Back Pain and Acupuncture: Consumer Reports Gets It Wrong (Even If Mostly Right)
May I direct your attention to the excellent coverage (with one critical exception) of treatments for back pain in the current issue of Consumer Reports? It seems to be available to non-subscribers at http://www.consumerreports.org/back-pain/guide-to-treating-back-pain/. (I am a subscriber but I can get to it without logging in.)
It’s comprehensive, and it’s a great follow-up to my blog of February 17, 2007, “American College of Physicians Endorses Acupuncture as Noninvasive Treatment for Low Back Pain” at https://www.weinsteinacu.com/single-post/2017/02/17/American-College-of-Physicians-Endorses-Acupuncture-as-Noninvasive-Treatment-for-Low-Back-Pain.
Among other things, CR emphasizes the importance of a conservative approach to pain and speaks positively about nonsurgical means such as acupuncture, chiropractic, yoga, and t’ai chi. It discusses the dangers of overdependence on medication. It offers a caution about imaging studies (x-rays, MRI’s, and CT scans) in determining a treatment plan, quoting a medical authority who notes that “the broken parts on seen on imaging studies do not always correlate with the source or degree of pain.”
This was something I learned in acupuncture school. Pain due to presumed osteoarthritis does not necessarily correlate with presence of osteoarthritic changes. I’ve treated osteoarthritic pain successfully, and I’m sure the osteophytes are still there when the pain is diminished or gone.
You can see CR’s discussion of acupuncture here, under Item 5, “Acupuncture”: http://www.consumerreports.org/back-pain/new-thinking-on-how-to-relieve-back-pain/. Yes, the article casts acupuncture in a positive light. At the same time, it undermines the profession by reiterating common prejudices.
Four statements (out of the article’s six-sentence total) caught my negative attention, in the following order:
1. “In Eastern thought, it’s believed that inserting thin needles at specific points on the body helps correct imbalances in qi, the flow of energy. From a Western perspective, acupuncture is believed to affect soft tissue and nerves in ways that lessen pain.”
If you’ve been reading my blog, you’ve probably surmised that I don’t believe that “Eastern thought” and the “Western perspective” can both, at the same time, explain the same phenomenon. Whether from the East or the West, living 3,000 years ago or today, believing in the Tao or walking in Confucius’s footsteps, or embracing Judaism, Christianity, Islam or atheism, all human beings have the same anatomy with the same metabolic pathways and requirements. The sole good explanation of how acupuncture works is the one that best tallies with our modern world’s scientific model, the model that has led to vaccines and heart transplants, generates electricity from sunlight, and enables human beings to fly like birds. So, yes, acupuncture is a soft-tissue therapy that works by creating a lesion in soft tissue that leads to physiological changes in the nervous system, fasciae and organs. To explain acupuncture otherwise misleads the public and ultimately undermines what acupuncture can achieve in a modern, science-based society. Since at least 80% of the body is soft tissue, acupuncture has an enormous playing field.
In addition, acupuncture not only relieves pain but helps to restore tissue to a healthier state. This goes unmentioned.
2. “Make sure the acupuncturist is licensed in your state.”
How often do you check to see whether a physician, physical therapist or other health care professional is actually licensed? If you do, kindly write to me and let me know. This statement demeans my profession. According to the National Certification Commission on Acupuncture and Oriental Medicine, only Alabama, Oklahoma, South Dakota and Wyoming have no acupuncture practice acts. (Pennsylvania and Vermont require herbology competence and not acupuncture competence.) Therefore, in 46 of the 50 states, acupuncturists are licensed and should be presumed to be licensed, unless skepticism extends to every other licensed profession.
3. “Therapy shouldn’t be painful, but you might feel a slight twitch when a practitioner inserts the needles.”
While it is certainly true that most needles are not uncomfortable and many feel relatively neutral, some needles engender a grabbing or pulling sensation or the sensation of heat or, yes, a twitch. Sometimes a needle does hurt, however. It may feel sharp or burning, or the muscle fibers and fasciae in this part of the body are so traumatized that the sensory neurons in this region have become hypersensitive. Placing a needle here is felt more intensely than in healthy tissue. I have seen this many times. Across visits, patients learn to associate this momentary intensity with an improvement in their condition; the changed expectation moderates their discomfort.
It’s simply untrue to say that needles never hurt. A human being is receiving a needle into his or her body, and that person is entitled to know that discomfort is possible. Some people are more susceptible to pain than others. They may simply be more physically sensitive than other people, or perhaps they’re anxious about their first acupuncture treatment. It’s the job of the acupuncturist to enable even physically sensitive individuals to gain the benefit of treatment. Acupuncturists learn to manage this by being compassionate, or, from a crass perspective, because they wish to earn a living. Some people like strong needling sensation, by the way, and connote it with a “real” treatment.
4. “Acupuncture is safe as long as you’re in the hands of a trained and licensed practitioner who uses sterile needles.”
When is the last time you checked on the sterility of a syringe in a doctor’s office? (See Item 2 in this list.) The author of this article cannot bring himself or herself to fully embrace acupuncture as a safe and legitimate therapy.
I recall my first acupuncture experiences in the mid-1980’s, from a friend who who was practicing unlicensed in the acupuncture underground. She gave me my own set of needles, which she applied to my body at each treatment and then put away in cotton for next week’s visit. Perhaps needles were more expensive or harder to come by in those days. And I was too naïve and trusting to think that there was anything odd about it all. It was exotic, I liked the strangeness of it all – and it was THIRTY years ago! This is the sort of baggage the acupuncture profession drags along with it. May I add that when I was growing up in Brooklyn in the 1950’s, the G.P. making a house call gave my mother a hypodermic to boil in a pot for a couple of minutes before he administered a “shot” to my young self? Do G.P.’s ever do this today? Are there still G.P.s? Does my anecdote suggest to you that you’d better check the sterility of the next injection you get in a doctor’s office?
Acupuncture needles are cheap. No one reuses them. Like syringes, acupuncture needles are single-use and go in sharps containers when they’re withdrawn. It’s true for physicians and true for acupuncturists.
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That’s the mention of acupuncture in the article, aside from a lovely quotation from Arya Nielsen. Arya was one of my instructors in days gone by at Tri-State College of Acupuncture. She was the author of what was then the English-language bible of guasha (a bodywork technique I continue to use regularly), and the thoroughly estimable individual who mentioned one day in class that arthritic changes don’t necessarily correlate with pain, and vice versa, as noted above.
Since acupuncture is included as one of the useful alternatives to surgery and medication, CR ultimately deserves a thank-you.
In 2000 I picked up a Schering-Plough brochure in a doctor’s office, “Are You Hip to Who’s at Risk for Hep?”, a trifold with a self-inventory of risky Hep-B behaviors. If you were at risk, Schering-Plough wanted you to know about its Hepatitis B vaccine. The behaviors included tattooing, gay sex, visits to prostitutes, and – yes – visits to acupuncturists (for acupuncture, of course). Reading the CR article reprised how I felt when I read this brochure. I wrote to Schering-Plough and suggested they rethink the list, explaining that, to be licensed, acupuncturists must demonstrate their knowledge of what’s called Clean Needle Technique, which entails single-use needles and sharps containers. To its credit, Schering-Plough replied months later to say that acupuncture would be removed as a risk factor from future editions of the brochure. (Tattooing has also come of age, at this point in time.)
It’s time for Consumer Reports to do the same.
© William Weinstein 2017