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Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a somewhat nebulous diagnosis with unknown etiology and no effective treatment. To make the diagnosis, bacterial infection must be excluded and the symptoms must last at least 3 months. Symptoms include pain in various locations (between rectum and testicle, in the testicles, at the tip of the penis, in the lower back, in the abdomen over the pubic or bladder area), pain or burning with urination, frequent urination, pain or discomfort during or after sexual climax. There are also systemic features like decreased libido, myalgias, and fatigue, and there is a higher incidence of chronic fatigue syndrome in these patients. The connection to the prostate is uncertain; in one study, women with chronic pelvic pain reported more of these symptoms than men did. Diagnosis is based on self-reported symptoms; there are no objective diagnostic markers. Somewhere between 2 and 10% of the male population are reported to suffer from this syndrome.

Since there is no effective mainstream treatment for this disorder, why not try acupuncture? Two randomized, placebo-controlled studies have reported positive results from acupuncture treatment. Is this enough evidence for us to recommend it to patients?

The Malaysian Study

This well-designed study was done in Malaysia, in a hospital with traditionally trained acupuncturists on its staff, in conjunction with the University of Washington Department of Urological Surgery. It was funded by the NIH and published in the American Journal of Medicine. There were 90 subjects randomized into two groups. They compared acupuncture at traditional points to sham acupuncture with more superficial needling 15 mm to the left of traditional points. They used no adjunctive treatments. They minimized interaction between participants and acupuncturists. They looked for a primary endpoint of a 6 point decrease from baseline to week 10 in a validated scale of symptoms, the NIH Chronic Prostatitis Symptom Index (NIH-CPSI), and for secondary outcomes including complete resolution and decreased scores at other intervals. They treated twice weekly for 30 minutes for 10 weeks, then followed the patients for an additional 24 weeks. They tested blinding by asking participants which therapy they thought they had received: 95% of those receiving acupuncture and 82% of those receiving the sham treatment thought they had received acupuncture. They found that acupuncture was twice as effective as sham acupuncture for the primary endpoint (73% vs. 48%, p=0.02) at 10 weeks, that more acupuncture patients had complete resolution of symptoms (18 vs. 10, p=0.07), and that acupuncture recipients had a greater long-term response 20 weeks after completing therapy (32% vs. 13%, p=0.04).

The Korean Study

The other study was done in Korea and was published in the journal Urology. It was a three-arm study comparing advice and exercise (A & E) alone to A&E plus electroacupuncture (where the acupuncture needles were electrically stimulated) to A&E plus sham acupuncture. There were only 13 men in each group. The sham acupuncture involved (1) more superficial needling, (2) placement 15 mm to the left of acupuncture points, and (3) the sound of the pulse generator without actual electrical stimulation. In the acupuncture group they found a significant reduction in the NIH-CPSI scores for pain, but no reduction in the scores for urinary symptoms or quality of life. On another scale, the International Prostate Symptoms Score, there were no significant differences. There is no mention of an exit poll to see if patients could guess which treatment they had received.

This study had one other intriguing wrinkle. There had been some hints of a correlation between prostatitis symptoms and prostaglandin E and beta endorphin levels, so they measured these in post-massage urine samples. They found a significant decrease in prostaglandin level in the electroacupuncture group (p=0.023) and a non-significant increase in the other two groups. They present a bar graph that makes it look like the increase in the sham group was more significant than the decrease in the electroacupuncture group, but they don’t provide the raw data or even report calculated p values, so we can only guess what the bars mean.

 EA pain

There was no significant change in endorphins for any group. It’s intriguing that they were able to measure something objective, but at this point, without replication, it’s impossible to say what the data mean, if anything.

