Acupuncture for headachePOSTED JANUARY 25, 2018, 10:30 AMHelene Langevin, MD, Contributor and Carolyn A. Bernstein, MD, FAHS, Contributor
Acupuncture for headachePOSTED JANUARY 25, 2018, 10:30 AM
Helene Langevin, MD, Contributor and Carolyn A. Bernstein, MD, FAHS, ContributorIt is easy to ridicule a 2000-year-old treatment that can seem closer to magic than to science. Indeed, from the 1970s to around 2005, the skeptic’s point of view was understandable, because the scientific evidence to show that acupuncture worked, and why, was weak, and clinical trials were small and of poor quality.
But things have changed since then. A lot.
Thanks to the development of valid placebo controls (for example, a retractable “sham” device that looks like an acupuncture needle but does not penetrate the skin), and the publication of several large and well-designed clinical trials in the last decade, we have the start of a solid foundation for truly understanding the effectiveness of acupuncture.
How do we know if acupuncture really works for pain?Individual large-scale clinical studies have consistently demonstrated that acupuncture provided better pain relief compared with usual care. However, most studies also showed little difference between real and sham (fake) acupuncture. In order to address this concern, a 2012 meta-analysis combined data from roughly 18,000 individual patients in 23 high-quality randomized controlled trials of acupuncture for common pain conditions. This analysis conclusively demonstrated that acupuncture is superior to sham for low back pain, headache, and osteoarthritis, and improvements seen were similar to that of other widely used non-opiate pain relievers.
And the safety profile of acupuncture is excellent, with very few adverse events when performed by a trained practitioner. Meanwhile, basic science studies of acupuncture involving animals and humans have shown other potential benefits, from lowering blood pressure to long-lasting improvements in brain function. More broadly, acupuncture research has resulted in a number of insights and advances in biomedicine, with applications beyond the field of acupuncture itself.
Is acupuncture really that good?We understand why there may be continued skepticism about acupuncture. There has been ambiguity in the language acupuncture researchers employ to describe acupuncture treatments, and confusion surrounding the ancient concept of acupuncture points and meridians, which is central to the practice of acupuncture. Indeed, the question of whether acupuncture points actually “exist” has been largely avoided by the acupuncture research community, even though acupuncture point terminology continues to be used in research studies. So, it is fair to say that acupuncture researchers have contributed to doubts about acupuncture, and a concerted effort is needed to resolve this issue. Nevertheless, the practice of acupuncture has emerged as an important nondrug option that can help chronic pain patients avoid the use of potentially harmful medications, especially opiates with their serious risk of substance use disorder.
Finding a balanced viewA post on acupuncture last year dismissed acupuncture as a costly, ineffective, and dangerous treatment for headache. This prompted us to point out the need for a measured and balanced view of the existing evidence, particularly in comparison to other treatments. Although the responses that followed the article overwhelmingly supported acupuncture, it nevertheless remains a concern that this practice attracts this kind of attack. Acupuncture practitioners and researchers must take responsibility for addressing deficiencies in acupuncture’s knowledge base and clarifying its terminology.
That said, we need to recognize that acupuncture can be part of the solution to the immense problem of chronic pain and opiate addiction that is gripping our society. That this solution comes from an ancient practice with a theoretical foundation incompletely understood by modern science should make it even more interesting and worthy of our attention. Clinicians owe it to their patients to learn about alternative, nondrug treatments and to answer patients’ questions and concerns knowledgeably and respectfully.
SourcesAcupuncture in patients with osteoarthritis of the knee: a randomised trial. Lancet, July 2005.
Acupuncture in Patients With Chronic Low Back Pain: A Randomized Controlled Trial. JAMA Internal Medicine, February 2006.
Acupuncture in patients with tension-type headache: randomised controlled trial. BMJ, August 2005.
Acupuncture for Patients With Migraine: A Randomized Controlled Trial. JAMA, May 2005.
