Acupuncture: Can Needles Relieve Your Pain?
Acupuncture has been around for a long time. Despite this, we know very little about the effect of treatment. To find out the truth about the old form of treatment, researchers have had to stage an illusion with false needles and ignorant patients.
Science gives its verdict:
Needles cushion back pain
Very few acupuncture studies meet the basic requirements of credible science. It's difficult to decide whether the form of treatment works or not. Larger analyzes that have gone through the best-performing studies suggest that acupuncture can have a positive effect on some diseases, such as pain and side effects of chemotherapy.
Well substantiated effect
- No diseases.
- Nausea after chemotherapy and surgery
- Chronic back pain
Lack of evidence
- menstrual pain
- Alzheimer's disease
- Irritable colon
- tennis elbow
The patient trembles with excitement. He has been suffering from back pain for several years, and the doctors have not been able to do much about it.
The patient is half-naked and with his eyes closed on a comfortable bench. A gentle hand touches his legs, and he feels a small stick and a slight twitching in his skin. Patiently and systematically, the hand moves over his body and stops at carefully selected points on his hands, feet, scalp, and arms. His whole body tingles, and he feels a slight soreness spread.
The patient is with an acupuncturist who has now stuck twelve thin needles, four millimeters into his skin at various points on the body. When he comes home, he has a feeling that the treatment has worked. He feels that it does not hurt as much in the back as it did the day before.
Over the past twelve months, 5% of Europe’s population have been treated with acupuncture or similar acupressure treatment, where they press with a finger instead of a needle. It shows a Finnish study from 2018.
Another explanation is much more likely – and it could undermine the whole basis of acupuncture. According to it, the improvements in the patient’s symptoms are due to the so-called placebo effect. Here, it is exclusively the soothing words of the acupuncturist and the patient’s expectation that the treatment should work that relieves the pain – the needles themselves have no effect.
The placebo effect is a well-documented phenomenon but is not a cure. Generally, the result is limited and short-lived, and it can rarely be measured with any greater certainty. It appears in conventional as well as alternative treatments – but in the traditional, it is accompanied by a well-founded and tangible medical effect.
Is Acupuncture Pure Placebo? The question is surprisingly difficult to answer. To find an answer, scientists must stage an illusion. They will do a study in which some patients are stung with needles while others do not – but where neither the patients nor the acupuncturists who manage the needles know who is receiving which treatment.
In this way, everyone experiences the same placebo effect, and the researchers can determine if the needle stick has any real medical effect.
Needles control energy currents
Acupuncture has been around for years. It appears in Chinese writings from about 200 BC, but finds of pins of bone or stone may mean that the method has been used even earlier. Today, acupuncture is respected and widely used in China, and Chinese medical students are given a thorough introduction to acupuncture.
The traditional philosophy behind acupuncture is that the body should be seen as a whole where there must be a steadiness between the two opposite energies, yin, and yang. If an imbalance occurs in the body, the person becomes ill.
The yin and yang energies are collectively called qi, and the energy stream flows between the organs through a network of channels, so-called meridians, on the surface of the body. By placing needles at specific points, so-called acupuncture points, the acupuncturist can regulate the energy flow through the meridians, and thus the body should regain its balance.
In practice, acupuncture is usually done with sterile stainless steel needles that are less than half a millimeter thick. Conditional to the thickness of the fat layer, the needles are inserted 2–8 millimeters through the skin, and where they should sit for almost half an hour. The needle stick itself does not hurt but can cause a slight cramp or tenderness. The treatment should usually be repeated several times every few days before the patient feels any effect.
Neither researchers nor acupuncturists have been able to demonstrate that there are any energy streams, meridians, or acupuncture points. This does not necessarily mean that acupuncture does not work.
Many doctors with regular medical education do not want to deny that acupuncture can be used advantageously as an alternative to regular painkillers or to counteract nausea after chemotherapy. And in many hospitals around the world – among other things in Scandinavia – doctors occasionally use acupuncture. But what does the evidence say?
The studies are poorly executed
In 2009, the English physician Edzard Ernst went through 32 scientific studies that had analyzed up to 26 acupuncture trials in humans.
The 34 studies included 240 trials described as randomized blind trials with a placebo control, trials in which the subjects were randomly divided into two groups. One group receiving acupuncture, and one is receiving ineffective treatment – and where individuals did not know which group they Included in.
These types of tests, if performed correctly, are among the most reliable in medical science.
