Re: Treatment of chronic pain

As a physician who is very interested in investigating so-called alternative medicine, and who is very familiar with the current literature on the most commonly used modalities, I was both puzzled and concerned by your positive recommendations for a variety of alternative medicine practices for the treatment of chronic pain.[1] 

I did first attempt to go the to the WorkSafeBC website to see the references myself, but the ones used for acupuncture are all nearly 10 years old. More recent, larger, and better-controlled studies have been able to properly blind both patients and practitioners, and have found that sham acupuncture is just as effective as real acupuncture, which leads to the conclusion that any positive effect is not from anything specific to acupuncture but to other nonspecific effects and the placebo res­ponse. 

In scientific circles, acupuncture is con­sidered as “astrology with needles.” Further, a poster on acu­puncture I found on the WorkSafeBC website seemed to treat traditional acupuncture and electro-acupuncture as the same thing. I don’t think the ancient Chinese ever hooked acupuncture needles up to an electric current, though in modern times we do have TENS, for which there is scientific evidence of efficacy. 

Those who be­lieve in ancient traditional treatments for emotional or philosophical reasons sometimes try to find physiologic explanations to justify the belief (the gate theory, substance P, release of endorphins), but there is little evidence for this, and again it is nonspecific to acupuncture. One may get the same effect by rubbing an injury. Unblocking of the flow of chi is nonscientific, superstitious nonsense.

Regarding the “touch therapies” such as reiki and healing touch, the WorkSafeBC website provides no literature to support your positive
recommendation that I am able to find. However, since you also comment that it is clinically insignificant, I am curious why you felt the need to recommend it as a positive effect in the first place. 

The literature on various touch therapies is even less impressive than that for acupuncture, and the underlying philosophy for the practice is just as nonscientific and un­proven. The most famous example of its debunking was the 1998 JAMA article presenting the science project of a 9-year-old, where the touch therapy practitioners were unable to even de­tect the alleged human energy field.[2]

Most practitioners now use the fallback position of “it’s untestable by science,” rather than attempt to demonstrate its effects scientifically, which basically admits it is the realm of the supernatural.

In essence then, all these alt-med therapies may result in short-term relief of minor subjective symptoms for nonspecific reasons. Attention from a caring practitioner, the ritualization of the treatment itself, expectation, disenchantment with medicine, and regression to the mean all play a role. When measured objectively, no convincing effect has ever been demonstrated in well-designed studies.

“Herbals” is a pretty vague recommendation. Which herb? What dose? Herbs are plants that may potentially have dozens of physiologically active chemicals, though the vast majority of them haven’t been tested to the extent that pharmaceuticals have. Even for herbs that may have beneficial properties, the active ingredient is seldom known, and quality control therefore is impossible.

Since placebos work best when the patient is lied to, ethically I don’t think I could recommend acupuncture or touch therapy to my chronic pain patients. I find your recommendations on complementary and alternative medicine both disappointing and not based on the best available scientific evidence.
—Tim McDowell, MD
Sechelt

References

1. Noertjojo K, Martin C, Dunn C. Evidence-based treatment of chronic pain.  BC Med J 2010;52:515-516.
2. Rosa L, Rosa E; Sarner L, et al. A close look at therapeutic touch. JAMA 1998;279:1005-1010. http://jama.ama-assn.org/content/279/13/1005.full.