Other Studies

A PubMed search for “clinical trials, chronic prostatitis and acupuncture” brought up these two studies and only 5 others that were a mish-mash of different kinds of prostatitis and different treatments: warm needle moxibustion, suspended moxibustion (where a burning stick is held above the acupuncture point with no skin contact), abdominal cluster needling, sometimes in association with herbal enemas and other treatments. A meta-analysis of case-control studies out of China found a significantly higher cure rate with acupuncture than with controls, but they were looking at studies of a different diagnosis: chronic prostatitis, not chronic prostatitis/chronic pelvic pain syndrome. And none of the studies were randomized controlled trials.

Additionally, the Korean study referenced another study that did not come up on my PubMed search for some reason. This study of CP/CPPS involved three sets of acupuncture points totaling 30 points (8 points were electrically stimulated) given alternatively twice weekly for 6 weeks. It showed an even more impressive effect: 83% of subjects reported marked improvement, but it was an uncontrolled pilot study with only 12 subjects.

So we don’t have a lot of evidence, but the evidence we do have consistently supports acupuncture for CP/CPPS. Acupuncturists can say their treatments are evidence-based.

Discussion

As you may have guessed, I have some reservations. In the first place, what do they mean by acupuncture? The Malaysian study used 4 acupuncture points: CV1, CV4, SP6 and SP9. The Korean study used acupuncture points BL 32, Bl33, GB30 bilaterally, for a total of 6 entirely different points. The Malaysian study used only needle insertion; the Korean study used electrical stimulation. The pilot study used 30 points with electrical stimulation of 8 of them. If you were going to do acupuncture based on these studies, which points would you choose?

Studies can’t really support each other if they’re not testing the same treatment, can they? In addition, even the Malaysian study was not a test of acupuncture per se. The “true” acupuncture arm did not even attempt to elicit the “de qi” sensation that many acupuncturists consider essential to the acupuncture effect. They followed a rigid protocol rather than offering the kind of individual treatment adjustments acupuncturists typically use in practice. And they did not twirl or stimulate the needles in any way after insertion. If their results had been negative, they might well have argued that their study didn’t discredit acupuncture because it didn’t represent the practice of acupuncture at all.

More importantly, we need to look at these studies in the context of everything else we know. Good studies with better controls (retracting needles) have shown no difference between acupuncture points and non-points. Other studies with toothpicks and with simple electrical transcutaneous stimulation have shown that it doesn’t matter whether the skin is penetrated. So many studies have shown sham acupuncture to be equal to “true” acupuncture that in several recent studies acupuncturists themselves have chosen not to use a sham acupuncture control on the theory that it is not a placebo control because any skin stimulation is effective. (But then what is acupuncture??!!) And even the best studies are not double blind: double blind studies would be extremely difficult to design, since the acupuncturist is aware of what he is doing.

Another concern is that studies from Asian countries are prone to the “file drawer effect” where negative studies are filed away rather than submitted for publication. This is a bigger problem in Asia than elsewhere: 98% of published acupuncture trials from Asia are positive, versus 30% of acupuncture trials from Canada, Australia and New Zealand. What if most of the evidence is really negative? What if 4 studies were done, 3 with negative results and one with positive results, and only the one with positive results was submitted for publication? Replication in a country with a better track record would make the results more credible.

We know there are many things that can go wrong with experiments, and that most published research findings are false. When initial findings are mixed for a treatment that really works, there is a gradual accumulation of more convincing data that tips the balance over time. Acupuncture studies have never shown any such progress.

I will admit to being prejudiced by the fact that acupuncture is based on pre-scientific thinking and on points, meridians and vitalistic forces whose existence can’t be demonstrated. But we wouldn’t have to know “how” it worked if it clearly “did” work. The evidence is inconsistent and not robust enough to convince rigorous scientists that acupuncture is more effective than placebo for any medical condition.

A Question Rather Than a Conclusion

Since medical science has little to offer for CP/CPPS, is recommending acupuncture ethically justified; and if so, should patients be told it is evidence-based?

