All you are saying in answer to the OP is - ‘I achieved temporary relief completely in line with the placebo effect. I have no idea how it would work for anybody else’ ? Yes, technically this is relating experiences with accupuncture. I am left wondering why you posted it. If you are not saying the OP should try it, why post it? If you are not saying that the OP should not try it, why post it?
If an OP asks ‘Does anybody own an electric car?’ posting simply ‘yes’ or ‘no’ is technically an answer to that question. It is not a helpful answer. There is no reasn to post it and not include any details. But, it is technically an answer.
@DocCathode & @StringsandHammers, you are both banned from this thread. If you want to continue this argument, take it to the pit, but you’re both done hijacking this thread with a personal conflict.
Not going to keep hammering the same nail back in over and over, but will close on this subject with a couple of things.
A statement about “numerous randomized, controlled trials” of acupuncture does not equate to double blinding.
Sham acupuncture (using a device where the needle touches but does not pierce the skin) has been found in various experiments to have equivalent effects to “real” acupuncture, be slightly less “effective” or even to be superior to “real” acupuncture. Bottom line: when sham and real essentially have the same outcomes, usefulness of the intervention is highly doubtful.
When evaluating clinical trials of acupuncture* (free PubMed database searches are available), be wary of reports coming out of China, since virtually 100% of them are positive, reflecting substantial bias. The same goes for Chinese researchers studying TCM (traditional Chinese medicine).
*it’s dispiriting but not that surprising to see posters still dependent on personal testimonials and citing “Western” medicine in a disparaging way. The latter implies that researchers and patients in non-western countries rely on woo, when in fact there are highly developed evidence-based medical systems in these countries and patients who insist on them (including in China).
Because it is safer a placebo to cover than many others. It rarely does harm (except the cost) and often gives relief albeit illusory relief. From the providers viewpoint it has other value: it makes the pestering patient shut up and go away, at least for a while. So placebo benefit with no harm to the recipient and a different desired effect for the prescriber of relief from a pestering frequent flyer imploring patient. A massage from a trained, licensed massage therapist has the same “hands on” placebo effect as can Reiki but it’s much, much harder to get insurers to pay for those.
In addition to the other points: Medicare has a pretty specific list of criteria before it will be covered, and private insurance is a for-profit industry, so including bullshit coverage can potentially increase market share…
Health insurance companies know it is woo. But they also know it is a lot less expensive than seeing a specialist MD, and often the patient is satisfied with the results (due to the placebo effect). It’s a win for the patient and a win for the insurance provider.
I wonder if cannabis derived gummies or gels tinctures, what have you are prescribed and covered by Rx insurance. Probably not since it’s still illegal at the federal level. Placebo or not woo or not?
Preclinical studies demonstrate a narrow therapeutic window for cannabis as pharmacotherapy for pain; the body of clinical evidence for this indication is not as extensive. A recent meta-analysis of clinical trials of cannabis and cannabinoids for pain found modest evidence supporting the use of cannabinoid pharmacotherapy for pain. Recent epidemiological studies have provided initial evidence for a possible reduction in opioid pharmacotherapy for pain as a result of increased implementation of medical cannabis regimens.
so not necessarily woo but- As cannabis use increases in the context of medical and recreational cannabis policies, additional research to support or refute the current evidence base is essential to attempt to answer the questions that so many healthcare professionals and patients are asking.
I wouldn’t give them the credit of knowing it is woo. But it is a cheap crowd pleaser.
My pushback though is to the standard set up by @Jackmannii for blinded controlled trials. It is to no small degree a double standard. There are many things in our standard medicine toolkit that fail to have that level of evidence that few label as woo. They are covered and can be both more expensive and riskier than the acupuncture being discussed here.
