Acupuncture Styles; Individual Treatment Response

Acupuncture Styles; Individual Treatment Response


The other point, very
interesting especially for practitioners, if different
acupuncture styles matter. This is one of the big discussions
you have with your colleagues. It’s one of the big issues
when you teach acupuncture. And there are three studies
out, and the results are not very convincing. The study from China, recently
published in the Canadian medical journal–the study
compared sham acupuncture with three acupuncture arms. And one of the acupuncture arms
was seen as much more effective for treating migraines, these
type of acupuncture points. So we found for most
secondary outcomes here, we did the data analysis
for the colleagues in China. We found a significant different
for most secondary outcomes between acupuncture
and sham acupuncture. We found no relevant differences
at all between the different acupuncture arms. And this is supported by the
work of Dan Cherkin and Karen Sherman, who compared standardized and
individualized acupuncture in chronic low back pain, and
there have been no differences. And I’ve just got the result
from one of our smaller trials, we randomized 150 patients with
low back pain to standardized and individualized acupuncture
and also here we see no significant differences. So the style does not
seem to matter so much. But what does really influence
the results of acupuncture? And I’m not such a country
fan, but here we really get differences in
different countries. So we have analyzed data on 10,000
patients with chronic pain, randomized patients–half of them got
acupuncture on top of usual care– and we found women had a
better effect than men. That those patients who had a
failure of other therapies, all who had a very positive
previous acupuncture experience, had a better effect. And we did an analysis
on another data set, was 800 patients who got
acupuncture or sham acupuncture and we found that those patients
who have a higher expectation had a better acupuncture effect. And the odds ratio for this
was 2.0 so it was not a small difference, it was a
relevant difference. Nevertheless the results
from the States are different. So this is an analysis from the
trial of Cherkin and Sherman, and they have found no impact of
expectation and preferences on the acupuncture
treatment outcome. And the point is also do we
really measure expectation, how we measure expectation, and
I know there’s a NIH grant on really a development of a more
stable measure and Karen Sherman and Sherry Redinbaugh
are working on this. But you see it’s very
heterogeneous if it comes to the effect modification
on the patient side. So what we have also an interest
in is that characteristics of the practitioner and how
those influence the outcome. And that’s again data from the
large German data set with the 10,000 patients. And this was a quite frustrating
result for me because I hadn’t expected this. We found that the training,
which is the duration of training, which is even if they
do a Chinese diagnosis or not, and also not the experience or
the years in practice and the percentage of practice. They had no influence on
the treatment outcome. The only factor which we
found had an influence on the treatment outcome was that
orthopedists performed worse. And I leave it to your
thoughts to explain this. We have just done a new
analysis on this data set, and we found that also the
expectation of the physicians had no influence on
the treatment outcome. And to get this heterogeneous
picture here remember also to the point that at the moment
we don’t know which type of patients really respond
well to placebo. That’s also still an open
question and now again having the feeling that non-specific
effects are a large part of the acupuncture effect, this might really
be affected also by this problem. Coming to patient
practitioner interaction… And you have seen the slide
also yesterday by Irving Kirsch, and it’s one of my most
beloved study of all. It was already published 2008
and I still find that it’s a brilliant study which
tells us a good story. And as you can see those
patients who had more prominent interaction with their practitioner
had a much better outcome. And I think this can also
teach us something for future research, that we really should
know more about the interaction and how different interaction
styles influence the outcome.

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