Acupuncture for Chronic Pain: Individual Patient Data Meta-analysis. JAMA Internal Medicine, October 2012.
Survey of Adverse Events Following Acupuncture (SAFA): a prospective study of 32,000 consultations. Acupuncture in Medicine, December 2001.
Safety of Acupuncture: Results of a Prospective Observational Study with 229,230 Patients and Introduction of a Medical Information and Consent Form. Complementary Medicine Research, April 2009.
The safety of acupuncture during pregnancy: a systematic review. Acupuncture in Medicine, June 2014.
Cost-effectiveness of adjunct non-pharmacological interventions for osteoarthritis of the knee. PLOS One, March 2017.
Paradoxes in Acupuncture Research: Strategies for Moving Forward. Evidence-Based Complementary and Alternative Medcine, 2011.
The Long-term Effect of Acupuncture for Migraine Prophylaxis: A Randomized Clinical Trial.JAMA Internal Medicine, April 2017.
Related Information: Headache Relief: Preventing and treating migraines and…
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The ACLU of California is working with several organizations to co-sponsor SB 10: The California Money Bail Reform Act of 2017. Introduced by Senator Bob Hertzberg and other legislators, the bill will reform California's money bail system by ensuring that people are not kept in jail simply because they cannot afford the bail amount.
Momentum for bail reform is gaining steam both here in California and throughout the country for one simple reason: the current money bail system isn't working.
We know that communities are safer and healthier when they are whole, but money bail is tearing them apart. Even just a few days in jail can lead to someone losing their job, losing child custody, and being evicted, yet people are being held in jail for days, weeks, and even months while awaiting trial. We also know that the current system isn't serving it's intended purpose of protecting communities and ensuring that people come to court, and that there are more effective and equitable alternatives out there. We're excited to work with the California Legislature, our allies, and ACLU members to build a system that truly works for everyone, not just the wealthy.
The ProblemMoney bail has created a two-tiered system of justice in California – one for the rich, and one for everyone else.
The current money bail system gives the rich a “get out of jail” pass while punishing everyone else with detention and debt.
All too often in California, people who have been arrested but not convicted of a crime are locked in jail for weeks, months, or even years while they wait for trial. Many would be able to return home, if they could afford to post bail.
Sometimes, law enforcement detains people — especially people of color — because of baseless arrests or mix-ups, but the consequences are swift, devastating, and long lasting. In California, one-third of felony cases are dropped or the person is later found innocent.
But even short stays in jail can cost people their jobs, cars, homes, and even custody of their children. We inflict this harsh punishment on people who are presumed innocent and have actually not been convicted of a crime.
Money bail is not making us any safer or making sure people return to court. Meanwhile, the for-profit bail industry is raking in the profits.
California's money bail system does not do a good job of protecting our communities. Under the current system, people’s freedom is determined by their wealth, not by whether or not they can be safely released. Wealthy people can buy their freedom, no matter how much of a risk they pose.
California’s system is also not very effective at getting people to come back to court for their hearings. In fact, California has lower court appearance rates than the rest of the country. Although some people think that posting bail is an incentive to make sure people come back to court, that’s not the case. If you use a bail bond company to secure pretrial release, you never get that money back regardless of whether you return to court, the District Attorney dismisses the case, or a court ultimately finds you innocent. The incentive just isn’t there.
At the same time, the for-profit lines its pockets with predatory practices to line its pockets with money from people already struggling to make ends meet. Although most people assume that bail bonds companies are 'mom and pop' shops, behind them are powerful, multinational insurance conglomerates that trap thousands of California families – especial in low-income communities of color – in debt with nonrefundable fees and installment plans. Because they are paid even if someone doesn’t up to court, is found innocent, or gets their case dismissed, the bail industry makes millions off premiums alone.
The SolutionCalifornia can build on proven models
Several California counties and states across the country have adopted reforms to truly promote the economic security, well-being, and safety of their communities. California can follow their lead by replacing our current one-size-fits-all money bail system with a system that: