Acupuncture shown to relieve post-op nausea

GuanYin

From Reuters
A set of 26 trials in China and Australia covering 3000 patients has shown that stimulating the pericardium, or P6, acupuncture point on the wrist reduces the nausea that affects about four out of five patients who have had anesthetics.

The review, which appears in The Cochrane Database of Systematic Reviews 2004, showed that patients who received P6 acupuncture were about 28 percent less likely to feel nauseous or be sick than those who received a sham treatment.

Acupuncture, which involves inserting very fine needles into the skin at specific points in the body, was also shown to be just as good as routine anti-nausea drugs in head-to-head trials.

It is one of the most popular forms of complementary medicine and has been shown to relieve headaches and migraine.

The researchers who conducted the review -- Anna Lee, of the Chinese University of Hong Kong, and Mary Done, of New Children's Hospital in Sydney, Australia -- said the treatment is safe and effective and side effects are minimal.

I have seen the review paper published and have to say I'm surprised by the data, which is both statistical and clear cut (although those terms are mutually inclusive). It seems acupuncture is quite an effective and worthwhile treatment after all.

New Scientist are heralding acupunture as "a cheap and safe way of preventing people who have just had an operation from being sick or feeling nauseous"

Poisonwood

Yes. Interesting. I think this has been shown before. In fact, I saw one of the irish sceptics people on the Late Late Show last year saying this to Pat Kenny. He said in fact that accupuncture had been shown to be effective for nausea and (??asthma I think). I think he said that the question remains whether the mechanisms purported to be at work by accupuncturists can claim credit for the outcome or whether something else is responsible. A friend of mine explained this distinction in a useful way to me. He said you could be taking something like st john's worth (the therapy) with the claim, let's say, that it is balancing your bioenergies and relieving depression (the theory). Here the therapy can work well while the theory might be off the mark.

I guess we'll have to wait for the research to show us how the observed effect in accupuncture is being brought about. I know that accupuncturists say that they are manipulating energy channels in the body. Does anybody know of any scientific explanations put forward as possible explanations of the observed effects?

GuanYin

Poisonwood wrote:

Does anybody know of any scientific explanations put forward as possible explanations of the observed effects?

Its actually well documented in the scientific literature. Acupuncture works by elevating endorphin levels in the body.

Endorphins are part of the body's "reward system" and are basically neurochemicals that work on the same receptor cells that are stimulated by opiates. This receptor system regulates nerve cells that relax muscles, dull pain, and reduce panic and anxiety. It has also been shown that endorphin stimulation lowers blood pressure.

Scientists first suspected endorphins when they noticed that bradykinin, an inflammatory response regulator (to infection) in the body that stimulates the nerves that increase blood pressure, had a reduced ability to raise blood pressure when acupuncture was carried out.

To test this, they used naloxone, an endorphin inhibitor for the part of the nervous system that regulates blood pressure, and this was shown to allow bradykinin to have its normal effect at elevating blood pressure.

So it seem natural endorphins are stimulated with acupuncture which have the effect we observe.

Poisonwood

So should scientists/doctors mainstream the practice under a different name reflecting the different underlying theories about the mechanism at work? Say, EST (Endorphin Stimulation Therapy). This would connect the therapy and the theory in line with the available evidence.

GuanYin

Poisonwood wrote:

So should scientists/doctors mainstream the practice under a different name reflecting the different underlying theories about the mechanism at work? Say, EST (Endorphin Stimulation Therapy). This would connect the therapy and the theory in line with the available evidence.

In that case about 90% of all medical treatment that have survived the last 50 years and even some new ones like antisense based therapies should all be renamed seeing as at the time of conception we either didn't fully understand the mechanisms involved or were totally wrong about their mechanism of actions.

What this has shown, is that some traditional therapies that have been ridiculed by skeptics and scientists actually have a therapeutic effect.

