That’s a pretty bold title, eh? I came across an article with this title in a scientific journal recently and found it quite amusing. As an assistant instructor of a large acupuncture program, and as someone who uses the predictable, comfortable benefits of acupuncture to help my patients on a daily basis, I know that acupuncture is not all placebo. I was mostly amazed that a research journal would publish an article with such a definitive title, as if it were referring to one of the laws of physics. It might as well have been titled “The Earth is Flat and Here is Why”.
The opinion piece was written by a headache researcher who has likely never used or experienced acupuncture. To begin, he narrowly defines acupuncture as way to modify the flow of life energy, known as Chi. Most of his arguments hinge upon the concept of the placebo effect – that the expectation or knowledge that acupuncture will be done is responsible for the majority of change observed in research studies, rather than the modality itself. Throughout the article he attempts to derail all possible reasons why acupuncture may work, but makes the critical error to never define what “working” consists of. He does acknowledge that acupuncture can stimulate brain activity and tissue changes, but then states that this doesn’t qualify acupuncture as actually “working”. Towards the end, he (ironically) outlines why many of the publications indicating a positive effect of acupuncture are heavily biased, low quality studies, and concludes that we should stop all research into the modality.
I use acupuncture as a neurophysiological input. I don’t know how to modify Chi or how to evaluate its flow. I do, however, have extensive knowledge of the physiology of pain, neuroanatomy, and functional movement. This allows me to select peripheral nerve targets that are related to my patient’s symptoms and use electro-acupuncture (among other techniques) to normalize the nerve activity. My outcome measures are rarely pain-focused – I attempt to restore range of motion, strength, and movement patterning. This approach consistently produces functional improvements as a result of the local and global physiological effects of acupuncture.
Our course through McMaster University has shared this contemporary approach with hundreds of health providers for almost two decades. I had assumed that there were many other groups who had figured this stuff out. I was frustrated by this biased observer’s claim that we had no demonstrable scientific basis for our treatments, so I set out to find the published evidence to support my broad clinical experiences.
I went to Google. I searched “acupuncture for ankle sprains” to see what articles, videos, and sites came up. I expected to get some results that talked about the affected nerves and muscles and how to effectively target them with acupuncture. And I figured that if I was really lucky, I’d find a site discussing functional outcomes like strength, balance, and range of motion using a global approach to injury and movement.
Instead, I mostly found articles and videos by western practitioners on the Traditional Chinese Medicine (TCM) acupuncture approach to treating ankle sprains. This involved determining which meridians were affected, where the Chi was blocked and how to free it up. Assessment was simply identifying tender areas. Treatment was either focused exclusively on the tender areas or involved dozens of areas in the calf and lower leg. They involved many different techniques, but never really provided a physiological explanation beyond encouraging healing, reducing stagnation of Chi, and affecting pain. Unfortunately it was very difficult to find quality resources on neuromuscular targets or functional outcomes.
Even though a Google search doesn’t mean everything, I did gain a better appreciation of what the indignant researcher was arguing. While he needs to do a better job of fact checking (and perhaps avoid using terms like “pre-scientific gobbledygook” and “quackademic medicine”), I can see his frustration with the apparent lack of Western scientific method in the application of TCM. There is definite value in the TCM techniques, but the rationale tends to leave something to be desired when it comes to modern medicine. At the same time, there are many practitioners out there who use acupuncture to modify physiology and produce consistent, outstanding results.
In general, practitioners need to do a better job of understanding the true physiological effects of their interventions, beyond any observed change in symptoms. This allows a more accurate selection of treatment targets, producing better functional outcomes overall. By embracing physiology and emphasizing function, the role of placebo becomes less significant.