrong places was exactly as effective as sticking them in the right places.

Doesn't that make you curious about what is making it effective?

It is a gigantic leap to claim there is something effective about the intervention.

I refer you to the meta-analyses above. Acupuncture can be effective, whether we understand the mechanism or not.

Offline Fast Eddie B

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Re: Acupuncture for low back pain
« Reply #11 on: February 17, 2017, 11:39:57 AM »
BTW, when you find the "placebo" really has an effect, it really is  no longer a placebo.


I don't think that's true. We know sugar pills or twiddling toothpicks or "energy healing" all have effects above the "no treatment" groups.

That is exactly what the Placebo Effect is.
"And what it all boils down to is that no one's really got it figured out just yet" - Alanis Morisette
• • •
"I doubt that!" - James Randi

Offline Mr. Beagle

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Re: Acupuncture for low back pain
« Reply #12 on: February 17, 2017, 11:54:33 AM »
IIRC Dr. Novella stresses that the placebo effect is technically any noted effect outside of the testing branch of a study, and that the more tightly-controlled the study, the more placebo effects tend to disappear. Do I have this right?
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Offline arthwollipot

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Re: Acupuncture for low back pain
« Reply #13 on: February 17, 2017, 08:41:21 PM »
The thing which sealed acupuncture's coffin for me was the finding that sticking the needles in the wrong places was exactly as effective as sticking them in the right places.

Doesn't that make you curious about what is making it effective?

It is a gigantic leap to claim there is something effective about the intervention.

I refer you to the meta-analyses above. Acupuncture can be effective, whether we understand the mechanism or not.

Yes - it's exactly as effective as a placebo, which is to say that it's exactly as effective as a fake treatment.

Offline jt512

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Re: Acupuncture for low back pain
« Reply #14 on: February 18, 2017, 12:05:37 AM »
The thing which sealed acupuncture's coffin for me was the finding that sticking the needles in the wrong places was exactly as effective as sticking them in the right places.

Doesn't that make you curious about what is making it effective?

It is a gigantic leap to claim there is something effective about the intervention.

I refer you to the meta-analyses above. Acupuncture can be effective, whether we understand the mechanism or not.

I refer you to the meta-analyses above.

From the abstract of the first one:

Quote
Acupuncture appears effective for AMCI when used as an alternative or adjunctive treatment; however, caution must be exercised given the low methodological quality of included trials. Further, more rigorously designed studies are needed.

From the abstract of the second one:

Quote
Our review provided low-quality evidence that real acupuncture has a moderate effect (approximate 12-point reduction on the 100-mm visual analogue scale) on musculoskeletal pain.

That's as far as I got with your list.

 

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