New York Times article on Acupuncture

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The New York times published this article two days ago. Here are the details and my thoughts on this article:
A debate was fueled last week by a study for arthritis research. Researchers from MD Anderson Cancer Center in Houston found that among 455 patients with painful knee arthritis, acupuncture delivered no more relief than a sham treatment.
Actually, patients got significant pain relief from both treatments an average reduction of one point on a scale of 1 to 7. And critics contend that the study was poorly designed. 

For one thing, they note, patients in both groups received treatment with needles and electrical stimulation; the main difference was that in the sham group, the needles were not inserted as deeply and the stimulation was far shorter in duration.
In the real world, however, a trained acupuncturist would customize the treatment to a patient’s specific symptoms. But in this study, the patients in the acupuncture group all received needles inserted in the same way.
Rather than proving that acupuncture does not work, in other words, the study may suggest that it works even when administered poorly. But the real lesson, acupuncture supporters say, is how difficult it can be to apply Western research standards to an ancient healing art.

But the study’s lead author, Dr. Maria E. Suarez-Almazor, notes that the sham treatment was developed with the help of trained acupuncturists. In a drug study, an equal response in the treatment and placebo groups would prove the drug does not work, she says.
A 2007 study of 1,200 back-pain patients, financed by insurance companies in Germany, showed that about half the patients in both real and sham acupuncture groups had less pain after treatment, compared with only 27 percent of those receiving physical therapy or other traditional back care.

When the German researchers tracked how much pain medicine the patients used, they detected a noticeable difference between real acupuncture and the sham treatment. Only 15 percent of patients in the acupuncture group required extra pain drugs, compared with 34 percent in the sham group. The group receiving conventional back therapy fared even worse than those receiving fake acupuncture: 59 percent of those patients needed extra pain pills.
Another study  financed by the National Institutes of Health and published in 2004, found that acupuncture significantly reduced pain and improved function in knee arthritis patients compared with a sham treatment or routine knee care.
But that result has been called into question because the patients in the sham group probably figured out they were not getting the real thing. They received only two needle insertions in the abdomen, while a needle was simply pressed along nine areas of the leg and taped to the skin to mimic acupuncture. A mock electrical stimulation machine whirred and blinked nearby, but didn’t deliver any current to the body.

This year, researchers at Henry Ford Hospital in Detroit solved the problem of creating a sham acupuncture treatment: they didn’t have one. Instead, they compared acupuncture to a proven remedy, the drug Effexor, an antidepressant that has been shown to significantly reduce hot flashes in breast cancer patients.
The results were striking. Acupuncture relieved hot flashes just as well as Effexor, with fewer side effects. The acupuncture recipients reported more energy and even an increased sex drive, compared with women using Effexor.

Source: A version of this article appeared in print on August 24, 2010, on page D5 of the New York edition of The Times.
My take on this
Acupuncture has been successfully used for thousands of years. Acupuncture is an integral part of my practice, particularly with erectile dysfunction, interstitial cystitis and chronic prostatitis. The reductionist approach in modern western science makes it challenging to come to any scientific conclusions regarding the benefits of acupuncture. Still and all, modern science has validated the use of acupuncture to treat: arthritic pain, depression , lower back pain and chronic non-bacterial prostatitis.
Particularly with prostatitis, a condition that is agonizing for men who suffer from it, acupuncture has revealed to be exceptionally effective. This is extremely good news for prostatitis sufferers since there is limited effective conventional therapies for this disorders and often times results in frustration from the patient and their well meaning physician.

Here is the current research on acupuncture and chronic prostatitis:
This study was done in Malaysia, in a hospital with traditionally trained acupuncturists on its staff, in conjunction with the University of Washington Department of Urological Surgery. It was funded by the NIH and published in the American Journal of Medicine. There were 90 subjects randomized into two groups. They compared acupuncture at traditional points to sham acupuncture with more superficial needling 15 mm to the left of traditional points. They used no adjunctive treatments. They minimized interaction between participants and acupuncturists. They looked for a primary endpoint of a 6 point decrease from baseline to week 10 in a validated scale of symptoms, the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), and for secondary outcomes including complete resolution and decreased scores at other intervals. They found that acupuncture was twice as effective as sham acupuncture for the primary endpoint (73% vs. 48%, p=0.02) at 10 weeks, that more acupuncture patients had complete resolution of symptoms (18 vs. 10, p=0.07), and that acupuncture recipients had a greater long-term response 20 weeks after completing therapy (32% vs. 13%, p=0.04). (Lee,SW et al., 2009)

This study was done in Korea and was published in the journal Urology. It was a three-arm study comparing advice and exercise (A & E) alone to A&E plus electroacupuncture (where the acupuncture needles were electrically stimulated) to A&E plus sham acupuncture. There were only 13 men in each group. The sham acupuncture involved (1) more superficial needling, (2) placement 15 mm to the left of acupuncture points, and (3) the sound of the pulse generator without actual electrical stimulation. In the acupuncture group they found a significant reduction in the NIH-CPSI scores for pain, but no reduction in the scores for urinary symptoms or quality of life. On another scale, the International Prostate Symptoms Score, there were no significant differences.
There was also some correlation between prostatitis symptoms and prostaglandin E and beta endorphin levels, so they measured these in post-massage urine samples. They found a significant decrease in prostaglandin level in the electroacupuncture group (p=0.023) and a non-significant increase in the other two groups. (Lee SH, LeeBC, Urology 2009)
Another study Acupuncture was performed using disposable stainless steel needles, which were inserted into the bilateral BL-33 points and rotated manually every 10 minutes for 30 minutes. The treatment was repeated every week for 5 weeks without other therapeutic maneuvers
RESULTS: No side effects were recognized throughout the treatment period. The average pain and QOL scores of the NIH-CPSI 1 week after the 5th acupuncture treatment decreased significantly (P < 0.05 and P < 0.01, respectively) compared with the baseline. The maximum width of the sonolucent zone 1 week after the 5th treatment also decreased significantly (P < 0.01, compared with the baseline). Intrapelvic venous congestion demonstrated by MR venography was significantly improved in four patients.(Honjo H et al 2004)

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by Dr. Geo

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