UK researchers have found the pain relieving effects of acupuncture compared with placebo are small and seem to lack any clinical relevance, questioning both the traditional foundation of acupuncture and the prevailing theory that acupuncture has an important effect on pain in general. The study reviewed clinical trials of acupuncture treatment for pain that included acupuncture, placebo acupuncture, or no acupuncture and found only a small analgesic effect of acupuncture that the authors say seemed to lack clinical relevance and could not be clearly distinguished from bias. 

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Professor Alan Bensoussan is Executive Director of the National Institute of Complementary Medicine

“This is an interesting study with a new approach to evaluating the difference between sham and real acupuncture.

We have known for more that two decades that stimulating any part of the body with acupuncture needles will lead to neurological responses that may create pain relief. The question has been whether real acupuncture intervention offers any additional benefit.

To demonstrate the difference between real or sham acupuncture treatments you need to have a large scale trial with more patients. This review only included 13 studies, three of which administered treatment for only one day.

In general, treatments with more patients and longer treatment periods appeared to generate better outcomes and the authors failed to report this.”

Professor Marc Cohen is Professor of Complementary Medicine at RMIT University in Melbourne. He has a medical degree and a PhD in traditional Chinese medicine and is an expert advisor to the Therapeutic Goods Administration’s Complementary Medicine Evaluation Committee.

“This study is severely limited by the fact that there is no definition for placebo acupuncture – or even any standardised form of acupuncture. Unlike drug treatments for pain, it is very difficult to blind acupuncture trials – doctors know when they are giving it and patients generally know when they are receiving it.

Pain is not a single entity and most trials have been done on chronic pain, which is a complex condition. The problem is that placebo acupuncture still works and trials see a reduction in drug therapy with either placebo or real acupuncture. Pain involves both mental and physical aspects but patients don’t care about separating out physiological and psychological components – they want pain relief and acupuncture seems to provide this.

A NHMRC funded multi-centre trial of acupuncture for acute pain relief in emergency departments is currently underway though RMIT University and two Melbourne hospitals.”

Professor Charlie Xue is Head of the Division of Chinese Medicine at the School of Health Sciences, RMIT University

“Madsen and colleagues raise a very important question concerning whether or not acupuncture is of significant benefit in the management of pain through a systematic review of 13 trials. Unfortunately, however, the review is not conclusive and further investigation is needed.

For any systematic review of this nature, readers need to be extremely cautious about the quality of the studies that were included. In this review the quality of the studies varies widely. Chronic pain is a complex condition. This review lumps headache, knee pain, back pain and pain experienced during colonoscopy in one study and this limits the rigor of any conclusions.
The included studies employed various forms of acupuncture procedures and different frequency and duration of treatment, which further limits the value of any findings.

Acupuncture represents a broad range of practices that may use manual needling or electro-acupuncture on different points. This review failed to inform readers whether the treatments used in these studies are consistent and replicable. The question raised by the authors will need to be answered by multi-centre, larger sample size trials. However there are still no validated placebo controls for acupuncture and no standardised treatment protocols for specific conditions, which limits the ability of systematic reviews to produce conclusive results.”

Professor Allan Bretag, Sansom Institute, University of South Australia

“It is known that all pain is bad and should be avoided if it is possible to do so. After all, the major physiological purpose of pain is to learn from the experience and if a baby isn’t going to learn from it, then why put it through the pain?

Australian hospitals need to improve pain management for newborns. There is no reason whatsoever why analgesic methods should not be used. Alternative forms of pain relief for babies such as sucking on sugar solutions are well known and if they are not being used for newborns around the country then they should be. I was surprised to note a majority of respondents thought sucrose or other sweet tasting solutions were not safe or they were not sure of their safety. It is particularly disappointing to see the states of South Australia and Tasmania did not seem to use any form of analgesia for most of the procedures mentioned in the Gray paper.

While there’s not any way of testing whether babies feel pain any differently from adults, adults are clearly more capable of causing a fuss.”

Professor Alison Garton, School of Psychology, Edith Cowan University, WA

“I agree that pain in newborn infants is often unrecognised. Both of these studies included specific procedures where pain would be expected (from an adult perspective) and found that the use of analgesics was not widespread. This is concerning enough. But of more concern is the lack of awareness of the researchers of the papers, and possibly the staff in neonatal units, of other types of pain, perhaps chronic, that infants may have.

Infants cannot express their pain in the same way as adults, although they do cry, but low grade, longer lasting pain may cause discomfort and not elicit crying. Thus it may go unrecognised. Infants can feel burning, throbbing and cramping pain, but cannot tell us about it. We do not know of any discomfort, although there may be behavioural cues such as muscle tension, poor sleep patterns, not eating and irritation. Better recognition of pain in infants, and not just acute pain as described in these research studies, may raise awareness of ways to soothe and manage pain in infants by parents and neonatal medical and nursing staff.”