There is no reason to suggest that many others do too and it highlights the need for an open mind and that we must restrict ourselves from lumping all "alternative therapies" into one catagory and then taking out the hatchet.

As it stands, the only therapies that I would be wary of are those involving chemical compounds that have not undergone FDA approved trials, this would include suppliments and the like.

Not because I don't believe they work (because in most cases, I have no facts or evidence to suggest either way), but because I believe that whats good for the goose is good for the gander - ie. no chemical therapies should be given to patients unless they all have the same level of FDA documentation.

tricky D

Pain tells us something is wrong, just removing the pain using acupuncture doesn't consequently remove the cause. Therein lies the danger.

That said, same goes for aspirin, *brufen, paracetamol, er, opium etc. I've often used acupressure to get rid of headaches by stimulating certain points (one set for tension, another for sinus headaches). It works a treat. As I have been led to understand it, the nerves, especially near the synapses, get stimulated to release the chemicals (endorphins, prolly as mentioned) sending messages to the brain to supress the pain. What it doesn't do is remove the cause of the pain. It may be possible that in limited cases it does actually do more than merely relieve symptoms, but I wouldn't know about any of that and wouldn't bet the farm on it. So the danger is to assume it removes the causes of the pain. The tale I once heard was of someone using acupuncture to relieve back pain, but ended up, in the long run causing all sorts of serious additional problems of the unable to walk properly again kind. Ages ago I was speaking to a practioner acquaintance about this and iirc they agreed with this.

What this has shown, is that some traditional therapies that have been ridiculed by skeptics and scientists actually have a therapeutic effect.

100s of years of emprical knowledge can't be easily dismissed (tho it might well be rubbish in cases). Also much of pharmaceutical/medical 'science' is based on trial and error. There are loadsa drugs which work well but no one has a clue as to why.

GuanYin

tricky D wrote:

Pain tells us something is wrong, just removing the pain using acupuncture doesn't consequently remove the cause. Therein lies the danger.

As you correctly pointed out, the exact same can be said for pain medication, however what you missed was that all pain medication is toxic to some degree and you therefore may experience side effects on taking it.

As acupuncture does not involve foreign chemicals that are toxic to your body, it is arguably a more medically sound alternative.

tricky D wrote:

So the danger is to assume it removes the causes of the pain. The tale I once heard was of someone using acupuncture to relieve back pain, but ended up, in the long run causing all sorts of serious additional problems of the unable to walk properly again kind. Ages ago I was speaking to a practioner acquaintance about this and iirc they agreed with this.

You are fogging the argument with inconsequential hypotheticals here. If you go back up to read the original post, the acupuncture treatment involved is specified for post-op nausea.

No-one is talking about using acupuncture as an alternative to the proper treatment, merely as an alternative to drugs that it can be substituted for.

tricky D wrote:

100s of years of emprical knowledge can't be easily dismissed (tho it might well be rubbish in cases).

Thats a nice concrete statement there

tricky D wrote:

Also much of pharmaceutical/medical 'science' is based on trial and error. There are loadsa drugs which work well but no one has a clue as to why.

Yet, traditionally, when alternative medicines are cited ad "working" people dismiss the claims (as was the case of acupuncture). What is a more advisable tactic, is to review each treatment on a case by case basis and above all, keep an open mind.

Poisonwood

I think the key is to have a critical mind actually which I don't see as being mutually exclusive from having an open one. That's what I like about scepticism. It says be open to the evidence but question it. I don't mean to be smart syke but sometimes i don't know what people mean when they say have an 'open mind'...some people have so open a mind that they believe anything and are unable to guard against nonsense. The thing that was argued about accupuncture was that it's proposed mechanism was unlikely although it was showing some statistically significant oucomes in relation to nausea and pain.

Also, in relation to something you mentioned a post or so ago, i think it would be more accurate to say that what this shows is that one alternative practice seems to work for one or two conditions and might be better explained by utilising standard biological knowedge ... if you'll excuse my being a pedantic b#+ch!

