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Acupuncture worse than sham acupuncture for CFS

Discussion in 'Latest ME/CFS Research' started by Simon, Aug 31, 2013.

  1. Simon

    Simon

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    This study apparently used a careful sham-acupuncture technique to effectively blind particpants to whether they were in the experimental or placebo-control group. Compared with baseline (which isn't a good comparison), there real acupuncture groups showed a moderate improvement in mental and physical fatigue, and in physical function. Unfortunately, those in the sham acupuncture (control) group improved more - the acupuncture group performed worse than controls, though it's not clear from the abstract if it was significantly worse.
    Altern Ther Health Med. 2013 Jul-Aug;19(4):21-6.
    Acupuncture for chronic fatigue syndrome: a randomized, sham-controlled trial with single-blinded design.

    Ng SM, Yiu YM.
    Source

    Department of Social Work and Social Administration, University of Hong Kong, Hong Kong, China. ngsiuman@hku.hk
    Abstract

    CONTEXT:

    Given that the etiology of chronic fatigue syndrome (CFS) is believed to be multidimensional, interventions generally have been nonspecific and typically produce only mild to moderate effects. In medical practice, treatment for CFS remains largely symptomatic. Preliminary evidence of the efficacy of acupuncture for CFS is available, but the field has lacked high-quality trials.
    OBJECTIVE:

    The research team conducted the study to determine the efficacy of acupuncture for CFS.
    DESIGN:

    A two-arm, randomized, controlled, singleblinded design was adopted.
    SETTING:

    The study took place in a teaching laboratory at the School of Chinese Medicine at the University of Hong Kong, Hong Kong, China.
    PARTICIPANTS:

    Recruited through press publicity in Hong Kong, 127 individuals--40 men and 87 women--participated in the study. Intervention Through careful implementation of sham acupuncture in the control group (CG), the study blinded all participants with regard to their experimental or control status. The treatment regime was 2 sessions/wk for 4 consecutive wk.
    OUTCOME MEASURES:

    Measures of fatigue (Chalder's Fatigue Scale), health-related quality of life (SF-12), and general mental health (GH Q-12) were taken at baseline and upon completion of treatment.
    RESULTS:

    Ninety-nine participants completed the interventions, with 50 and 49 participants in the experimental group (EG) and CG respectively. Repeated measures ANOVA revealed a significant decrease in physical (F(1,93) = 4.327; P = .040) and mental fatigue (F(1,96) = 10.451; P = .002) and improvement in the physical component score of SF-12 (F(1,93) = 4.774; P = .031). Considerable effects with Cohen's d were observed in the sham-control group: 0.92, 0.78, and 0.38 for the three scores, respectively. These positive effects could have included some therapeutic effects due to pressure on the acupuncture points from the sham needles in addition to normal placebo effects. The EG showed moderate net effect sizes with Cohen's d: 0.52, 0.63, and 0.54 for the three outcome measures, respectively.
    CONCLUSION:

    Despite considerable positive effects for the CG, the EG demonstrated significant net-effect sizes at a moderate magnitude in physical and mental fatigue and in the physical component of health-related quality of life. The impacts on general mental health outcomes appeared to be smaller.
     
    alex3619, Bob, wdb and 2 others like this.
  2. Firestormm

    Firestormm Guest

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    What the 'eck is 'sham acupuncture'? Some bloke stands behind you pretending to jab needles into your body? Or maybe blunt needles? Or needles poked into the wrong places?! :)
     
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  3. Esther12

    Esther12 Senior Member

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    And it's one of the most promising treatments currently available for CFS!

    Anyone want to pay me to jab em with stuff?
     
    dsdmom, Valentijn and Simon like this.
  4. Firestormm

    Firestormm Guest

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    I was thinking the olde Indian 'bed of nails' :snigger:
     
  5. peggy-sue

    peggy-sue

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    Another study I read about fairly recently (sorry, no references) on acupuncture found that it didn't matter whether the needles were in the correct places or not.
    I've never been convinced it's anything more than placebo - but I do have a very big "thing" about needles which might be biasing me.
     
  6. Valentijn

    Valentijn Activity Level: 3

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    Can I pay you to jab someone else with stuff? :D
     
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  7. Dolphin

    Dolphin Senior Member

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    I'm wondering whether it means that the experimental group got better results again (i.e. the cohen's d values quoted for it plus the control group results)?
     
  8. Simon

    Simon

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    It would be unusual to quote a cohen's d vs baseline for the control group and a different cohen's d (vs control) for the treatment group. Also, if the control group had an effect size of 0.92 and the treatment group had an additional 0.54, that's a whopping 1.44 effect size vs baseline for the treatment group. If that were the case, I think the abstract would have been more bullish (as opposed to being slightly confusing).
     
  9. SOC

    SOC Moderator and Senior Member

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    Question to our resident statisticians~
    Do these results simply mean that the study was just a hot mess? I'm thinking of, say, poorly controlled variables such as personality of the different person(s) doing the different treatments, or maybe not equivalent sample sets? And, of course, these are CFS (whatever that means to them) patients, and so could be a random set of people and this is just a random result. Can we tell anything from the statistics?

    Or does it just mean real acupuncture makes us feel worse? ;)
     
    L'engle likes this.
  10. L'engle

    L'engle moderate ME

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    I feel worse just thinking about acupuncture. *shudders*
     
    peggy-sue likes this.
  11. peggy-sue

    peggy-sue

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    Do you run away and lock yourself in the loo too, when threatened with long pointy bits of metal, L'engle?;)
     
    L'engle likes this.
  12. alex3619

    alex3619 Senior Member

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    I tried acupuncture in the 80s. My main goal was to deal with the increasing widespread muscle pain. It seemed to help for a day or two, but was no lasting help.

