Acupuncture for chronic headache in primary care: large, pragmatic, randomised trialBMJ 2004; 328 doi: https://doi.org/10.1136/bmj.38029.421863.EB (Published 25 March 2004) Cite this as: BMJ 2004;328:744
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We acupuncturists know the actuality of this finding and this, among
others, gives us great satisfaction in our work. Often working with
individuals who've undergone various and sometimes extensive other forms
of intervention acupuncture provides dependable therapy in many cases.
If, besides acupuncture, we examine energetic etiology, look
carefully at behaviors and undesirable responses to food, enviromental
toxins, hypertonic states of unrelenting natures, we often can give logic
for a clients personal re-creation of their living ways such that the
headaches no longer are fed their necessary "food". This becomes
delightful indeed as people once reduced and limited with chronic
headaches literally become free. It is gratifying to see Andrew Vickers
et. al. find the outcomes they have.
Competing interests: No competing interests
Acupuncture is not a placebo intervention. It is subcutaneous and
often intramuscular insertion of a fine needle at any of 2,000 (or more)
sites. It is a mechanically induced trauma with puported distantly
projected benefits rationalized by an oriental philosophy of care that
predates both our understanding of "western" medicine and the scientific
In this study treatment accords with teaching of current day
acupunture advocates and was "individualised to each patient and were at
the discretion of the acupuncturist". "Acupuncturists in the study had
completed a minimum of 250 hours of postgraduate training in acupuncture,
which included theory and practice of traditional Chinese medicine".
This BMJ trial indicates that the measurable outcome of those
receiving subcutaneous needle insertion, compared to those not receiving
the needling, does not affect the number of visits to health care
practioners (General practitioner, Specialist, Complementary therapist) or
the number of days off sick, by a difference accountable for by chance
ranging from a P value of 0.1 - 0.8. Despite this lack of statistical
significance the article states "Table 4 shows data on use of resources.
Patients in the acupuncture group made fewer visits to general
practitioners and complementary practitioners than those not receiving
acupuncture and took fewer days off sick." This is misleading.
Pain related scores benefited from needle insertion. In fact, "The
effects of acupuncture seem to be long lasting; although few patients
continued to receive acupuncture after the initial three month treatment
period (25, 10, and 6 patientsreceived treatment after 3, 6, and 9,
months, respectively), headache scores were lower at 12 months than at the
follow up after treatment." This is puzzling, but may be in part explained
by a survivor effect.
Although there were equal numbers of patients lost from the
acupuncture arm of the trial (54) compared to the non acupuncture group
(56), withdrawals from acupuncture because the treatment was either,
ineffective, adverse or inconvenient in the acupuncture group (12)
compared to zero in the regular care group. Note that nonresponders
remained in the other group. This bias was not addressed.
Given the modest improvement demonstrated, this trial demonstrates
the relative safety of the intervention, not the benefits. As in many
studies of an intervention purporting benefit there is no true control
group receiving "sham" intervention, in this case acupuncture. It is also
not stated if additional traditional chinese therapies were used.
The patient population is striking for being overwhelmingly female
(83 - 86%) with two decade history of headache. How this might be
generalizeable to other groups is not addressed other than indicating
acupuncture should be considered as part of NHS.
Among the other concerns one might raise in this specific study is
the minimal data on the groups. Data for weight, BP, or activity/exercise
intervention is not presented. The lack of description of intercurrent
treatment other than the statement "Use of medication use fell by 23% in
controls but by 37% in the acupuncture group (adjusted difference between
groups 15%; 95% confidence interval 3%, 27%; P = 0.01)." may further
confound the outcome.
E. Klimek MD
145 Queenston Street Suite 301
St. Catharines, Ontario Canada
Postal Code L2R 2Z9
Competing interests: No competing interests