Acupuncture Pain Research: Quantitative and Qualitative

Abstract

Acupuncture and related techniques have been widely used to treat different types of pain conditions. This chapter evaluates the role of acupuncture in the context of chronic low back pain; it draws on the evidence from recent large-scale randomized controlled trials on acupuncture to address issues on efficacy and effectiveness. The controversy over specific and non-specific effects of acupuncture, and what constitute an appropriate sham acupuncture control, will be highlighted. The question of whether the randomized placebo-controlled trial is the most appropriate trial method to evaluate a complex intervention such as acupuncture will be discussed. Similar evidence from trials evaluating western interventional procedures for chronic back pain will be presented. In addition, the concept of qualitative research in acupuncture will be introduced, highlighting the experiences of trial participants (patients and acupuncturists), and patient’s perceived differences in the two paradigms of Western medical acupuncture and traditional acupuncture. This reflects a shift of the concept of medicine from a biomedical model to a bio-social-medical model, especially in the context of chronic pain. The authors conclude that acupuncture is indicated in chronic pain condition such as low back pain; this is supported by effectiveness studies (pragmatic trials) and positive patient’s feedback from qualitative studies, and is cost-effective. Suggestions for future clinical research on acupuncture include: more emphasis on evaluating the whole effect versus components’ effect of acupuncture, to further understand the dynamic relationship and their contribution to the whole effect, and transparent and detailed reporting according to the CONSORT and STRICTA guidelines.