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Acupuncture worse than sham acupuncture for CFS

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
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.
 

peggy-sue

Senior Member
Messages
2,623
Location
Scotland
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.
 

Dolphin

Senior Member
Messages
17,567
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.

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)?
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
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)?
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).
 

SOC

Senior Member
Messages
7,849
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? ;)
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
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.
 

rosie26

Senior Member
Messages
2,446
Location
NZ
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.
 
Messages
11
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.
 

Snow Leopard

Hibernating
Messages
5,902
Location
South Australia
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.
 
Messages
758
Location
Israel
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.

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.
 

IreneF

Senior Member
Messages
1,552
Location
San Francisco
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.
 

Hope123

Senior Member
Messages
1,266
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.
 

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
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
 

peggy-sue

Senior Member
Messages
2,623
Location
Scotland
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.