Wise caveats about Hsieh et al.’s promising acupressure evidence

PainSci » bibliography » Frost et al 2006
updated Apr 14, 2025

Tags: TrPs, back pain, acupuncture, study_opinion, muscle, pain problems, spine, anatomy, spine pain, alternative medicine, controversial, manual therapy, professions, treatment, modalities, quackery, traditional Chinese medicine, ancient, vitalism

One page on PainSci cites Frost 2006: The Complete Guide to Trigger Points & Myofascial Pain

PainSci commentary on Frost 2006: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided wherever possible.

This is a sensible BMJ editorial about the surprising, interesting, and promising results of Hsieh et al.’s test of acupressure for back pain. Key points:

Although I like this piece overall, I disagree with the background point there has ever been any reliable positive evidence about acupuncture. I maintain that acupuncture does not work and all apparently “positive” evidence is pure spin and wishful thinking (see Does Acupuncture Work for Pain? for my full argument).
But this study was well-designed and the results were “striking.”
“ … we might need to ask why Chinese medicine clinicians use acupuncture for back pain, rather than acupressure.” Good question.
“Cultural differences are probably important in the experience and reporting of back pain” — true, and an understatement.
Treatment in the physical therapy group “may have been suboptimal.” Another understatement. (It included infrared light “therapy.” Seriously?)
And this is the main caveat, and it’s huge: “patients' expectations and placebo effects are both likely to play a part in determining the outcome of interventions such as acupressure, and the additional benefits of acupressure cannot be established from this pragmatic trial.”
In other words, acupressure may have had an unfair advantage: a treatment nearly guaranteed to have a huge placebo effect compared to shabby physical therapy. Perhaps the results aren’t so striking after all?
“Would the effect be the same if Western clinicians were trained in these techniques, and would patients in the West with different cultures and lifestyles respond as well?”

~ Paul Ingraham

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