This HealthDay story explains the findings from what it describes as the “the world’s largest randomized, controlled trial of acupuncture in the emergency department.” More than 500 patients were seen in four major hospital emergency departments for acute lower back pain, migraine headaches or ankle sprains. For pain control, they received either conventional painkiller drugs, acupuncture or a combination of the two.
The story states that the acupuncture was proven as safe and effective as other treatments. Yet, as the study abstract states, “none of the examined therapies provided optimal acute analgesia.” That point didn’t make it into this story, which relied heavily on the news release.
For another in-depth take on this story and the news coverage, see “A skeptical look at a study of acupuncture delivered in emergency rooms.”
Given the growing trend in overdosing and dependency with the use of opiate painkilling medications, any effective alternative will be a welcome addition to public health care. Some patients cannot use some conventional analgesic medications and having an alternative therapy when needed would certainly be an improvement. But the story fails to give readers any insight into whether they might expect acupuncture as a possible alternate therapy when they visit the hospital’s emergency department.
There was no mention of the cost of acupuncture treatments in the story, nor was there any comparison between such costs and the costs for standard analgesic drugs that might be administered in an emergency department.
A provider trained in acupuncture would need to be available at the time the patient needed assistance. If acupuncture increased time in the ED, that would add cost and reduce capacity for other patients. These are important considerations (as cost drivers) in a fast-paced environment.
The story does a good job quantifying the measured benefits of the study, giving readers a lot of information on what the researchers measured, especially when it describes how many points the pain dropped on the pain scale.
However, the story makes the claim that “acupuncture is a safe and effective alternative to pain medications for some emergency room patients, a new study reports.” None of the data presented in the story proves it is a safe and effective alternative.
Instead, the data just shows that none of the pain interventions worked very well. As the story describes, “one hour after treatment, less than 40 percent of all patients had significant pain reduction, meaning at least a 2-point decline on the 10-point scale.”
And as the study abstract states, “none of the examined therapies provided optimal acute analgesia.” That point didn’t make it into this story.
There is no mention in the story of possible harms from the use of acupuncture. While the risks may be slight in most cases, they are not negligible. Infection is always possible and some can be serious. Also if a patient is not given an actual pain reliever and has to revisit the ER later, that is a harm.
The story identifies this research as a multi-center, randomized clinical trial comparing three alternative therapeutic approaches. It also states that this was “billed as the world’s largest randomized, controlled trial of acupuncture in the emergency department” and included a patient population of more than 500 people.
Still, we would have appreciated more information on what they meant by “satisfied” in the follow-up visit. Did they say the pain was much better? Or gone? Wouldn’t a majority of the patients in a typical ER with one of these three problems (acute back pain, migraine, or ankle sprain) have their pain “satisfied” (mostly gone) no matter what you gave them, since those issues are all self-limited? These and other limitations needed more discussion in the story.
The story does not appear to be disease-mongering.
This story offers quoted statements only from the lead investigator for the trial. No independent sources or quoted, nor are we told who funded the study.
The story explains that the study compared the result of using acupuncture versus the use of painkillers versus the use of both in tandem, so it is clear that there are alternatives available for analgesia.
However, the three conditions–acute low back pain, migraines or ankle sprains–are all treated differently and have a host of known appropriate strategies. For example, rest for back pain, triptan medications for migraine, ice and elevation for sprain. We think this deserved a mention in the story.
While acupuncture is becoming more widely available in most communities, there is no information in the story that suggests how available it might be in large hospital emergency departments. Also, would it be available in a timely manner?
It would be pretty novel if the study had shown that acupuncture was more effective than conventional analgesic drugs in controlling pain, but that’s not what this study showed. While both the study and the story did seem to indicate that acupuncture was as effective as either painkillers or painkillers and acupuncture, the abstract of the study also said “none of the examined therapies provided optimal acute analgesia.” Controlling pain was arguably the reason the study’s patients went to the emergency departments. The study basically said acupuncture was as good as painkillers for pain control but that for these patients, neither was successful. We think that should have been explained in the story to help establish the novelty of this research.
The two quoted statements in this story are identical to those in the university’s news release. The story appears to rely heavily on that news release.
For example, this quote appears in both the news story and the news release:
“While acupuncture is widely used by practitioners in community settings for treating pain, it is rarely used in hospital emergency departments,” said study lead investigator Marc Cohen. He is a professor in the School of Health and Biomedical Sciences at RMIT University in Melbourne, Australia.
Systematic, Criteria-Driven
The tale of two “negative” studies. Or, how spin is applied to make research findings look more impressive. A must read. https://johnmandrola.substack.com/p/the-tale-of-two-negative-studies
The @nytimes chose to interview one of the editors of the @AnnalsofIM (publisher of this paper) who "gushed with extraordinary glee: It’s huge! There are very few things that reduce your mortality by 30%."
Turns out coffee is not one of those few things despite all that glee. https://twitter.com/garyschwitzer/status/1533202075928215558
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