How to understand acupuncture research, and the annoying nuances to take into consideration

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I’ve gotta point out to you, that real-life acupuncture is not really anything like science-studies-research-acupuncture. And the number of times I’ve felt like banging my head against the table whilst writing this web page for you has been vast- because, honestly- choosing the same set of acupuncture points for everyone and just giving a couple of treatments and expecting magical results… well, this is just daft.

 

For example, do you really expect birth rates to be higher when you have given someone just TWO acupuncture treatments? Of course not. But the nuance here in research headlines is that it then gets recorded that ‘acupuncture doesn’t increase birth rates’, as opposed to being very clear that ‘having only two sessions of acupuncture doesn’t increase birth rates’.

 

Despite this, I’m delighted to tell you you’ll find some studies that actually HAVE been positive for acupuncture increasing birth rates! How amazing is that?!

 

Please take your time to understand the following pointers about the world of research to help you to understand the nuances in acupuncture research. Because ideally, you hop onto Google Scholar, start doing your own searches, and reading the research yourself critically.

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The 'sham' problem

 

Frustratingly, most research studies compare acupuncture (true/’verum’ acupuncture) with ‘fake’ acupuncture (‘sham’ acupuncture). As opposed to, acupuncture versus usual care, or versus being on the waitlist. Or, acupuncture versus physiotherapy, or acupuncture versus medication.

 

The problem lies when we unpick that sham acupuncture ISN’T inert (it doesn’t do anything- it still does something). Acupuncturists (myself included) would say the sham does have real affects. And that’s because there are styles of acupuncture where the needle isn’t even inserted! I remember observing a fantastic acupuncturist during my training who worked in the NHS using non-insertive acupuncture techniques for pain in the hospital pain clinic. Also, acupressure will still have an affect (simply applying touch to a point). So, when studies use a sham acupuncture as acupressure with non-insertion, of course you’re still going to see a change in the sham group, as well as the acupuncture group.

 

Another type of sham acupuncture is where they use acupuncture points which aren’t true acupuncture points, or are acupuncture points you might not typically use. However, an acupuncturist will advise you that you can’t really find an area of the body which isn’t under the domain of an acupuncture channel- so you’ll always be affecting acupuncture channels wherever you place a needle- so ‘sham’ areas don’t exist, you will still influence that region/ that domain. You’ll always still be influencing acupuncture channels according to traditional acupuncture theory.

 

Also, you’ll sometimes see diagrams of the ‘sham’ points the researchers have chosen, and they are so near to true acupuncture points that you can see how they could really easily be mis-located and be hitting actual points and actual acupuncture channels. (And, don’t get me started on when non-acupuncturists actually doing the acupuncture in the studies- who knows if they are locating the real points or sham points correctly anyway!)

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In my opinion, studies which include a sham like this, aren’t finding whether acupuncture works, they’re finding out which TYPE of acupuncture works best.

 

Unfortunately, and frustratingly, it’s never reported or interpreted like this. To the ridiculous extent that, for example, if both sham and true acupuncture worked really well for a condition - much better than no treatment, or even better than another type of treatment - results are often interpreted as acupuncture not working because it didn’t work better than the sham. This is the sham acupuncture paradox.

 

So as Acupuncturists- we have often have a hard place to start from. Which you know what, makes positive results even more compelling. (And you'll find lots of positive results in the pain and fertility sections).

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Lack of funding 

 

Doing big pieces of research costs a lot of money. There’s a lack of acupuncture research because companies have no reason to fund it -  because acupuncture research doesn’t cause financial gain for companies. A lot of research in the medical world is compiled by pharmaceutical companies, which is why you can find quality research about medicines. You can’t put a patent on acupuncture and sell it, so why would a company bother investing in the research.

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It's not like 'real-life' acupuncture

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Research acupuncture is not like real-life acupuncture. In order to complete a piece of research properly, the same protocols have to be followed between the participants. Usually this translates to a strict set of acupuncture points (although sometimes the practitioner is allowed to add some variations). But, this just ISN’T the way we work as acupuncturists.

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We never use the same set of points over and over again for the same client, let alone loads of clients. In real life acupuncture, the points are chosen according to that specific person’s needs and they can change each time. It’s so person-centred, it’s doesn’t follow generic protocols. And whilst we do have favourite and brilliant points that we do use over and over again, there’s always personalised rational behind the choice of acupuncture points. True acupuncture like this is tricky to research, or, isn't funded to be researched. There are too many variables.

 

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Research hasn't been done yet

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If the research doesn’t exist in scientific research papers, this doesn’t mean that it doesn’t work. It means it hasn’t been researched with many randomised control trials.  Gold standard research doesn’t/can’t really take into account single-person case studies/ doesn't collate info about small case study work with real-life acupuncture.

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Acupuncture isn't JUST about the acupuncture

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If you’ve been for treatment personally with me, you’ll know that having acupuncture isn’t just about the acupuncture. We may discuss many different aspects of lifestyle and wellness advice to support your treatment. You can’t do any of this additional stuff with research acupuncture, so a large chunk of the holistic (whole) approach is missed out. Imagine comparing real-life acupuncture, delivered over the full recommended course of treatment schedule with individualised acupuncture points, and lifestyle and wellness advice,  versus usual care or waitlist. I have no doubt that people’s health in a variety of conditions would benefit. I am of course, biased as I'm an acupuncturist!

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What does the BAcC say about the evidence?

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I’d also love to direct you to the webpage about acupuncture research on the British acupuncture council website. This helps explain what we do and don’t have high quality research for, some great A-Z Evidence fact sheets about the evidence base for different conditions, and case study presentations.

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How to understand statistical results

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If you do begin reading full research papers. something I found really useful to understand is seeing what the ‘p’ numbers are.  Researchers report ‘p’ numbers- which basically mean how likely the results are to be due to a real effect versus random chance. With the lowest p number of 0.001 meaning it’s a solid ‘we think this is due to the thing’ whereas a higher reading of say 0.2, means there’s a high element that the results are due to chance (and results can be anywhere along a scale). Some of the results I share have fab p numbers at 0.001.