Chronic pain and joint issue management is also not an abstract issue in mine. Not just low back pain. My wife has Ehlers Danlos Syndrome. More surgeries than I want to count from head to ankle, no period of time in multiple decades not in PT. Many other interventions to various results. But of course if she’s done it it is not a true woo.
I personally don’t care about the plausibility argument. Often things that work with a plausible basis actually work but not by way of that plausible mechanism. In my clinical lifetime theophylline in asthma care was the best example. It was standard in my training days. And it was held up as working by way of a phosphodiesterase cascade. Which was actually not how it worked. (More by central brain and diaphragmatic mechanisms as it turned out, but we had no idea of that then.) What mattered though was how well it worked vs what the potential side effects and risks were, not that we had no idea how it actually was working. It went out of favor simply because other interventions worked better with less risk.
Less is not none. Of course there is a nonzero risk with acupuncture. And clearly less risk than other many unproven interventions. And to be fair, adverse outcomes occur with chronic NSAID use sometimes too.
I do not see acupuncture as ever being done instead of other interventions of proven efficacy and low risk. Of course active rest, activity modification, and low kk risk pain relief come first. I am a bit shocked that your list includes kyphoplasty higher than PT? I would also be curious as to how good the evidence basis for say radio frequency ablation is.
But would you seriously object to someone trying acupuncture after PT has not provided relief rather than moving immediately onto an infusion pump nerve ablation or fusion? I personally was supportive when my wife tried that along with ongoing PT rather than surgery.
@DavidNRockies I am extremely familiar with evidence based medicine guidelines and the grades of the strength of the evidence and recommendations. Part of the process not highlighted in your link is that stronger evidence should be required for recommending an intervention of significant possible harm and cost and less is required for recommending one that is likely relatively benign. Your link does discuss respecting patient values and preferences.
IMHO @GailForce should, if they have not already, avail themself of low risk interventions like PT. Acupuncture as an adjunct to that, or before doing something more aggressive, is fine, with full recognition that its efficacy is neither proven or disproven and that is not completely risk free. I would as clinician share, as I did as spouse, my full skepticism about the woo of how it works, and would be loud if it was being used instead of a proven and fairly low risk better choice, or had high risk or cost itself.
Oh for kicks! Evidence based guidelines for low back pain:
For chronic LBP, the guidelines recommended therapeutic exercise, the use of NSAIDs, spinal manipulation, and acupuncture.
So WTF are spinal manipulation and acupuncture doing there? I suspect due to low risk and cost more than any evidence of benefit. But again there are tons of expensive procedures done with little evidence of efficacy over conservative management with few calling them woo. More people getting angry when insurance companies don’t want to cover them
… but that has been other threads!
Oh. To the op, @GailForce. Personally I’d suggest your next step as seeing a physiatrist, a western medical doctor who specializes in physical medicine and rehabilitation. It is a specific residency. They can fully evaluate and design a best possible treatment plan. That plan will likely include PT (sometimes with strong opinions on whom) and they do sometimes recommend trying acupuncture as a low risk intervention. If they do then they will be able to recommend decent people near you.
Some aches and pains are common (not unavoidable) parts of aging; disability does not need to be. Get knowledgeable nondismissive care.
Science-based medicine does tend to get hung up on plausibility, especially when there’s a lack of good evidence that an intervention is effective.
It turns out that there are a bunch of therapies for stuck or improperly flowing qi, not just acupuncture. And they can be done remotely, like on a Zoom call.
This particular enthusiast (on Healthline, which I now view in a somewhat different light than formerly), doesn’t seem worried about plausibility.
Might want to look into other non-invasive modalities like specific exercises and activity modification before moving immediately into woo.
Your suggestion about seeing a physiatrist/physical medicine and rehabilitation specialist is good, though potential patients should be reassured that such an M.D. is not necessarily (as you put it) a “western medical doctor”. The specialty is well-regarded in “eastern” countries as well.
Whether acupuncture is “woo” also depends on who uses it, and how.
If a physician inserts acupuncture needles into the back for back pain, it’s probably legitimate. Some of them also use electrical stimulation along with it. However, if they’re the kind of person who sticks the needles in, for instance, your ear, that’s woo.
A physician may insert needles for a scientific reason, but that doesn’t make what she is doing “acupuncture”, any more then studying the stars makes an astronomer an astrologist.
I’ve known loads of doctors, surgeons, PAs and NPs.
They come at me with a needle it better be to get blood, or give me western medicine.
I don’t think I’ve ever met a real medical doctor that actually would have given acupuncture treatments.
I haven’t met all the quacks in the world, though.
I am not sure what you mean by “legitimate.” As has been repeatedly stated in this thread, there’s no scientific evidence that acupuncture works. The best you can say about it is that it’s a placebo.
Worthy of its own discussion perhaps. My perspective is that observation and testing of whether or not an intervention’s possible benefit is greater than its possible risks is the key pillar, even when we are clueless or even flat out wrong as to what the mechanism of action is. Understanding the mechanism of what we observe advances the science but is not required to apply the intervention. Yes, we are appropriately biased to believe things that are consistent with our current models and understanding, but the body is a complicated beast. The theophylline story is a fairly common theme: often our science based stories for how things work are later discovered to be fantasy, but our not understanding the true mechanism of action did not make them work less well.
