Study : Acupuncture for migraine prophylaxis

[Jonno]

Any thoughts on this:
https://www.ncbi.nlm.nih.gov/pubmed/19160193

AUTHORS' CONCLUSIONS:

In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.

[daniel1948]

Any thoughts on this:
https://www.ncbi.nlm.nih.gov/pubmed/19160193

AUTHORS' CONCLUSIONS:

In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.

Underlined emphasis mine. In other words, sham acupuncture, where they don't actually do anything, is an effective treatment and prevention of migraines.

I am skeptical.

[DevoutCatalyst]

Steven Novella covered that here,

"The results are not difficult to guess. The first two groups showed a benefit from acupuncture. Of course they did – these were unblinded studies. It is already well-established that most symptomatic interventions, acupuncture included, will have a perceived placebo effect, most notably for pain symptoms."

https://theness.com/neurologicablog/index.php/obamas-health-initiative-acupuncture-for-migraine/

Any thoughts on this:
https://www.ncbi.nlm.nih.gov/pubmed/19160193

AUTHORS' CONCLUSIONS:

In the previous version of this review, evidence in support of acupuncture for migraine prophylaxis was considered promising but insufficient. Now, with 12 additional trials, there is consistent evidence that acupuncture provides additional benefit to treatment of acute migraine attacks only or to routine care. There is no evidence for an effect of 'true' acupuncture over sham interventions, though this is difficult to interpret, as exact point location could be of limited importance. Available studies suggest that acupuncture is at least as effective as, or possibly more effective than, prophylactic drug treatment, and has fewer adverse effects. Acupuncture should be considered a treatment option for patients willing to undergo this treatment.

[Jonno]

There is an updated review:
https://www.ncbi.nlm.nih.gov/pubmed/27351677

AUTHORS' CONCLUSIONS:

The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.

[daniel1948]

There is an updated review:
https://www.ncbi.nlm.nih.gov/pubmed/27351677

AUTHORS' CONCLUSIONS:

The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.

It seems to me that Steve has covered this or something like it on the show and concluded that the studies showing any benefit are flawed, and the supposed positive results are actually below the noise. I.e, there is no benefit of acupuncture over sham acupuncture. But the placebo effect for any treatment is strong when you're just looking at subjective reporting of pain.

[Jonno]

There is an updated review:
https://www.ncbi.nlm.nih.gov/pubmed/27351677

AUTHORS' CONCLUSIONS:

The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.

It seems to me that Steve has covered this or something like it on the show and concluded that the studies showing any benefit are flawed, and the supposed positive results are actually below the noise. I.e, there is no benefit of acupuncture over sham acupuncture. But the placebo effect for any treatment is strong when you're just looking at subjective reporting of pain.

I suppose when there is a meta analysis like this that seems to show efficacy it's hard to counter when people use it to suggest therapies work.

[The Latinist]

There is an updated review:
https://www.ncbi.nlm.nih.gov/pubmed/27351677

AUTHORS' CONCLUSIONS:

The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.

It seems to me that Steve has covered this or something like it on the show and concluded that the studies showing any benefit are flawed, and the supposed positive results are actually below the noise. I.e, there is no benefit of acupuncture over sham acupuncture. But the placebo effect for any treatment is strong when you're just looking at subjective reporting of pain.

I suppose when there is a meta analysis like this that seems to show efficacy it's hard to counter when people use it to suggest therapies work.

I'm not sure what you're saying, here. But I would challenge the assertion that unblinded studies which show a small effect and an effect that is not significantly greater than placebo 'show efficacy.'

[daniel1948]

There is an updated review:
https://www.ncbi.nlm.nih.gov/pubmed/27351677

AUTHORS' CONCLUSIONS:

The available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Contrary to the previous findings, the updated evidence also suggests that there is an effect over sham, but this effect is small. The available trials also suggest that acupuncture may be at least similarly effective as treatment with prophylactic drugs. Acupuncture can be considered a treatment option for patients willing to undergo this treatment. As for other migraine treatments, long-term studies, more than one year in duration, are lacking.

It seems to me that Steve has covered this or something like it on the show and concluded that the studies showing any benefit are flawed, and the supposed positive results are actually below the noise. I.e, there is no benefit of acupuncture over sham acupuncture. But the placebo effect for any treatment is strong when you're just looking at subjective reporting of pain.

I suppose when there is a meta analysis like this that seems to show efficacy it's hard to counter when people use it to suggest therapies work.

A meta-analysis is only as good as the studies that go into it. A meta-analysis of crappy studies is not worth the paper it's printed on.

Acupuncture is nonsense because it claims to influence the flow of chi in the body. There's no such thing as chi. It claims that chi flows through channels in the body. Those channels do not exist. There are no physical structures in the body corresponding to those channels and there are no physical structures at the alleged acupuncture sites. In fact, there are many systems of acupuncture that use entirely different sites, and claim accordingly entirely different channels for the chi to flow in.

Acupuncture claims a physiological effect from the stimulation of a non-physical, spiritual "energy" flow. I put "energy" in quotes because proponents of acupuncture use the word to mean something entirely different than the dictionary definition of the word. They have no definition for what it is, therefore it is untestable. In the real world, energy is a scalar measure of the ability to do work. It isn't "stuff." It doesn't flow. The "energy" or chi of the acupuncturist is some kind of "stuff" that flows through the body (in channels that do not exist). Energy can be carried by actual stuff (gasoline, for example, or carbohydrates) but there is nothing of the sort moving in the body through the supposed acupuncture channels. In the body carriers of energy move through the blood vessels, and this flow is unaffected by acupuncture.

Acupuncture is mumbo-jumbo and the only "evidence" that it works consists of self-reported pain levels, and well-designed studies all show no difference between acupuncture and placebo.

ETA: But you will never convince an advocate of acupuncture of any of this. They will simply say "Well, I know it works."

[Sawyer]

I'd recommend anyone really curious about this go read the Science Based Medicine articles on "Methodolotry".  A lot of respectable medical schools and hospitals have sort of shot themselves in the foot with how they teach people to interpret a hierarchy of evidence-based medicine.  Most people know how to look out for and discard the lowest quality research, but unfortunately a lot of mediocre mid-tier research is still taken way too seriously.  Often with alternative medicine a single type of study will repeatedly yield positive results, and so then that kind of study is touted by the proponents as the one true way to test the specific treatment in question.  And because basic laboratory research is depicted as being inferior to any kind of clinical trials, this means that zero attention is placed on basic questions of biological plausibility.

There is no easy way to explain this problem by dissecting a single study, or even a large scale meta-analysis.  You have to fix the overall approach in which evidence from clinical trials and laboratory experiments are combined.  In an ironic twist, I'd say mainstream medicine needs to steal away the concept of "holistic" medicine from their alt-med counterparts, and learn how to look at the big picture.