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Acupuncture, Alexander Technique offer modest relief for neck pain but at what cost?

Acupuncture and Alexander Technique ease chronic neck pain better than usual care

Our Review Summary

Acupuncturist at workThis news release describes the outcome of a study on two alternative therapies — acupuncture, a form of Traditional Chinese Medicine (TCM) that involves placing thin needles in specific points of the body, and the Alexander Technique, which teaches people how to improve their posture and movement habits in an effort to release tension and reduce pain.

The news release does a good job of reporting relevant facts from the published study. It demonstrates a good grasp of the quality of evidence in the study. A major stumble is the lack of concrete numbers that could have given the interested reader the scope of the potential benefits of the two therapies discussed. The release also doesn’t make it clear what’s new and different about the study compared with previous research, or what these therapies cost.

 

Why This Matters

Chronic neck pain is a leading cause of disability. People suffering from this condition often seek complementary therapies to manage their condition. This news release reports on a study examining the long-term effects of two particular complementary health care strategies for chronic neck pain — acupuncture and the Alexander Technique.

Other complementary or alternative therapies have been shown to offer short-term pain relief that does not lead to longer-term relief. The length of time of relief reported here (one year) is what makes the study important.

Criteria

Does the news release adequately discuss the costs of the intervention?

Not Satisfactory

The news release does not mention the costs of either acupuncture or the Alexander Technique. This is important to include since both therapies probably require the patient to pay out of pocket, at least in the United States. A quick web search found that the median cost of an acupuncture session  nationwide is $100. Alexander Technique sessions cost about the same as massage therapy — around $70 to $100 per 45-minute session. In this study, 12 acupuncture sessions and 20 Alexander Technique sessions were required.

Does the news release adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The release states that both acupuncture and the Alexander Technique led to a significant reduction in neck pain at 12 months, as determined by the Northwick Park Questionnaire (NPQ). Statistical significance does not, however, necessarily indicate strong treatment effects. For instance, with enough data in hand, we can discover that minute differences between treatment and control can have very significant p-values (calculated probability), although we are not claiming this is the case here. From the original study, we learn the treatment effects of 3.92% reduction in NPQ versus usual care for acupuncture, and 3.79% for the Alexander Technique.

Even with these numbers, the information is still lacking in interpretability. What does a 3-4% reduction in NPQ score really mean? Is the benefit worth the number of sessions of each therapy?

Does the news release adequately explain/quantify the harms of the intervention?

Not Satisfactory

The release doesn’t mention the possible harms of each intervention. While these methods are generally considered safe, no treatment is without risk of harm so we would like to see some discussion.  The risks associated with acupuncture generally rest with the acupuncturist and can include soreness, infection, and in rare cases, organ injury if the needle is pushed in too far. Because the Alexander Technique calls for changes to posture and movement, it may cause harms to people with specific spinal injuries that are better left treated by licensed medical experts.

Does the news release seem to grasp the quality of the evidence?

Satisfactory

There is a good grasp of the quality of evidence. The article specifies the patient population for whom the treatments can be expected to help, namely people with chronic, non-specific neck pain. The news release also points out importantly that both interventions enjoyed a high rate of adherence.

Two additions would’ve furthered the satisfaction of this criterion. First, the news release might have mentioned the limitations of the study outlined in the original article, namely, practitioners of each technique belonged to their respective main U.K.-based professional associations. This hinders the generalization of the findings since both procedures are somewhat subjective and can vary more greatly from practitioner to practitioner than a “standard” treatment requiring clinical approval. Second, the impressive sample size of the randomized controlled trial should’ve been reported. More than 500 volunteers took part.

Does the news release commit disease-mongering?

Satisfactory

There is no disease-mongering here about chronic neck pain.

Does the news release identify funding sources & disclose conflicts of interest?

Not Satisfactory

The news release does not disclose funding sources for the study. In addition, the study was more transparent than the release in disclosing potential conflicts of interest. Two of the authors of the original study, Drs. Woodman and Ballard, are both on the Society of Teachers of the Alexander Technique and contributed toward obtaining funding for the study. Coincidentally, all practitioners recruited in the study for the Alexander Technique came from the same society. The fact that the study authors and practitioners were all closely allied with the Alexander Technique was worth disclosing to readers, especially journalists, who were relying on the release.

Does the news release compare the new approach with existing alternatives?

Satisfactory

The goal of the news release is in fact to accomplish this very criterion. The release accurately states, “Usual care for neck pain generally consists of prescribed medications and visits to physical therapists and other health care professionals.”

Does the news release establish the availability of the treatment/test/product/procedure?

Satisfactory

It’s clear from the release that both of these therapies are widely available.

Does the news release establish the true novelty of the approach?

Not Satisfactory

What’s novel about this study is the longer term relief gained from the therapies. The study points this out, but the release doesn’t explicitly mention it.

Does the news release include unjustifiable, sensational language, including in the quotes of researchers?

Satisfactory

The release maintains an objective, scientific voice throughout the piece.

Total Score: 5 of 10 Satisfactory

Comments (2)

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Dr JP Woodman

November 17, 2015 at 5:30 pm

As co-authors of this study published in Annals of Internal Medicine, we would like to correct the impression the review gives that there may have been potential conflict of interest or study bias in relation to the Alexander Technique. The study was designed and managed by a large, experienced, multi-disciplinary research team based at the University of York, UK. As a well-designed clinical trial, all the interventions being studied were represented on the study team by research-experienced professionals from all the relevant disciplines (acupuncture, Alexander Technique and usual physician-led care). In addition to ourselves who belong to the Society of Teachers of the Alexander Technique, two of the other authors belong to the British Acupuncture Society. In the spirit of complete transparency all these affiliations are listed in the Disclosures section of the article and we are puzzled as to why you have picked up just on the Alexander Technique, or why you seem to think there is an issue. We would also like to point readers in the direction of the original publication for answers to most of the other questions you raise in your review, including the funding source (Arthritis Research UK). Regards, Drs Woodman and Ballard

Reply

    Kevin Lomangino

    November 18, 2015 at 6:24 am

    Thank you for your comment Dr. Woodman. Because many journalists and lay readers will never see the original article upon which this news release is based (especially as it is behind a paywall), we think it’s vitally important for news release writers to include relevant funding and disclosures in the news release itself. We think it’s inadequate to “point readers in the direction of the original publication for answers” because most readers don’t have access to and will have difficulty understanding the original research. We think the disclosures that were made in the study relevant to the investigators’ professional affiliations were appropriate to include in the news release. We don’t think that asking for that information in any way suggests that the trial was not well designed or well conducted. As with any similar study, the possibility of an “allegiance effect” related to these affiliations should be considered. This is just one of many sources of potential bias in such a study (any such study) that journalists and readers should be aware of when evaluating the results.

    Kind regards,

    Kevin Lomangino
    Managing Editor

    Reply