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Številni ljudje s kronično bolečino prisegajo na akupunkturo, vendar so skeptiki do starodavnega
zdravljenja z iglicami dolgo časa trdili, da je to le malo več od izpopolnjenega placeba.
Zdi se, da nova raziskava, ki je bila objavljena prejšnji teden v Archives of Internal Medicine, vsaj nekako indicira ljudi, ki verjamejo v akupunkturo.
Po ponovni analizi podatkov iz 29 visokokakovostnih kliničnih raziskav, ki segajo vse do 90-ih let, so raziskovalci povzeli, da je lajšanje bolečine z akupunkturo deloma resnično; torej ne moremo popolnoma pripisovati zaslug placebo učinku.
Vsi poskusi, ki so okvirno vključevali 18.000 ljudi s kroničnimi bolečinami zaradi artritisa, glavobolov ali težav v hrbtu in vratu, so primerjali pravo akupunkturo in eno izmed alternativ: običajno zdravljenje ali lažno akupunkturo - ponarejeno (tj. placebo) različico zdravljenja, kjer se iglice zabadajo nesistematično.
Olajšanje bolečine za 50 % ali več na lestvici od 0 do 100 - recimo s 60 pade na 30 - je običajen standard učinkovitosti v raziskavah bolečin. Glede na to mero je raziskava pokazala, da so mere učinkovitosti za pravo akupunkturo, lažno akupunkturo in običajno zdravljenje v naslednjem vrstnem redu: 50%, 43% in 30%.
‘’Večina kliničnih zdravnikov in pacientov bi rekla, da je 50% mera uspeha proti 30% pri nečem, kar je neobvladljivo, kot je kronična bolečina, pravzaprav izjemno dobra,’’ pravi vodilni avtor raziskave, Andrew J. Vickers, statistik pri Memorial Sloan-Kettering Cancer Center v New Yorku.
Akupunktura, ki izvira s Kitajske, vključuje zabadanje iglic na določena mesta oz. meridiane telesa z namenom zdravljenja različnih tegob, predvsem bolečin. Izvajalci akupunkture trdijo, da ta tehnika lajša bolečino z uravnavanjem pretoka energije skozi telo.
‘’Akupunkturisti govorijo o konceptih, ki izhajajo iz tradicionalne biomedicine,‘’ pojasni Vickers. ‘’’Zdravnik bo rekel: ‘Pri Fiziologiji 101 se nismo učili o pretoku energije.’’’
Teorija pretoka energije se je v Združenih državah in pri ostalih zahodnih narodih srečala z veliko mero skepticizma, raziskovalcem pa ni uspelo identificirati ostalih podpornih dejstev glede učinkovitosti zdravljenja.
Na ducate kliničnih raziskav je iskalo dokaze, da je akupunktura več kot le placebo, in sicer s primerjavo med pravo akupunkturo in lažnimi zdravljenji, ki poleg naključnega zabadanja iglic vključujejo električno in lasersko stimulacijo, ki je oblikovana tako, da oponaša občutke vboda.
Nova raziskava podpira dokaze glede akupunkture, vendar še vedno ne premaga ideje, da se pacienti večinoma le odzivajo na placebo učinek, pravi dr. Andrew L. Avins, epidemiolog na University of California, San Francisco, in raziskovalec na Kaiser Permanente, velikem nepridobitnem zdravstvenem načrtu, ki ima sedež v Oaklandu, Kalifornija.
Čeprav je prava akupunktura sodelujočim pacientom vidno koristila, Avins pravi, da dejstvo, da je bila raven učinkovitosti veliko večja pri pravi akupunkturi kot pri običajnem zdravljenju, vendar le malo višja kot pri lažni akupunkturi, namiguje na to, da je večina koristi akupunkture res povezana s placebo učinkom.
Poleg tega, doda, skromna razlika med pravo in lažno akupunkturo morda ne bo imela velikega pomena za povprečnega pacienta v resničnem svetu.
‘’Zdi se, da ima akupunktura res nek zelo majhen učinek, ki presega placebo akupunkturo ali lažno akupunkturo,’’ pravi Avins, ki je napisal uvodnik raziskave. ‘’Vendar so učinki res majhni in večina jih je placebo učinkov.’’