I guess i'm interested in not just the treatment outcome (which is obviously important)but the accuracy or truth of the ideas behind it. If i think there's something to 'lines of energy' (can't remember what they call it), then i may invest time and energy in exploring what else manipulation of these things can do based on the erroneous assumption that research into accupuncture has somehow verified them ... if that makes sense??!!

GuanYin

I take your point of view Poisonwood and I wasn't specifically rebutting your arguments, but what you have to understand is that modern medicine basically evolved from village witchcraft.

The basis of the pharmaceutics industry came from mans first early dabblings with herbs and medicinal "potions". In the same light, acupuncture is a 3000 year old technique. Those who discovered it could have no way of knowing the science. But the parallell is valid, Many traditional remedies have a scientific basis, the people involved in creating these techniques reasoned as best they could to why they worked. They simply did't have the wherewithal to understand it properly.

Should todays people know better? Perhaps, but I grant you that you probably believe many scientific "folk-tales" and half-truths that have been warped by the media (and I am sorry to say the Irish education systems) habit of relaying scientific details through chinese whispers. The new-agers who believe in acupuncture energy centres are doing noone any harm. And laughing at them or looking down on them is a very shallow victory for any skeptic, seeing as in this case "they were right and you were wrong" all along.

When I say have an open mind, I mean that peopel should learn to take all tehse remedies and treatments and look at them one at a time before deciding their worth. Many threads here (admittedly most are championed by one now-departed poster) tend to lump everything in one basket and denounce them from high.

I would argue that this is not what skepticism should be about.

As far as these treatments go, what is worrying is that those who know better, allow many treatments to the masses without examining them in detail. This is were skeptics should bow in. *IF* these treatments are available for mass consumption, *somebody* should know exactly what is happening and how they work (if they even do work). However, many seem more interested in clinging to ill reported science-media rags and speaking as a collective.

No good scientist was ever part of a collective.

davros

syke wrote:

What this has shown, is that some traditional therapies that have been ridiculed by skeptics and scientists actually have a therapeutic effect.

To state that a little differently: what this has shown is that alternative (traditional or otherwise) therapies can be proven effective (or not) using the same methods applied to conventional medicine. A proper skeptic will require nothing more than that, not even an explanation as to why it works.

Skeptical literature has long admitted that acupuncture can have an analgesic effect (e.g. this article in Skeptical Inquirer). Acupuncturists make a lot of other claims though (Acupuncture Ireland). So the practise of acupuncture, as a whole, has not been vindicated just yet.

In fact, The Cochrane Library, 2004 Issue 3 (the cited source in the article), lists ten reviews of acupuncture in clinical trials. The nausea result is the only one that is not negative or inconclusive.

Poisonwood

I think we're all pretty much on the same wavelength here. Syke, when you said "I would argue that this is not what scepticism should be about" I think you're making an argument that most committed sceptics would make (remember, we don't like to be put into one category either! I recall hearing one of the early sceptics lectures on alternative medicine and speaking afterwards with various people. I think the general consensus was that not all therapies could be lumped together and that there were therapies that ranged from plausible (e.g. herbal medicines) to questionable to almost certainly impossible (e.g. homeopathy). Also, the point was to challenge those who 'sell' both the theories and the therapies, why should they fear being questioned? Here it was stated that both the theory and the therapy are open to challenge and that sometimes (accupuncture was given as the example) a therapy can have limited effect because of mechanisms other than those stated by the therapists. While this might not matter to the consumer it should matter to scientists etc and those interested in understanding how things work.

The point made to me by the speaker was that the users of the therapies should not really be challenged, rather these consumers should be offered appropriate information to allow for informed choices to be made. However, those who sell these therapies (collectively, these are BIG business) should be subject to the same demands as we make for anyone selling any product ... that there is evidence that it lives up to the claims it makes. I think that's all reasonable.