Category Archives: Blog
Recently, I attempted to contact and discuss an interesting paper I came across authored by James Dunning DPT, Raymond Butts PhD DPT, Thomas Perreault DPT, Firas Mourad OMT and Ian Young PT titled Dry needling: a literature review with implications for clinical practice guidelines. Interestingly enough, five out of six of the authors of this paper work for the Spinal Manipulation Institute where they teach physiotherapists, osteopaths and medical doctors dry needling and spinal manipulation with James Dunning being the president of this institute. This conflict of interest was declared in the appropriate section of the paper.
Unfortunately, Mr.Dunning appeared to be suspicious of my intentions and asked which organization I represented, what was my background and my work situation. When I informed him that I authored a blog called Needle Chat, and I wanted to ask him about his paper, he explained he was not interested in giving sound bites to acupuncture organizations that believe physiotherapists should go to acupuncture school before doing dry needling.
I further informed Mr.Dunning that I wanted clarification on certain points made in his paper regarding the techniques described. This appeared to push Mr.Dunning over the edge and he replied that he wasn’t interested in discussing his paper further on a blog, and any further comment would be dedicated to peer reviewed journals. He informed me that I should write a letter to the editor if I wanted to engage him in an academic discussion. Finally he stated that his point of view was made quite clear in his paper.
Surprised and confused by this response, I decided my only option was to use my interpretation of the paper to analyse what I believe was proposed in this literature review.
Acupuncture sure has it’s fair share of skeptics, despite gaining in popularity. But who exactly is recommending patients to acupuncture these days?
THESE STATEMENTS MADE IN THIS ARTICLE ARE THE OPINION OF JASON TUTT AND DO NOT NECESSARILY REFLECT THE OPINIONS OF OTHER PAST, PRESENT OR FUTURE AUTHORS AND CONTRIBUTORS OF NEEDLECHAT.COM, NOR DO THEY ATTEMPT TO SPEAK ON BEHALF OF OTHER ACUPUNCTURISTS OR THE ACUPUNCTURE COMMUNITY AS A WHOLE.
The most controversial concept in all of Chinese medicine is the concept of qi (pronounced chee) flowing through invisible lines called meridians. Many wonder, how can those who practice Chinese medicine, specifically acupuncture ever expect to be taken seriously, if they believe an invisible substance known as qi that can’t be seen or measured is flowing along predefined, and also equally elusive lines called meridians?
What is qi?
Let’s look at a couple of popular Chinese medicine websites.
- YinYangHouse.com – Qi, pronounced “chee”, means energy
- Arthur Rosenfeld (Taoist Monk) – What we can say for sure is that qi is nonmaterial, and therefore, as TCM suggests, falls under the umbrella of “energy.”
- AcuHealing.com – For example, if the above functions are weakened as a result of the deficiency of Qi (vital energy)….
- Yin Lo PhD
- Qi is vibration.
- Qi is oscillation of the meridians. More precisely, qi is quantum oscillations on the system of meridians.
- Qi is what carries the effect of acupuncture from one acupoint to other parts of the body.
- SacredLotus – The concept of Qi representing a continuum between immaterial and material is not so far from the concepts of matter and energy in modern physics.
What about some of the modern Chinese medicine text books, what do they have to say about qi?
If you practice pharmaceutical medicine, or physiotherapy (physical therapy), you are considered to practice “conventional” medicine. And anything and everything else is considered part of the umbrella term CAM (Complimentary and Alternative Medicine). According to the hardcore pseudoskeptics, if CAM actually worked, it wouldn’t be classified under CAM, it would just be called medicine.
Funny enough, the biggest criticism of CAM, is that it’s not evidence based. And by evidence based, their definition means it hasn’t passed the ultimate test, the gold standard, the randomized double blind placebo controlled trial. (RCT)
Any type of healthcare treatment that is offered that isn’t based on pharmaceuticals, surgery or physiotherapy and hasn’t undergone and passed the test of the RCT is considered pseudoscience and quackery.
Coming from Acupuncture training based on Traditional Chinese Medicine theory, I primarily prefer to treat pain. In fact, the laws in the province that I live in state that Acupuncture can be used to alleviate pain. Knowing that pain was a huge area of interest for me, I began to wonder what physiotherapy was doing right, and what Acupuncture was doing wrong. After all, every single hospital within a 50km radius of me has a physiotherapy department, and any time in the past when I had hurt my back, the medical doctor I would go see told me to go to physiotherapy if my back didn’t heal on it’s own.
So physiotherapy is the gold standard, it’s the “go to” for medical doctors when patients come in with musculoskeletal pain. So I began to look through the research journals for the mountains of RCTs that show physiotherapy is efficacious over a placebo treatment. Strange….. where are they?
