A look at the evidence for acupuncture in pain, infertility, and asthma treatment by the Science Based Medicine Club.

1. Acupuncture
UBC Students for Science Based Medicine
UBC SBM

2. UBC SBM
What I’ll Cover
• Acupuncture
– History, Definition, and Basis in Traditional Chinese Medicine
• What does the research say about acupuncture for …
– Nausea?
– Pain?
– Infertility?
– Asthma?

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History: Unclear

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History
1800 CE
• Connection
1000 CE between electricity
and nerves made
• Professionalized
1600 CE
• Circulatory system fully
described
• Reproduction not
understood.

5. What is acupuncture?
BC Health Professions Act:
Traditional Chinese Medicine Practitioners
and Acupuncturists Regulation
Acupuncture
is an act of stimulation, by means of
needles, of specific sites on the skin, to
promote, maintain, restore or improve
health, to prevent a disorder, disease or to
alleviate pain and includes
A. Needles: mechanical, thermal,
electrical
B. Lasers & magnets
C. Burning dried leaves (moxibustion)
UBC SBM

6. UBC SBM
What is Acupuncture?
College of TCM Practitioners and Acupuncturists
of BC
• Acupuncture is a procedure in Traditional Chinese
Medicine.
• TCM grows out of Daoism (religion/philosophy):
– Yin/Yang (bright/dark)
– Five Elements

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What is Acupuncture?

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Acupuncture Basics
• Scientists in China divided on whether meridian
system is relevant
• Current research does not strongly support the idea
that there is something unique about acupuncture
points or that meridians exist
1) Sampson, WI (September/October 1996). "Traditional Medicine and Pseudoscience in China: A Report of the Second
CSICOP Delegation (Part 2)". Skeptical Inquirer 20 (5).
1) Langevin, H. M., & Yandow, J. A. (2002). Relationship of acupuncture points and meridians to connective tissue planes. THE
ANATOMICAL RECORD (NEW ANAT.), 269, 257-265. Retrieved from http://www.uvm.edu/annb/faculty/PDFs/257.pdf

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Research
• There’s a lot of research out
there

10. Levels of Research
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Why reviews have different results
• Reasons why reviews come up with different
conclusions:
– No one likes publishing negative studies, so positive studies are
overrepresented
– Different statistical formulas
– Different studies

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Nausea
2008 2009
(10 studies) (40 studies)
Acupuncture
Abraham, J. (2008). "Acupressure and acupuncture in preventing and managing postoperative nausea and
vomiting in adults". Journal of perioperative practice 18 (12): 543–551.
Lee A, Fan, LTY (2009). Lee, Anna. ed. "Stimulation of the wrist acupuncture point P6 for preventing postoperative
nausea and vomiting". Cochrane Database of Systematic Reviews (Online) (2): CD003281.

13. UBC SBM
Nausea: Conclusion
• Acupuncture at wrist helps with nausea
after surgery
• But
– No difference between needles and pressure
– Not better than present medication
– Only tested nausea after surgery
• Not food poisoning or motion sickness

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Pain
Somewhat unclear
Conflicting Evidence

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Pain
Review of
reviews
Review 1 Review 2 Review 3 Review 4 Review 5
Individual Studies
Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review
of reviews." Pain 152 (4): 755–764.

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Pain: Review of reviews
• Migraines
• Tension Headaches
• Rheumatoid Arthritis
• Cancer Pain
• Fibromyalgia (long term body wide pain)
• Muscular-skeletal Pain
• Shoulder Pain
• During Surgery Pain
• After Surgery Pain
• Jaw Joint Pain
• Sciatica (leg pain)
• Neck Pain
• Low Back Pain
• Osteoarthritis
Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review
of reviews." Pain 152 (4): 755–764.

17. UBC SBM
Pain: Chronic Low-Back Pain
People who experienced
pain reduction
40
30
20
10
0
Acupuncture Fake No
Acupuncture Treatment
• But
– Short term only (3 months)
– Not better than conventional therapies
Furlan, Andrea D; Van Tulder, Maurits W; Cherkin, Dan; Tsukayama, Hiroshi; Lao, Lixing; Koes, Bart W; Berman,
Brian M (2005). Furlan, Andrea D. ed. "Acupuncture and dry-needling for low back pain" (PDF). Cochrane
Database Syst Rev (1): CD001351.

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Pain: Review of reviews
• Migraines
• Tension Headaches
• Rheumatoid Arthritis
• Cancer Pain
• Fibromyalgia (long term body wide pain)
• Muscular-skeletal Pain
• Shoulder Pain
• During Surgery Pain
• After Surgery Pain
• Jaw Joint Pain
• Sciatica (leg pain)
• Neck Pain
• Low Back Pain
• Osteoarthritis
Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review
of reviews." Pain 152 (4): 755–764.