Posted in: Acupuncture

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35 thoughts on “Acupuncture for Chronic Prostatitis/Chronic Pelvic Pain Syndrome

  1. shawmutt says:

    You stated, “So many studies have shown sham acupuncture to be equal to “true” acupuncture that in several recent studies acupuncturists themselves have chosen not to use a sham acupuncture control on the theory that it is not a placebo control because any skin stimulation is effective.”

    Do you have any cites for this? I would love to file them in my anti-woo woo folder for future arguments.

  2. Harriet Hall says:

    I covered one of the no-sham studies at http://www.sciencebasedmedicine.org/?p=44 There are others, but I can’t locate them at the moment. Maybe other readers can cite them.

  3. Scott says:

    There’s also this one:

    http://www.sciencebasedmedicine.org/?p=492

    Which was even worse than no-sham. The “real” acupuncture had no more effect than the sham, so the authors concluded that the sham worked too!

  4. windriven says:

    “Since medical science has little to offer for CP/CPPS, is recommending acupuncture ethically justified; and if so, should patients be told it is evidence-based?”

    The first phrase, of course, poses the fundamental question. The second is easy: NO, until there is a body of scientific evidence that suggests that it is evidence based.

    I would argue that it is unethical for a medical doctor to recommend acupuncture until there is compelling evidence that it works. Substitute any other form of woo and this becomes clearer, i.e. is recommending colon hydrotherapy for CP/CPPS ethically justified?

  5. edgar says:

    Hmm,
    i think this raises an interesting point about RCT’s NOT being the be-all end-all. In some cases (as in acupuncture) I think attempting a RCT is foolish.
    I would think multiple cohort studies would be a better indicator of effectiveness.

    As for recommending a treatment what is wrong with “The jury is still out, there have been two studies showing that it works, but I have some reservations about how these were conducted. However, I cannot forsee the harm (if that is indeed the case), and so it might be a ‘can’t hurt, might help’ thing. ”

    I fail to understand why docs are reluctant to say this. I myself just got back from vacation from the Caribbean, a bought my mom some nutmeg spray. it is sold in local pharmacies, and is claimed to relieve joint pain. Will it work? I don’t know. if I am wrong, I am out a couple of bucks. Big deal.

  6. windriven says:

    @edgar

    “As for recommending a treatment what is wrong with …”

    It isn’t so much that there is anything wrong with that as that there isn’t anything right with it. People are all too quick to grab at straws even when solid, science-based treatments are available.

    The practice of medicine by MDs is based on science. Recommending unproven therapies is inconsistent with that practice (in my humble and not-an-MD opinion). If MDs condone treatments that are scientifically shaky because ‘what’s the harm’ it encourages lay people to question why they shouldn’t believe in other quackery. And that is exactly where the harm may reside.

  7. Emma B says:

    I’ve got a chronic pelvic pain condition (endometriosis), so I’ve pondered this same question from a personal level.

    There are legitimate medical and surgical treatments for endometriosis, but they often don’t work very well (birth control), and/or can’t be used for long periods of time (GnRH agonists), and/or come with serious side effects (GnRH agonists, hysterectomy). I’ve got 15-20 years until I can expect menopause to bring the endo to its natural conclusion, and my only choices at this point are to get a hysterectomy or just suffer through with pain management. It’s a pretty lousy position to be in, honestly.

    I don’t believe in acupuncture, so I personally wouldn’t be a good candidate for a placebo effect, and I’ve got very mixed feelings about it. On the one hand, I feel like it’s dishonest and dismissive for a doctor to recommend a non-evidence-based treatment, especially one that’s likely to cost me a good bit of money. My reproductive endocrinologist mentioned acupuncture in passing to me, and I definitely felt like I was being shoved off with a pat on the head.