With all the controversies about Acupuncture since the beginning of the 21st century, there has been much debate over whether or not Acupuncture is a mere placebo, or actually has some specific value to it. However, one result has become seemingly clear for Acupuncture and chronic low back pain, and that is; Acupuncture is at least as effective, if not more effective than drugs and physiotherapy for chronic low back pain.
Now, how is it, if Acupuncture is nothing more than a placebo, could it be outperforming drugs and physiotherapy in large research studies? Researchers at Harvard suggest that acupuncture is a more powerful placebo in their study on sham acupuncture compared to a placebo pill for headaches. Other suggest that when participants join a trial hoping to receive acupuncture, and get randomized into the usual care group (drugs and physiotherapy) instead, they are affected by the nocebo effect due to their disappointment in their group assignment. And finally, we have Acupuncturists who suggest that the reason Acupuncture is outperforming usual care (drugs and physiotherapy) is because Acupuncture actually does have some specific effects that are more powerful than conventional medicine.
Is acupuncture a popular therapy? Is it becoming more or less popular? How does it compare to other therapies? Let’s look at the statistics for the available data that has been collected over the years.
A 1998 paper reported on two surveys for complimentary and alternative health usage in the United States. In 1990, with a population of 249 million, 0.4% of Americans had reported acupuncture use within 12 previous months. In 1997, 1.01% of Americans had reported acupuncture use within 12 the previous months. In 1990, massage was most popular at 11.1% with in chiropractic in a close second at 11.0% but by 1997, chiropractic went to most popular at 10.1% and massage dropped to 6.9%.
This is a 250% increase in acupuncture use over a 7 year period from 1990 to 1997.
Public safety should be our number one priority as health care practitioners. The term “first do no harm” comes up time and time again, that we should use the least dangerous methods of treatment first. And whenever we begin to use treatments that may increase risks of adverse events, the patient should always be fully informed and allowed to give informed consent to that treatment.
When looking at acupuncture and pregnancy, we should be looking at all aspects of pregnancy. This includes prior to pregnancy, during pregnancy and during labor. Based on the available evidence, I present a review on both in vitro fertilization and pregnancy, as well as the safety of acupuncture for common conditions during pregnancy.
IVF and pregnancy rates
A 2014 study comparing acupuncture to no acupuncture in women who underwent fresh embryo transfer found that no treatment resulted in significantly higher pregnancy rates compared to the acupuncture group (64.8% vs 43.6%) and higher live birth rates (56% vs 36%).
I talked about in a previous post that improper training in needling of any kind, whether Acupuncture, dry needling/IMS or injection therapy can be dangerous, and here is another piece of evidence to prove it. A massage therapist, who received his Acupuncture training from a continuing education institute called the Acupuncture Foundation of Canada Institute, offers training to health care practitioners such as physiotherapists, chiropractors, medical doctors and massage therapists.
But when compared to an acupuncturist who receives an average of 450 to 600 hands-on clinic hours in order to write the licensing board exam, this institute only requires 200 hours of total training, which is mostly online work and 50 hours of on-site training. In my opinion, this is not enough training to be working on real patients without direct supervision from an instructor or person licensed to perform Acupuncture to make sure your needle depth and angle are correct.
A San Diego woman has filed a lawsuit against a Chula Vista chiropractor accusing him of collapsing her lung during an acupuncture procedure that he is not licensed to perform.
The problem here was obvious, when you aren’t trained properly, you can’t get a license to use acupuncture on patients. Acupuncture can be very dangerous if not used properly, an improperly placed needle can penetrate arteries, organs with the lungs being at the highest risk, even the brain!
Even somebody such as a chiropractor who has extensive anatomy training can make a potentially fatal mistake if they are not properly trained on depth, angle and length of the needle.
What are the risks of Acupuncture?
1) A 2001 survey of Acupuncturists practicing in the UK reported no serious adverse events, and 43 minor events out of 34,407 acupuncture treatments. The most common of these 43 minor events were severe nausea and fainting. Three avoidable events—two patients had needles left in, and one patient had moxibustion burns to the skin—were caused by practitioners’ errors.
Practitioners also recorded 10,920 mild transient reactions occurring in 5136 treatments, 15% (14.6% to 15.3%) of the 34 407 total treatments. Some local reactions at the site of needling were reported—mild bruising in 587 (1.7%) cases, pain in 422 (1.2%) cases, and bleeding in 126 (0.4%) cases. Patients experienced an aggravation of existing symptoms after 966 (2.8%) treatments, 830 (86%) of which were followed by an improvement, possibly indicating a positive “healing crisis.” The most commonly reported mild transient reactions were “feeling relaxed” in 4098 (11.9%) cases and “feeling energised” in 2267 (6.6%) cases, symptoms that often indicate an encouraging response to treatment