Edzard Ernst’s review showed that 25 of the 32 parent studies failed to show that acupuncture was better than the so-called placebo treatment. Two of the studies did not come to any conclusion at all, and only five concluded that acupuncture could have a real effect on patients’ health.
The only conditions in which acupuncture had any effect were head and back pain, nausea following chemotherapy and surgery, and incontinence. The effects should be taken with a pinch of salt, as most trials do not meet basic medical test requirements.
In 2018, Professor Xin Sun of Sichuan University in China carefully examined 318 acupuncture attempts in the seams. All trials referred to the effect of acupuncture on knee osteoarthritis, and all trials were reported to be randomized with placebo control.
Xin Sun’s analysis revealed, among other things, that less than five percent of the trials described the distribution in the acupuncture and placebo group – so it is doubtful if they are randomized trials.
One problem was also that only about eight percent of the trials had defined in advance how they would assess any improvements.
The problem is that there are many ways to measure improvement: the patient’s feelings, the physician’s assessment of the pain level, or changes in the patient’s ability to move. If the treatment does not work, most of these parameters are unchanged, but some may show improvements or deteriorations by chance.
If the researchers only measure them together, they can ultimately select the most favorable results and thus give a false picture of the effect of the treatment.
The false needle should deceive acupuncturists
Xin Sun’s review shows that the vast majority of acupuncture attempts are poorly performed – and their results are not credible. However, some researchers have sought to deliver more accurate acupuncture tests, but they have encountered a seemingly insoluble problem.
To obtain the most credible assessment of the effect of the treatment, the researchers should conduct a so-called double-blind study. In such a study, patients do not know if they are receiving acupuncture or placebo.
Equally important is that the acupuncturist also does not know what treatment he is giving. If he knows this, he may consciously or unconsciously behave differently to patients in one group and thus make the placebo effect greater or less in that group.
The researchers now want to try to invent a form of a false needle that can deceive both patients and the acupuncturist. One of the suggestions, which is considered the best, is a needle that is not sharp enough to penetrate the skin and is equipped with a spring mechanism so that the needle can go up into the shaft when pressed against the skin. However, a test of this type of needle has shown that the illusion does not deceive all patients and virtually no acupuncturist.
A useful illusion is crucial to the results of the trial. It revealed statistician Andrew Vickers at the Memorial Sloan Kettering Cancer Center in the United States.
In 2018, he analyzed 39 studies of acupuncture, which together comprised 20,000 subjects, and concluded that treatment could be more effective than a placebo in alleviating pain. The most exciting thing about the analysis, however, was that this difference in perceived pain relief became smaller and smaller the better the attempts were to trick the placebo patients into believing that they were receiving proper acupuncture treatment.
Vicker’s results show that a large part of the pain-relieving effect of acupuncture depends only on the subjects’ belief that they receive acupuncture. It also seems to indicate that the needles provide extra relief that is more than just a placebo effect. If that is true, it is not possible to determine until researchers succeed in inventing a false needle that can completely deceive both patients and acupuncturists.
However, the idea that needles can relieve pain is supported by a completely different type of study – experiments on mice.
Needle signals to the brain
A research team with Danish neurobiologist Maiken Nedergaard at the head examined in 2010 what happens in the body of mice when a needle is inserted into the skin and swirled around – just like in acupuncture.
The researchers revealed an increase in the amount of adenosine in the tissue around the needle. Adenosine acts as a neurotransmitter that, among other things, helps cells repair tissue after injury. It also has an apparent effect on the nerve cells that send pain signals to the brain.
Nedergaard discovered that adenosine blocks pain signals in mice so that the brain’s pain center is not activated as much as before.
In the experiment, the acupuncture-treated mice reacted less to, among other things, high heat, which was painful for other mice.
To ensure that the effect was not a form of placebo effect triggered by the entire treatment process, the researchers developed genetically modified mice whose nerve cells did not respond to adenosine. They received the same acupuncture treatment as the normal mice but did not experience any pain relief. Thus, the researchers could, with some certainty, rule out that the effect was pure placebo.
Later, Maiken Nedergaard has also shown that acupuncture, even in humans, triggers a local increase in the amount of adenosine around the needle.
This increase depends on where on the body the needle is inserted and whether it is twisted or not. It is still unclear whether increasing adenosine has the same analgesic effect as in mice.
Besides, in mice, the effect was short-lived – less than a day – so although adenosine works in the same way in humans, it is not certain that it is relevant for patients who want a more lasting treatment for their pain.