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bibliography * The PainScience Bibliography contains plain language summaries of thousands of scientific papers and others sources, like a specialized blog. This page is about a single scientific paper in the bibliography, Vickers 2012.

Biased review of acupuncture for chronic pain

Vickers AJ, Cronin AM, Maschino AC, Lewith G, Macpherson H, Foster NE, Sherman KJ, Witt CM, Linde K; for the Acupuncture Trialists' Collaboration. Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. Arch Intern Med. 2012 Sep:1–10. PubMed #22965186.
Tags: treatment, acupuncture, chronic pain, neck, back pain, arthritis, head, mind, controversy, debunkery, energy work, pain problems, head/neck, spine, aging

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The conclusion of this acupuncture meta-analysis sure sounds positive, but it’s the usual hard-spun, garbage-in-garbage-out, damned-with-faint-praise-anyway nonsense. The conclusion indicates that “acupuncture is more than a placebo” but the differences are too minimal to care, or to attribute to anything more than a sloppy, biased meta-analysis.

An editorial for the Huffington Post confidently, absurdly declares of this study, “It turns out acupuncture works. It's not a placebo, and it's not a scam. It's a technique with documented efficacy,” but the author’s next statement is “I have little to say about the evidence involved.” Clearly! What do actual experts say? Dr. Edzard Ernst: “In my view, this meta-analysis is the most compelling evidence yet to demonstrate the ineffectiveness of acupuncture for chronic pain.” Dr. Steven Novella:

The Vickers acupuncture meta-analysis, despite the authors’ claims, does not reveal anything new about the acupuncture literature, and does not provide support for use of acupuncture as a legitimate medical intervention. The comparison between true acupuncture and sham acupuncture shows only a small difference, which is likely not clinically significant or perceptible. More importantly, this small difference is well within the degree of bias and noise that [is] inherent in clinical trials.

~ Paul Ingraham

original abstract

BACKGROUND: Although acupuncture is widely used for chronic pain, there remains considerable controversy as to its value. We aimed to determine the effect size of acupuncture for 4 chronic pain conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.

METHODS: We conducted a systematic review to identify randomized controlled trials (RCTs) of acupuncture for chronic pain in which allocation concealment was determined unambiguously to be adequate. Individual patient data meta-analyses were conducted using data from 29 of 31 eligible RCTs, with a total of 17 922 patients analyzed.

RESULTS: In the primary analysis, including all eligible RCTs, acupuncture was superior to both sham and no-acupuncture control for each pain condition (P < .001 for all comparisons). After exclusion of an outlying set of RCTs that strongly favored acupuncture, the effect sizes were similar across pain conditions. Patients receiving acupuncture had less pain, with scores that were 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs lower than sham controls for back and neck pain, osteoarthritis, and chronic headache, respectively; the effect sizes in comparison to no-acupuncture controls were 0.55 (95% CI, 0.51-0.58), 0.57 (95% CI, 0.50-0.64), and 0.42 (95% CI, 0.37-0.46) SDs. These results were robust to a variety of sensitivity analyses, including those related to publication bias.

CONCLUSIONS: Acupuncture is effective for the treatment of chronic pain and is therefore a reasonable referral option. Significant differences between true and sham acupuncture indicate that acupuncture is more than a placebo. However, these differences are relatively modest, suggesting that factors in addition to the specific effects of needling are important contributors to the therapeutic effects of acupuncture.

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