    On the other hand, though, what if the alternative really is “I’m sorry, there’s nothing else I can (or will) do for you”? At least acupuncture doesn’t have the side effects of GnRH agonists, or the risks of infection or bowel injury or adhesions from repeated surgeries. Nor is it much less evidence-based than some of the other lifestyle recommendations doctors often issue for chronic pain, like therapy and relaxation/meditation techniques.

    The fundamental problem, of course, is how terribly medicine handles chronic pain issues — not just the “questionable” ones like fibromyalgia, but the demonstrably real physical conditions like endometriosis and arthritis. If medicine had more to offer, maybe you wouldn’t need to ask whether it’s right to recommend woo.

  8. fitzerald says:

    I agree with edgar on this one. RCT is not applicable to all types of treatment. It’s very effective for double-blind studies for drugs, but treatments where individuality is involved cannot be evaluated solely on RCTs. Are all surgical procedures evaluated through RCTs? It’s also not possible to develop a true placebo for acupuncture, so that makes it hard to evaluate fully through RCTs. One can only say whether addition of acupuncture yielded better results than not doing it. Yoga and meditation is the same way. How can you do sham yoga? Studies can only show the benefits of yoga vs. not doing yoga for a specific condition.

    I also don’t understand why doctors can’t say that patients try out an alternative but safe therapy that may or may not work, at least for the diseases that aren’t completely cured by the medicine we have right now. It’s not like you’re recommending acupuncture to treat a bacterial infection. Such alternative treatments are mostly used when modern medicine has some limitations, like managing chronic conditions. All you need to say is that the effectiveness of the therapy is unclear and it’s up to the patient whether to give it a try or not. I’d want my doctor to do the same for me, if I wasn’t fully satisfied with the medical treatment options.

    Finally, the standard of not recommending anything until scientific evidence supports it is not a standard that is followed in medical practice anyways. Drugs are often used off-label, and certain procedures are evaluated only after they’ve been done on a lot of people. There are studies suggesting that some cardiac surgeries don’t really improve longevity, but we started doing them before any evidence, and we’re still doing them. Science based medicine is a necessary evaluation process, but the practice of medicine has always been both a science and an art.

  9. I think it needs to be emphasized more strongly that “electroacupuncture” is NOT acupuncture. It is electrical stimulation through acupuncture needles – which is no more acupuncture that injecting morphine through hollow acupuncture needles would be acupuncture.

    So in reality, there is one controlled study of acupuncture for this condition – and it is entirely unconvincing. The blinding was not adequate, for one.

    And Harriet raises an excellent point – we have one study from a part of the world where there are strong cultural biases in favor of acupuncture.

    We know that this level of clinical evidence is all but worthless. Combine that with negligible plausibility, and we are left with no science-based or ethical reason to recommend or use this modality.

    The harm comes from the downstream effects of abandoning science-based practice.

  10. edgar says:

    But see,
    I don’t think you are abandoning science based practice, nor are you ‘recommending’ anything. You are answering a question as factually as you can, and saying “I really don’t know the answer.” Which is something, in my experience Doc’s are unwilling to do.
    Medicine is NOT solely a science based specialty.

  11. JerryM says:

    Can’t one design a study where the applicator of the needles is unaware of the ‘correct’ and ‘incorrect’ position of the needle?

    For example, the acupuncturist would put a mark on a picture of the patient where the real point was, he or a computer would put a mark on a fake point, mix the 2 pictures up, and give one of the pictures to a non-acupuncturist.

    The applicator would have no clue if it was a real or a fake point.

    My answer to your question is it’s ethical based on current, even though it’s flawed, evidence to suggest acupuncture for this specific problem, with some caveats, it should not be covered by any insurance, not even private ones – private insurers may not think it effective, and may even think it will cost them, but they may calculate that offering the option to insure this will bring in enough people (who won’t need it but will still pay for it) to counter the expense of the woo – and only because it doesn’t appear to be a condition that is life threatening and acupuncture is unlikely to adversely affect the condition or cause other symptoms, and because there is no SBM alternative.
    This does gloss over the possibility that should the patient experience a positive reaction, they may be more inclined to turn to acupuncture for other conditions, where there are health risks associated with non-action and SBM alternatives are present.

