Intended for healthcare professionals

Rapid response to:

Primary Care

Acupuncture for chronic headache in primary care: large, pragmatic, randomised trial

BMJ 2004; 328 doi: https://doi.org/10.1136/bmj.38029.421863.EB (Published 25 March 2004) Cite this as: BMJ 2004;328:744

Rapid Response:

What was trialed?

Properly conducted high quality trials of any healthcare intervention
are a must and properly conducted trials of therapies such as acupuncture
should be funded and conducted more often than is the current norm.

However, in this study it is difficult to assess what about
acupuncture was actually on trial. Clearly, acupuncture needles, gauge
unknown, number unknown, were inserted somewhere, to some depth, for some
time, using some acupuncture technique, for some number of treatments by
12 Physiotherapists in the patients allocated to receive acupuncture. We
also know that those physiotherapists had some training in Traditional
Chinese Medicine (TCM).

What we do not know is, whether the way the acupuncture was given at
each treatment was based upon the western diagnosis or a TCM diagnosis.
The paper does state that treatment was individualised to each patient but
does not report on how such was decided.

The study would therefore seem to be the equivalent of a trial
reporting "Any drug for chronic headache" versus some other form of care!
Would such a trial ever get ethical approval unless powered in such a way
that sub-group analysis of, at minimum, each class of drug could be
undertaken.

It would therefore seem that this trial missed a real opportunity to
make fundamental progress in our understanding about acupuncture. It
should have been powered to allow for at least some level of sub-group
analysis based upon protocoled "needle insertion plans" and or TCM
diagnosis.

Acupuncture in the UK is given by 4 groups of people- 1) those with a
recognised TCM qualification 2) GPs who have undertaken some training in
acupuncture but do not use TCM diagnosis 3) Physiotherapists without
advanced training who do not use TCM diagnosis 4) Physiotherapists with
advanced training who may or may not use a TCM diagnosis. What does each
of these groups learn from this study? I am not sure.

Competing interests:
5 years ago I undertook some consultancy for the British Acupuncture Council

Competing interests: No competing interests

05 May 2004
John Parkinson
Dept. Community Health Sciences
University of Dundee DD1 9SY