We live in a world now that strictly regulates medicine, the practice of allied health and the type of care that can be provided and advertised depending on the clinical condition
Thousands of years ago when acupuncture appears to have been first conceived, success of Acupuncture and Chinese Medicine over the generations seemed to have been accounted for by clinical observation, both of responses that patients had to treatment, and subjective and objective measures that the patient or practitioner observed. A successful measure may have been the patient articulating they felt no pain after treatment, or felt a reduction in pain following treatment.
But science as we understand it today, relies upon randomised double Blinded controlled trials and systematic reviews of the highest calibre such as those seen on the cochrane database. And further, science often requires a physiological mechanism to be identified in the body, before it can be observed as verifiable.
One obvious problem with that is:
How can science know every mechanism that the human body is capable of?
Should we have to wait for science to find a mechanism of action for the observable effects of Acupuncture? Let me give you a totally hypothetical Clinical Example:
If a patient visits an Acupuncture clinic for lower back pain. The Acupuncture Practitioner and patient discuss the case together and after careful consideration the practitioner comes up with a treatment based on Chinese Medicine principles. The Acupuncturist then administers the treatment.
Let’s say the patient reported a pain of 8/10 prior to the practitioner applying the treatment, which consisted of 2 x needles at any given location. 5 seconds later the practitioner then asks the patient: “how does the pain feel now?” or “Where is the pain now?”.
If the patient makes the observation that they have no pain or can not locate the pain that they had prior to the Acupuncture being administered, do we trust the patient is telling the truth?
If we don’t have a mechanism of action, it appears we can’t prove that Acupuncture is causing the pain reduction, so maybe the patient has actually experienced the powerful effects of placebo giving rise to the subjective perception.
But lets question this out further:
How much time should there be between stimulation and response, before we can say that an effect is a direct consequence of the stimulus?
For the example in question, if it wasn’t the Acupuncture that caused the response, how is placebo choosing Acupuncture as the preferred transition medium?
I think these are fair questions. Because, what alternatives exist for patients that have lower back pain?
If we can’t find a mechanism of action that describes how the above scenario takes place, do we turn a blind eye and wait 50 years for science to find a mechanism and leave the patient without hope, or wait for systematic reviews that require years and sometimes decades to accumulate a level of evidence that is acceptable to the scientific arena?
That seems far removed from the “duty of care” model.
Although, as far as real treatment options, Acupuncture has a place as far as NICE is concerned. The recently revised NICE guidelines, cited Acupuncture ,Exercise and CBT as the primary modalities considered in the treatment of Chronic Pain.
This comes at a time when increasing evidence is beginning to advise against the use of prescription drugs and opioids in the treatment of pain conditions, information included in the NICE guidelines.
So, in considering the hypothetical clinical situations that can occur, with current NICE recommendations and what the rigorous scientific scrutiny requires for Acupuncture to be a more widely adopted care model, where do we go from here?
It seems that patients in chronic pain conditions need support and options to live a happier existence. Is it possible that Acupuncture has its place in the current age of medicine?
Feel free to read another article in relation to perception of pain here.
This Article is a work in progress and will be updated periodically