    Any needle anywhere induces a cascade of inflammatory and anti-pain effects. When substrate is used up producing some of these, it takes time to regenerate. I suspect that is what acupuncture does. So it might help with pain, but if the problem is something else entirely it may do nothing other than divert your body chemistry down a different path for a few hours.

    When we get a result that seems to show that treatment is worse than placebo that is always cause for concern.

    Given the recruitment process, how reliable is the study cohort anyway? Presumably there are more details on the recruitment criteria in the paper, but its possible that the study cohort was not a CFS cohort, and probable it was not an ME cohort.
     
    redrachel76, L'engle and SOC like this.
  13. rosie26

    rosie26 Senior Member

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    In the late 80's I had a fall at work and landed on my tail bone "ouch". As I was carrying something in both hands I couldn't save myself from the fall quick enough. Anyway I was very sore for well into a week, so I decided when I was out to go see a doctor. It wasn't my usual doctor that I saw, the doctor I think was Chinese and he suggested acupuncture might help.

    So I thought perhaps I would give it a try. I must say it was quite weird, he stuck needle like things in above each eyebrow, some around the knee area and other places I can't now remember. The funny thing was I was right as rain the next day. No more soreness, I was fine.

    I don't know whether it was the acupuncture or whether it was just my body coming right on its own. ? I have never had acupuncture since and not sure if I would again.
     
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  14. Suella

    Suella

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    It sounds like flawed study. Who did they decide to choose and how did they measure the improvements? ME/CFS is so multidimensional and so varied that I feel each of us is on a unique journey towards improvement if not recovery. We all develop the tools that work for us.

    ME is not just physical fatigue but a lowering of ability to cope with stressors in social, emotional and environmental areas too. Never mind the other symptoms...

    I used acupuncture for a while and it certainly supported my body well enough for me to return to work with pacing and rests. I then subverted the healing that had taken place by push-crashing through ignorance.

    One of my GP's has been trained to use it for pain. I use the standard acupressure point for pains of all sorts including long standing pain and am very grateful that it works for me.

    Because I have learned enough that I can generally manage my illness, I tend to cope rather than more actively work towards improvement.

    Thanks for this reminder it is well worth while returning for another acupuncture top-up.
     
    Sparrowhawk likes this.
  15. Snow Leopard

    Snow Leopard Senior Member

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    So basically, the patients received a "treatment" and rated themselves as being slightly better, even though their overall health status didn't change. It is easy to explain: humans are generally positive and like to report change even if there isn't one.
     
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  16. redrachel76

    redrachel76 Senior Member

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    I always felt worse and more tired and weak after acupucture. ...and that was when I got over my fear of the needles.
    I have got really sick of "M.E patients" telling me that they recovered or improved with it or healthy people saying it helped them so this study makes a great change. It's nice to have validation. Also your theory sound correct.
     
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  17. IreneF

    IreneF Senior Member

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    Another question--did the effect wear off? Assuming acupuncture helps you feel better (for whatever reason), do you have to keep going in for treatments?

    Even when placebos work, they don't usually work for very long.
     
    Valentijn likes this.
  18. Hope123

    Hope123 Senior Member

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    Interesting study. I'm glad they tried to do a trial at least but as usual no objective outcomes.

    I've studied acupuncture for low back pain, observed its use in China as part of a medical exchange program, and have tried it for CFS (different practictioners for extended periods of time) with little effect. On the whole acupuncture is fairly harmless to one's body and shouldn't be painful if the practitioner is good so there's no great downside to trying it except to one's pocketbook/ effort spent going back and forth to the clinic.

    Problems with trials of acupuncture for anything include:
    -- more than one style of acupuncture -- which style is used?
    -- this study is singleblinded meaning the practitioners knew who got sham vs. real - hopefully the outcomes were
    asked in a way to not allow researchers to influence the answers
    -- sham might not be so "sham" -- it's only sham in the sense that the points used are not the points dictated for the
    style of acupuncture studied but there are arguments made that sticking needles anywhere still elicit something
    -- some acupuncture experts argue that the points used must be individualized so the same points used on different
    people won't work well

    One thing I do wonder about re: CFS and acupuncture -- since people are forced to lay still for a time in a quiet room while getting it --i.e. enforced rest -- maybe that has to do with why they feel better and not the needles. How about a "just rest" control group?

    BTW, there are some good trials of traditional Chinese medicine out there -- the trials on acupressure for nausea related to pregnancy and post-cancer chemo shows it may work. But my feeling is too many people think TCM is a cure-all for too many things.
     
  19. Firestormm

    Firestormm Guest

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    All such trials should also be performed in silence. I am of the belief that what is said to the 'pin-cushion' lying semi-naked under a towel, often is the main - if not only - source of 'feeling better' and not the needles.

    Also, no incense should be used. No distractions such as 'calming music'. It should be clinical. All means of reinforcement should be kept to an absolute minimum: no chanting either! :D
     
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  20. peggy-sue

    peggy-sue

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    Acupuncture is not always safe - I have been reading documents relating to the psychological treatments that cause harm thread, and there have been several deaths from acupuncture - ranging from infections to perforated bowels and punctured lungs.


    redrachel76 , how did you get over you fear of needles?

    I've had hypnotherapy for it and can now "handle" giving a blood sample. :thumbsup:

    But only by "transferring" the adrenalin rush of my panic into a "stream-of-consciousness-load-of-twaddle-burblings"
    and if I am lying down on a bed-thing,
    and somebody is hanging on to my arm to stop me pulling myself off the needle.

    My blood pressure still goes through the roof.
    It makes a visit to the gp for a blood sample an extra incredibly difficult thing to do and recover from.
    I still could not cope with an injection of anything from a gp.
    I would be locked in the loo, sobbing again, if threatened.
     

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