Skeptiki do akupunkture bodo zelo verjetno posegli po tem dejstvu, pravi Avins, vendar odkritja raziskave ne pomenijo, da akupunktura ne deluje, ali pa da zdravniki svojih pacientov ne bi smeli nanje napotiti.
‘’Akupunktura,’’ je predlagal, ‘’bi morda morala biti videna kot način zagotovljenega lajšanja bolečine, ki hkrati izrablja placebo učinek.’’
‘’V preteklosti so ljudje videli placebo učinek kot negativno stvar, vendar bi lahko imel pravi učinek za paciente,’’ pravi Avins. ‘’Bil bi v stiski, če bi moral reči pacientu, ki pravi, da mu koristi nekaj, kar je ‘’samo placebo’’, naj to preneha uporabljati.’’
vir: health.com, napisala Amanda Gardner
prevod: Tanja Topić
Acupuncture works, one way or another
Many people with chronic pain swear by acupuncture, but skeptics of the ancient needle-based treatment have long claimed that it's little more than an elaborate placebo.
A new study published this week in the Archives of Internal Medicine appears to at least somewhat vindicate the acupuncture believers.
After re-analyzing data from 29 high-quality clinical trials dating back to the 1990s, researchers have concluded that the pain relief derived from acupuncture is partly real, in that it can't be ascribed entirely to the placebo effect.
The trials, which included roughly 18,000 people with chronic pain stemming from arthritis, headaches, or back and neck problems, all compared genuine acupuncture with one of two alternatives: treatment as usual, or "sham" acupuncture -- a counterfeit (i.e. placebo) version of the treatment in which needles are inserted unsystematically.
Pain relief of 50% or more on a 100-point scale -- pain that drops from a 60 to a 30, say -- is a commonly used standard of effectiveness in pain research. By this measure, the study found, the effectiveness rates for real acupuncture, sham acupuncture, and treatment as usual are 50%, 43%, and 30%, respectively.
"Most clinicians and patients would say a 50% success rate versus a 30% success rate for something like intractable chronic pain is actually pretty good," says lead author Andrew J. Vickers, a statistician at Memorial Sloan-Kettering Cancer Center in New York.
Acupuncture, which originated in China, involves placing needles in specific locations or "meridians" of the body in order to treat various ailments, especially pain. Acupuncture practitioners claim the technique relieves pain by modifying energy flow through the body.
"Acupuncturists talk about concepts coming from outside traditional biomedicine," Vickers explains. "Doctors will say, 'I didn't learn about energy flow in Physiology 101.'"
The energy-flow theory has met with a great deal of skepticism in the United States and other Western nations, and researchers have failed to identify other, biological underpinnings for the treatment.
Dozens of clinical trials have sought to prove that acupuncture is more than a placebo by comparing the real thing with sham treatments, which in addition to misplaced needles can include electrical or laser stimulation designed to mimic pinpricks.
The new study bolsters the evidence for acupuncture but doesn't quite put to rest the idea that patients are largely responding to the placebo effect, says Dr. Andrew L. Avins, an epidemiologist at the University of California, San Francisco and a research scientist at Kaiser Permanente, a large nonprofit health plan based in Oakland, California.
Although genuine acupuncture clearly benefited the study participants, Avins says, the fact that the effectiveness rate was much higher than treatment as usual but only slightly higher than the sham treatment suggests that most of the benefit associated with acupuncture is indeed attributable to the placebo effect.
What's more, he adds, the modest difference between genuine and sham acupuncture may not be meaningful for the average real-world patient.
"Acupuncture does appear to have some very small benefit above and beyond placebo acupuncture or sham acupuncture," says Avins, who wrote an editorial accompanying the study. "But the effects really are pretty small, and the majority of the effect is a placebo effect."
Acupuncture skeptics will likely seize on this point, Avins says, but the study findings don't mean that acupuncture doesn't work, or that doctors shouldn't refer pain patients for the treatment.
Acupuncture, he suggests, should perhaps be viewed as a way of providing modest pain relief while also harnessing the placebo effect.
"In the past, people have viewed placebos as negative things, (but) they could have some real benefits for patients," Avins says. "I would be hard-pressed to tell a patient who says they're benefiting from something that's 'just a placebo' to stop using it."
By Amanda Gardner, Health.com
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