Acupuntura Biomed.pdf

BMC Complementary and

Alternative Medicine

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How might acupuncture work? A systematic review of physiologic rationales

from clinical trials

BMC Complementary and Alternative Medicine 2006, 6 :25

doi:10.1186/1472-6882-6-25

Howard H Moffet ( Howard.H.Moffet@kp.org)

ISSN 1472-6882

Article type Research article

Submission date 29 March 2006

Acceptance date 7 July 2006

Publication date 7 July 2006

Article URL http://www.biomedcentral.com/1472-6882/6/25

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Title: How might acupuncture work? A systematic review of physiologic rationales

from clinical trials

Author: Howard H. Moffet

Kaiser Permanente – Division of Research, Oakland, CA

July 5, 2006

2,320 words

Howard.H.Moffet@kp.org

Abstract

Background

Scientific interest in acupuncture has led numerous investigators to conduct clinical trials

to test the efficacy of acupuncture for various conditions, but the mechanisms underlying

acupuncture are poorly understood.

Methods

The author conducted a PubMed search to obtain a fair sample of acupuncture clinical

trials published in English in 2005. Each article was reviewed for a physiologic rationale,

as well as study objectives and outcomes, experimental and control interventions, country

of origin, funding sources and journal type.

Results

Seventy-nine acupuncture clinical trials were identified. Twenty-six studies (33%)

offered no physiologic rationale. Fifty-three studies (67%) posited a physiologic basis

for acupuncture: 33 (62% of 53) proposed neurochemical mechanisms, 2 (4%) segmental

nervous system effects, 6 (11%) autonomic nervous system regulation, 3 (6%) local

effects, 5 (9%) effects on brain function and 5 (9%) other effects. No rationale was

proposed for stroke; otherwise having a rationale was not associated with objective,

positive or negative findings, means of intervention, country of origin, funding source or

journal type. The dominant explanation for how acupuncture might work involves

neurochemical responses and is not reported to be dependent on treatment objective,

specific points, means or method of stimulation.

Conclusions

Many acupuncture trials fail to offer a meaningful rationale, but proposing a rationale can

help investigators to develop and test a causal hypothesis, choose an appropriate control

and rule out placebo effects. Acupuncture may stimulate self-regulatory processes

independent of the treatment objective, points, means or methods used; this would

account for acupuncture’s reported benefits in so many disparate pathologic conditions.

Background

Clinical trials often test a causal association between intervention and outcome [1].

However, Ernst has asserted that, “Viewed from a scientific perspective, acupuncture is

rarely, if ever, a causal therapy” [2]. Perhaps acupuncture is not causal – no more so than

flipping a light switch “causes” illumination. However, if acupuncture is a causal

intervention, investigators should be able to suggest a biological pathway, hypothesis or

rationale for how it might work.

“How might acupuncture work?” is asked and answered on the website of the National

Center for Complementary and Alternative Medicine (NCCAM) of the National Institutes

of Health: “It is proposed that acupuncture produces its effects through regulating the

nervous system, thus aiding the activity of pain-killing biochemicals such as endorphins

and immune system cells at specific sites in the body. In addition, studies have shown

that acupuncture may alter brain chemistry by changing the release of neurotransmitters

and neurohormones and, thus, affecting the parts of the central nervous system related to

sensation and involuntary body functions, such as immune reactions and processes that

regulate a person's blood pressure, blood flow, and body temperature”[3]. More detailed

rationales for acupuncture are readily available [4].

The CONSORT (Consolidated Standards of Reporting Trials) Statement recommends

that clinical trial authors “suggest a plausible explanation for how the intervention under

investigation might work” [5]. Clinical trials of acupuncture might be more useful if they

had not just a hypothesis about efficacy, but also a hypothesis about a mechanism. The

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