Devroey D, Van De Vijver E. Acupuncture for 'frequent attenders' with
medically unexplained symptoms. Br J Gen Pract. 2011 Aug;61(589):492.
Eerste auteur: Devroey D.
Jaar: 2011
Type: Publicatie
Medline
Abstract:
Acupuncture does not help frequent attenders
We have some serious concerns about the methodology and the conclusions of the studies by Paterson and Rugg.1,2
First of all, the results of these studies would have been more acceptable if five-element acupuncture would have been compared to placebo, which was not the case. Acupuncturists often argue that placebo control is not feasible with acupuncture. But in several studies investigators were able to compare acupuncture to placebo by using non-invasive acupuncture or superficial needling at non-acupuncture points.3,4
It has been proven that simulated acupuncture procedures are a reasonable control treatment for acupuncture-naïve individuals in randomized controlled trials (subjects receiving acupuncture with real needles vs. pokes with a toothpick in a guide-tube).3 In a placebo controlled study with patients suffering from chronic low back pain there were no significant differences between real acupuncture and minimal acupuncture at non-acupuncture points.4
Secondly, Paterson and Rugg do not clearly describe how patients with medically unexplained physical symptoms (MUPS) were defined. Inclusion and exclusion criteria remain unclear. Being an inhomogeneous group, patients with MUPS undoubtedly present with different diagnoses, each needing a specific treatment. As the study groups consisted of frequent attenders with MUPS, we are concerned about a selection bias favouring ‘medical shoppers’. These patients may feel better after any medical 'consultation' as such, enhancing the role of a placebo effect. In this study the patients knew whether they were in the treatment group or control group. The cross-over design of the study does not surmount this issue, especially because all outcome measures are subjective evaluations of health status and wellbeing.
Thirdly, improvement on the Measure Yourself Medical Outcome Profile (MYMOP) was only borderline significant (P=0.05), while except for wellbeing there was no significant improvement for any of the other parameters. This confirms the fact that medical 'attention' might play a more important role than the treatment, e.g. acupuncture itself.
Finally, the non-significant decrease in consultations with the general practitioner should have been adjusted with the 12 sessions of acupuncture. In our opinion the gain in number of consultations will be small, but there will be a shift in consultations from the GP to the acupuncturist.
In conclusion, we are not convinced of the benefit of acupuncture for patients with MUPS. There certainly is a further need for higher quality trials in this domain before treatment guidelines can recommend acupuncture for MUPS.
REFERENCES
1. Paterson C, Taylor RS, Griffiths P, et al. Acupuncture for 'frequent attenders' with medicalty unexplained symptoms: a randomised controlled trial (CACTUS study). Br J Gen Pract 2011; 61[587]: 383-384.
2. Rugg S, Paterson C, Britten N, Bridges J, Griffiths P. Traditional acupuncture for people with medically unexplained symptoms: a longitudinal qualitative study of patients' experiences. Br J Gen Pract 2011; 61[587]: 385-386.
3. Sherman KJ, Hogeboom CJ, Cherkin DC, Deyo RA. Description and validation of a noninvasive placebo acupuncture procedure. J Altern Complement Med. 2002; 8[1]: 11-19.
4. Brinkhaus B, Witt CM, Jena S, Linde K, Streng A, Wagenpfeil S, Irnich D, Walther HU, Melchart D, Willich SN. Acupuncture in patients with chronic low back pain: a randomized controlled trial. Arch Intern Med. 2006; 166[4]: 450-457.