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Friday, June 26, 2009

Acupuncture in Emergency Departments


I have read in todays Sydney Morning Herald that Victorian Emergency Departments are going to trial acupuncture for the treatment of acute migraine, back pain and ankle injuries. Quoting the Herald, "The National Health and Medical Research Council has granted more than $400,000 for a three-year clinical trial in which 400 people will receive drug therapy, acupuncture or both to treat pain."
Apparently there has been a pilot study run at Northern Hospital in Epping, Victoria. This pilot study has allegedly shown promise with managing pain and nausea.
An Emergency Physician Robyn Parker said that patient who turned up at the Emergency Department were given the option of being treated by final year or graduate acupuncture students from RMIT in conjunction with standard medical treatment. Allegedly patients reported a significant reduction in pain and most said they would have it again.
In this multiple Emergency Department trial traditional Chinese medicine practitioners will be employed to carry out the acupuncture.
The lead researcher, Marc Cohen, a professor of complementary medicine at RMIT, said that the patients pain levels will be assessed every hour up until they leave Emergency and for several days afterwards to see which treatment worked best.
What worries me about these trials if carried out the way the pilot study was, is the unscientific way the trials are formulated. I am no scientist but surely a proper clinical trial is double blinded. The pilot study if going on reports in the SMH was not blinded at all. Any improvement in pain and nausea could be put down to the placebo effect. Pain and nausea are very subjective symptons so the placebo effect needs to be ruled out.
According to the authors of the book "Trick or Treatment", Simon Singh and Professor Edzard Ernst a Complementary Medicine Professor. The conditions where acupuncture has possibly shown some benefit in properly conducted trials are, pelvic and back pain during pregnancy, low back pain, headaches, post-operative nausea and vomiting, chemotherapy induced nausea and vomiting, neck disorders and bed wetting.
They do stress that essentially acupuncture seems to only have a placebo effect.
I think much caution should be placed on the findings of this trial once it is finished because as I see it, it will be done in a very unscientific way. I hope I am wrong and they will do randomised double blind studies.

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