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Pain: Conclusion
1. Small pain reduction in some types of
pain, no reduction in most other types
1. Little or no difference between
acupuncture and fake acupuncture

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Infertility

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Infertility
Review 1 Review 2 Review 3 Review 4
(2008) (2008) (2009) (2011)
More
Pregnancies
More
Babies

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Infertility: Conclusion
• Conclusion:
– There is conflicting evidence about whether acupuncture treats
infertility
– Most reviews suggest acupuncture does not increase odds of
giving birth

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Asthma
• Long term lung disease.
• Reversible breathing difficulty.
• Often, but not always, caused
by allergies.
• 250,000 deaths/year
worldwide (GINA, 2009)
"Global Strategy for Asthma Management and Prevention 2010
(update)" (PDF). Global Initiative for Asthma. 2010.

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Asthma
• Review 1 (2002):
– “The current analysis did not find evidence of the efficacy of acupuncture in the
treatment of patients with asthma”
• Review 2 (2002):
– “There is not enough evidence to make recommendations about the value of
acupuncture in asthma treatment.”
Linde K, Jobst K, Panton J. Acupuncture for chronicasthma (Cochrane Review). The Cochrane Library, Issue 2. Oxford,
Update Software, 2002.
Martin J, Donaldson AN, Villarroel R, Parmar MKB, Ernst E, Higginson IJ. Efficacy of acupuncture in asthma: systematic
review and meta-analysis of published data from 11 randomised controlled trials. The European Respiratory Journal.
2002;20(4):846–852.

25. Placebo Effect:
Does it really help?
Feeling Better Getting Better
Wechsler ME, Kelley JM, Boyd IO, Dutile S, Marigowda G, et al. (2011) Active albuterol or placebo, sham acupuncture, or no
intervention in asthma. N Engl J Med 365: 119–126.

26. Acupuncture Conclusion: UBC SBM
Benefits
Subjective Objective
After Surgery Nausea Infertility
– Acupuncture at wrist seems to – Latest review says fertility does
help not increase chance of having a
– No difference between needles baby
and pressure
Asthma
Pain Weak
- - – Best evidence does not
Evidence is weak
- – Comparable to conventional
Both fake acupuncture and real – support it’s use
Existing therapies prevent death
therapies
acupuncture have small effect - Conventional therapies
- – Those therapies aren’ttypes of
Mostly equal for most great much better (Asthma)
to begin with
pain - No competing therapy (IVF)
– For some types of pain real - Except IVF is a therapy
acupuncture seems to be better itself that does help
than fake acupuncture but with infertility
there’s conflicting evidence

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Acupuncture Conclusion:
Risks and side effects
– Bacterial and viral infections
• Non sterile needling
• Small risk, but still real
– Trauma
• Not bleeding (surprisingly)
• Pain, headache, numbness
• Pneumothorax
• Death
Ernst, E.; Lee, M. S.; Choi, T. Y. (2011). "Acupuncture: Does it alleviate pain and are there serious risks? A review of
reviews" (pdf). Pain 152 (4): 755–764.

28. Concluding Statements
• Acupuncture:
– minor benefits, evidence generally weak
– minor to major risks
– has been studied for decades and still no clear effect
– If acupuncture were a drug it would not make it to
market and would be abandoned
• Alternative Medicine
• Controversial to recommend
UBC SBM

29. Works Cited
1. Manheimer, E., Zhang, G., Udoff, L., et al., 2008. Effects ofacupuncture on rates of pregnancy and
live birth among womenundergoing in vitro fertilization: systematic review andmeta-analysis. British
Medical Journal 336, 545–549.
2. El-Toukhy, T., Sunkara, S.K., Khairy, M., et al., 2008. A systematicreview and meta-analysis of
acupuncture in in vitro fertilization.British Journal of Obstetrics and Gynaecology 10, 1203–1213.
3. Sunkara, S.K., Coomarasamy, A., Khalaf, Y., El-Toukhy, T., 2009.Acupuncture and in vitro
fertilization: updated meta-analysis.Human Reproduction 24, 2047–2048.
4. Moy I, Milad MP, Barnes R, Confino E, Kazer RR, Zhang X. Randomized controlled trial: effects of
acupuncture on pregnancy rates in women undergoing in vitro fertilization. Fertil Steril.
2011;95:583–7. doi: 10.1016/j.fertnstert.2010.05.024

30. Acupuncture
By Ratib Islam
UBC Students for Science Based Medicine
UBC SBM