Thursday, September 22nd
Acupuncture for Chronic Pain: Evaluating the Evidence on Efficacy, Effectiveness and the Question of Benefits
Even though acupuncture is recommended in guidelines for some pain conditions, there remains uncertainty about the evidence regarding its efficacy, primarily due to the question of how well acupuncture outperforms placebo. In this presentation, high quality evidence will be shared from the NIH-funded Acupuncture Triallists Collaboration on the following chronic pain conditions: back and neck pain, shoulder pain, osteoarthritis, and headache and migraine. Reporting on the analysis of individual patient data from 39 international trials with over 20,000 patients, the findings show that acupuncture has a small yet statistically significant beneficial effect when compared to sham acupuncture controls. However, acupuncture had a statistically significant and clinically relevant effect when compared to non-acupuncture controls. In this presentation, a thorough discussion of this paradox, including a review of the purpose and assumptions of both efficacy and pragmatic trials as well as conceptual and practical ways of resolving this paradox will be undertaken. Finally, because of the urgent need to move forward evaluating potentially viable alternatives to medications in some types of pain patients, the design of a new large NIH funded pragmatic trial of acupuncture in older adults will be presented as a promising approach at this stage of our knowledge.