    That last point may be the biggest reason why any altmed option even when not causing harm could be unethical…

  12. Geekoid says:

    “…and if so, should patients be told it is evidence-based?”

    If there was a drug that didn’t work in every study but one, would you give the drug to your patients and tell them it was evidence based?

    If not, why is this different?

  13. JerryM says:

    I think I should revise my original position, given some further reading and understanding and on my own final argument.

    Since medical science has little to offer for CP/CPPS, is recommending acupuncture ethically justified; and if so, should patients be told it is evidence-based?

    It is not ethically justified.
    The possibility that should the patient experience a positive reaction, they may be more inclined to turn to acupuncture for other conditions, where there are health risks associated with non-action and.or SBM alternatives are present, is, given what we know about placebo effects, too high to take the risk.

  14. windriven says:

    @edgar

    You’ve shifted the line of scrimmage a little from your first post to this one.

    MDs come in all intellectual shapes and sizes. Perhaps there are some who are unwilling to admit the limits of their knowledge or of the current limits of medicine. But I would flatly contest the broad assertion that ‘Doc’s (sic) are unwilling to [admit areas of ignorance].”

    “Medicine is NOT solely a science based specialty.” But isn’t that the goal? Isn’t that how we moved away from bleedings and trepanning and whatnot? Look, the goal of physics is to explain the entirety of the laws governing the universe. The fact that we aren’t there yet doesn’t invite physicists to recommend alchemy or astrology as potential explanations because ‘belief therein probably won’t hurt anything.’

    I understand your point that people may sometimes find amelioration of their symptoms in queer places. I would simply posit that they don’t need the guidance of physicians to do that.

  15. Scott says:

    Look, the goal of physics is to explain the entirety of the laws governing the universe. The fact that we aren’t there yet doesn’t invite physicists to recommend alchemy or astrology as potential explanations because ‘belief therein probably won’t hurt anything.’

    It does, however, lead some physicists to recommend string theory (and some to assert that string theory is known to be correct), so the analogy isn’t all one might hope for.

  16. edgar says:

    “isn’t that the goal?”

    I honestly struggle with that one, to be honest. While I AM a firm believer in Evidence-Based Practice, I equivocate a bit in some areas, off-label drugs, for one.

    I also would never consider medicine a hard science, comparable to physics, because of the human component. Or, in a positive light, the art of medicine, which does indeed, exist.
    And you are right, I did shift the line of scrimmage, but I do feel that medicine can (and should) encompass both, as with anything it’s the ‘how’ that is the difficulty.

  17. edgar says:

    “isn’t that the goal?”

    I honestly struggle with that one, to be honest. While I AM a firm believer in Evidence-Based Practice, I equivocate a bit in some areas, off-label drugs, for one.

    I also would never consider medicine a hard science, comparable to physics, because of the human component. Or, in a positive light, the art of medicine, which does indeed, exist.
    And you are right, I did shift the line of scrimmage, but I do feel that medicine can (and should) encompass both, as with anything it’s the ‘how’ that is the difficulty.

    No i didn’t, it didn’t post (to the internet who said I posted this already)
    :)

  18. windriven says:

    @Scott-
    Physics isn’t immune to crappy science. That said, any physicist arguing that string theory is settled science is either stupid or drunk. Worse, string theory has become the AGW of physics in that it is awfully difficult to get grant money to study alternatives. That sets up a positive feedback loop that doesn’t have much to do with truth, science, or the frontiers of knowledge.

  19. fitzerald says:

    I understand the fear that doctors suggesting one alternative therapy might lead their patients down the road of harmful therapies and justify quackery, but I don’t think it plays out in reality. Some patients will try out alternative therapies even when the doctor doesn’t recommend it, and some patients will refuse to try an alternative therapy even if the doctor mentions it as an option (like Emma B).

