Abstract
Variable results of pain alleviation in response to acupuncture have been reported, complicating its interpretation. Sources of variability are probably multi-factorial, including the contribution of gender related effects. Gender related variation in perceived pain has been discussed frequently, but documented effects of acupuncture referring to gender are sparse. Furthermore, factors such as operationalisation of the outcome variable and the statistical method for evaluation could also be sources of variability. When pain is regarded as subjective, the produced data should be treated as ordinal. The rank-based method by Svensson, taking the non-metric qualities of the ordinal data into account as well as the variability at the group and the individual level, is therefore an alternative. The present commentary aims to (1) evaluate changes in electrical sensory thresholds and electrical pain thresholds after low frequency electro-acupuncture separately in healthy women and men; (2) introduce and exemplify the method by Svensson in a user-friendly approach. To analyze the systematic patterns of change in thresholds, indicating evidence of treatment on a group level, the relative position (RP) and relative concentration (RC), were measured. The variation related to the individual, the relative rank variation (RV) was also measured. The results were divergent between women (n = 23) and men (n = 22), i.e. unchanged sensory threshold after acupuncture at the group level in women while changed in men. The assessed pain threshold after acupuncture on the other hand was changed towards higher levels in women and unchanged in men. The individual variation was apparent in both women and men but larger in women. For statistical analysis of the variability for both group and individual related effects, the rank-based method by Svensson could be used. The present study indicates that evaluation of sensory and pain threshold response should be analysed separately in women and men.
Highlights
Some clinical trials that compared acupuncture with no treatment or other treatment modalities have been reported [1-6]
The assessed electrical sensory threshold (EST, i.e. the least perceived stimulation described as a paresthesialike sensation) and the electrical pain threshold (EPT, i.e. the least stimulation leading to the first perception of pain distinct from unpleasantness) were recorded
All subjects fulfilled the protocol with one women and one man failing to report the EST results
Summary
Some clinical trials that compared acupuncture with no treatment or other treatment modalities have been reported [1-6]. Variability in the study results [7,8] makes the interpretation difficult [9-11]. Some positive results were mistakenly attributed to placebo [12]. Variability in acupuncture treatments of pain is multifactorial, such as clinical conditions, treatment strategies, study designs, outcome variables, instrument used and gender. Gender differences in pain evaluation have been discussed [13] but documentation of gender related responses to acupuncture is scarce. Possible gender differences in response to transcutaneous electrical nerve stimulation (TENS) and vibration have been discussed [14,15]
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