Chronic back pain is horrible and people suffering it will sometimes try anything. The actual evidence of meaningful clinical efficacy for the invasive surgical intervention of lumbar fusion is crap, for example:
However, neither of these studies referenced the minimal clinically important difference (MCID) — a measure describing the threshold change in an outcome that is clinically, rather than just statistically, significant for patients. 43 , 44 The remaining three RCTs found no benefit of spinal surgery for LBP. A trial published in 2005 described a small, statistically significant, improvement with lumbar fusion that did not meet the threshold of MCID (n = 349). 40 The other two RCTs reported on a cohort of Norwegian patients with degenerative LBP (n = 64) and subsequently on an additional group of patients who had undergone previous lumbar microdiscectomy with persistent axial LBP (n = 60). 39 , 41 Neither trial found a statistically or clinically significant benefit with lumbar fusion.
And few are holding the surgical RCT to a standard of requiring the control arm have a convincing sham.
Our OP, @GailForce, is pretty typical for people suffering chronic debilitating low back pain, feeling “desperate.” Possibly they have already been doing the standard issue conservative management of NSAIDs and PT. A person desperate is unlikely to just accept living in pain because there are no interventions proven to work well by blinded RCTs. When told they are not good surgical candidates they will often keep shopping until they find someone willing to operate, offering them hope.
Which path of interventions without solid evidence would you prefer they take?
I vote giving acupuncture a try. Shit give sugar pills a chance. Try to stall moving up the more aggressive and riskier poor evidence that they work interventions ladder.
You have brought up a debatable issue: is it ethical or “right” to suggest a placebo to someone who is suffering with pain? The question is a bit outside this thread, so perhaps a GD thread should be started on this topic.
Feel free. It is not the major point I am trying to make.
The largest point is that there is far less of our standard accepted toolkit is supported by high level evidence than many of us would like to think. “Evidence based guidelines” are often full of recommendations that are acknowledged as based on low quality evidence or “expert consensus” which is no evidence at all.
I do not know for sure that acupuncture is only a placebo. I do know there is not convincing evidence it is more than placebo. But it could be and there is small risk of harm. I do not know whether lumbar fusion is only a placebo or helps in any clinically significant way. But it can cause significant harm.
If asked as a clinician I would honestly state that and be open to a patient trying the less potentially harmful unproven intervention first.
Actually, I never stated here that double-blind controlled trials were mandatory for evaluating acupuncture. I was responding to [b]DD[//b]'s dismissal of the article I posted for supposedly not including such trials and his pointing instead to a review which he claimed referenced them (what he cited did not).
It’s true that a number of widely used medical interventions have not passed rigorous, randomized double-blind controlled trials. It’s difficult to imagine, for example, surgery for gangrenous acute appendicitis being suspended until we had such evidence. A key difference between such medical interventions and acupuncture is plausibility - classical acupuncture with its theory of “chi” (or “qi”) flow lacks both plausibility and evidence.
Acupuncture, while generally safe when administered by adequately trained individuals, does come with a risk of serious adverse effects, as noted in a review by Ernst et al (pneumothorax and infections were the most frequently reported; 4 of the pneumothorax cases resulted in death). Uncommon but concerning.
There’s no one-size-fits-all remedy for chronic back pain with overwhelmingly dependable results. What one risks with resorting to woo is not just expense and risk of adverse effects, but a delay in seeking evidence-based and ultimately more beneficial therapy.
The choice is not between acupuncture and lumbar fusion. There are numerous more sensible and useful non-surgical interventions, detailed here (acupuncture is at the very end of the list).
*chronic low back pain is not an abstract issue in our household. We’ve managed to avoid quackery and woo thus far.
Randomized, controlled, double-blinded clinical trials are still pretty much the gold standard, but – because of infinitely complex and variable individual physiology – it’s risky both to extrapolate from the individual to the many and to extrapolate from the many to the individual.
Meaning: in a randomized, controlled, double-blinded trial of a cancer drug, it’s entirely possible that the drug both killed one or more participants and/or cured one or more participants.
But the goal is still to demonstrate both safety and efficacy across large groups that exceeds the threshold for the results likely having been coincidence.
Here’s a pretty concise review of what “evidence-based medicine” looks like:
It’s really much less binary and more nuanced than solely evaluating the results of one or more randomized, controlled, double-blinded clinical trials. There’s reasonably well-established and algorithmic latitude provided to health care professionals.