Heh. More a “western medicine” doctor turn of phrase? What should be the best way to say that? “Allopathic”? Does the general public consistently understand that phrasing?
Completely agree that activity modification and a guided exercise program should be the first step, which in my mind is best guided by a decent PT.
This is on several levels an inaccurate statement. There is evidence that acupuncture works and it would be graded as low strength level evidence: it is far from convincing evidence, but fairly few of the interventions available for chronic low back pain have evidence that is of much higher strength, even if they seem more plausible. And many of these other unproven interventions have much higher risk levels. Do not forget that “lack of evidence is not evidence of lack.” It may be working by placebo effect, or it may effective for reasons “we” do not fully understand (although there are non-woo potential mechanisms proposed).
We can help the general public understand that science-based medicine (SBM) is practiced around the world, and that physicians in “western”/developed countries have no monopoly on it.
“Allopathic”, a term similarly used by alt med proponents to sneeringly refer to SBM, is misused to an even greater extent. It was invented by Hahnemann (the father of homeopathy) in the 19th century to describe medical practice that aimed to counter deleterious signs and symptoms with treaments producing opposing effects (for instance, prescribing a laxative to relieve constipation), while homeopathy depends on using substances that if present in sufficient amount would increase deleterious signs and symptoms, but because in most cases they’ve been diluted out of existence, they’re supposed to be healing/curative.
By that definition, most alt med treatments including the vast majority of herbalism are “allopathic” (but alties do not like it when they’re characterized as such).
Bottom line: “allopathic” is largely a derogatory term without value, even though it occasionally crops up in mainstream medical discourse. Supposedly (though I can’t find the original reference in the literature) allopathy was defined in a report published by the W.H.O. in 2001 as "the broad category of medical practice that is sometimes called Western medicine, biomedicine, evidence-based medicine, or modern medicine”.
In other words, “stuff alties don’t like”. Best to follow Tim Minchin and just call it “medicine”.
I am partial to the “science based medicine” moniker but I think that cuts us in the western tradition trained medicine approach way too much slack. There is simply too much of what we in the western medicine tradition have done and still do that is far from science or evidence based. Lots of what is learned in training is simply because it is the way it has been done, or at least as local truth to the program. Or based on anecdotal experiences at best.
I think we need to honest about how much of what we believe works has very weak level evidence to support it, and really only has “plausibility” and “consensus” to justify it. At least we would if we really were “science based.”
@Jackmannii the only places I have read “allopathic medicine” is in mainstream medical journals. FWIW. I want a medicine word that differentiates between what I believe because it fits plausibility and what I am highly skeptical because as of now there is no plausibility argument. Solid evidence for and against apply to both.
The placebo effect is recognized science. It has been proven to work. Time and again double blind tests show that the placebo effect produces better results than no treatment at all. Unfortunately it’s efficacy is severely limited by it’s non-systemic application.
There are plenty personal preferences people associate with particular doctors, specialties, treatments, etc., even how a physician dresses and whether they walk around with a stethoscope draped over their shoulder.
Quoted for truth. Acupuncture is quackery. Mild stretching exercises, of the type easily found on YouTube, works wonders and will save you a trip to the doctor. Or have your doctor refer you to physical therapists, who are miracle workers. We go to half-hour exercise sessions three times a week, taught by a physical therapist, and our back and joint issues are minimal. Something as simple as a pelvic tilt exercise can do wonders.
Let’s be very clear and repetitive: exercise therapy, often guided by a physical therapist, is my preferred approach to chronic low pain, with better strength of efficacy than other interventions including acupuncture, and much lower risk than many other options that some jump to when it fails.
But it might surprise that the actual evidence for even minimally clinically significant efficacy is not so strong even for that. Cochrane review. The best it gets is “probably” on subgroup analysis.
The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
Be aware of how witnessing of how well it has worked for you plays in the context.
It is the best we got. But even some of its efficacy may actually just turn out to be getting better with time and placebo.
I haven’t read all of the previous replies, so I apologize if this is redundant… I used acupuncture for a different condition (because I was desperate) and it really helped a lot. My acupuncturist was certified by the National Certification Commission for Acupuncture and Oriental Medicine and licensed by the state where I live. She has a degree in Traditional Oriental Medicine and has other education history related to sports medicine.
So if you’re interested, give it a try, it can’t do any damage and it might really help you. Just make sure the person is licensed and certified.
It hardly seems that the best way to address that is to embrace woo.
Really? When I see it, the vast majority of the time it’s being used in a pejorative
sense by promoters of quackery*. A typical theme is that the bad “allopathic” doctors just treat symptoms, while holistic alties address the root cause of illness (in reality, alt med favors fanciful and erroneous conceptions of “root causes” and consistently fails to alleviate symptoms).
It may be a hopeless task to get you to stop referring to science-based medicine as “western”, which implies that Eastern/Asian physicians aren’t concerned with following science-based practices.**
*this “Dr.” practices craniosacral therapy (widely regarded as quackery) listing a PhD in Energetic and Transformational Healing (betcha you don’t have that qualification).
**One of the physicians I follow on Twitter is an Indian hepatologist with a strong interest in opposing health quackery, particularly the use of Ayurvedic remedies which can cause serious liver damage and liver failure. I don’t know if he’d be more amused or offended at the notion that he’s a devotee of “western” medicine.
