Acupuncture works. If you expect it to.

Acupuncture works. If you expect it to.

I like antibiotics. They kill of the bacteria infecting my patients.  It doesn’t matter what the patient thinks about the effectiveness of the antibiotics.  They just work.  Having a practice based almost entirely in acute care medicine, most of the interventions have effect (or not) independently of patient belief concerning the interventions.

Not so with acupunctures. As I have said many times, acupuncture doesn’t work i.e. alter any underlying physiologic process. But that doesn’t mean that the innumerable forms of acupuncture don’t have an effect. They do.

 

I have mentioned in other entries the importance of expectation in acupunctures effect. Believing does make it so is an example. The more patients thought acupunctures would have an effect, the greater the response. If the patients were unenthusiastic about acupunctures efficacy, nothing happened.

There is a paper in the Clinical Journal of Pain, Psychological Covariates of Longitudinal Changes in Back-related Disability in Patients Undergoing Acupuncture that carries on that theme.

They note

Indeed, acupuncture can be conceptualized as a complex intervention in which changes in patients’ health are produced not only by needling but also by more psychosocial factors such as empathic therapeutic relationships and holistic consultations in which discussions of lifestyle and self-care can trigger changes in how patients think and feel about their symptoms and their ability to manage them.

But ask what are the psycho-social factors that lead to success or failure of acupuncture for low back pain?

They had 485 patients from 83 acupuncturists before starting acupuncture for back pain who took several questionnaires over the 6 months of their acupuncture

Interstingly, among other findings,

“People who started out with very low expectations of acupuncture – who thought it probably would not help them – were more likely to report less benefit as treatment went on.

As is often the case with the response to pseudo-medicines, rather than concluding that since the effects of acupuncture are an elaborate ritual with no intrinsic value betond placebo, perhaps it should be abandoned as useless at best and unethical at worst, they suggest teaching acupuncturists to be better at their elaborate ritual:

Dr Bishop added that to improve the effectiveness of treatment, acupuncturists should consider helping patients to think more positively about their back pain as part of their consultations…his understanding could lead in the future to better targeting of acupuncture and related therapies in order to maximise patient benefit.”

Why not keep the power of positive thinking but attach it to reality-based interventions instead of selling patients the TCM equivalent of supplements?

But researchers in pseudo-medicines are never looking to apply negative results to patient care. 

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