    Do patients need the guidance of doctors on the issue of alternative therapy? It depends, and I think it’s all about communication. I think a doctor who’s open to discussing alternatives and recommending what might be worth trying can discourage a patient from choosing an alternative that has risks. Not all alternative medicines are harmful to the same extent or effective to the same extent. It’s possible that when a doctor lumps all alternatives together a patient would not heed their warnings anyway, thinking that both “good” and “bad” alternatives are the same to the doctor.

    Again, all of this is pertinent in the diseases where treatment is variable and not perfect. I’ve tried home remedies for certain skin ailments that helped. I’ve also tried dietary changes and yoga for other things, and they helped despite me being skeptical of them. So anyways, I’d like my physicians to give different alternative treatments a little more critical thought than “there’s no evidence for them so don’t try it.”

    Sure, the goal of medicine is to be evidence based, and that’s why we should be evaluating our practices. But a patient’s wellness is more complicated than evidence based practice, so if something enhances wellness, then doctors can talk about it without saying it’s a proven therapy. As I mentioned before, doctors use a lot of non-evidence based therapies or procedures at any given point. Sometimes the evidence isn’t strong either way.

  20. fitzerald says:

    “If there was a drug that didn’t work in every study but one, would you give the drug to your patients and tell them it was evidence based?

    If not, why is this different?”

    Whether a doctor prescribes that drug depends on better alternatives being available. If better alternatives are not available, I don’t see what’s wrong with trying a drug that wasn’t shown to work all the time. I would not tell the patient that it is evidence based, I’d tell the patient that the evidence is mixed and this is worth a try. All this is assuming that the drug doesn’t have serious side effects, or that the patient wants to try something no matter what.

    There are many things about psychiatric diagnoses and psychiatric drugs that we don’t know about, but doctors still have to do something to make the patient better. Sometimes such inventions do more harm than good, like lobotomies, and then we stop them.

  21. Scott says:

    They were neither stupid nor drunk, just overtaken by an almost evangelical fervor. Plus the belief (more suitable to pure math than physics, though IMO that’s what string theory IS right now) that elegance necessarily implies truth. I’ve also wondered on occasion how much of their certainty was based on the fact that they’d pinned their entire professional life on it.

    Worse, string theory has become the AGW of physics in that it is awfully difficult to get grant money to study alternatives.

    It’s almost worse in some ways, since there are some organizations happy to give money to anyone questioning AGW. (Respectability issues notwithstanding.) Funding sources for theoretical physics are a lot less diverse.

    The whole takeover by strings is a significant part of why I left HE theory for experiment, and later departed the field entirely. I was somewhat shielded by being at Boston (having Shelly there helps) but the disgust still builds up.

    But we’re getting a bit off-topic here. Shall we get back to acupuncture?

  22. Scott says:

    Whether a doctor prescribes that drug depends on better alternatives being available. If better alternatives are not available, I don’t see what’s wrong with trying a drug that wasn’t shown to work all the time. I would not tell the patient that it is evidence based, I’d tell the patient that the evidence is mixed and this is worth a try. All this is assuming that the drug doesn’t have serious side effects, or that the patient wants to try something no matter what.

    Here’s a less-obvious problem. No drug would ever be approved for use based on one study – the FDA would demand far more. So the situation could never arise with pharmaceuticals.

    Yet acupuncture is accepted as safe without such testing. But if it really works, then it’s because it’s “rearranging your qi” or some such. Doesn’t it stand to reason that it could be rearranged in a detrimental way as easily, if not more, than a beneficial way? But nobody’s ever even TRIED to check out what risks there would be to acupuncture, or understand how to avoid them.

    So it’s ironic, really. The only thing that saves acupuncture from killing piles of people is the fact that it doesn’t actually do anything. (Similar arguments may be made for reiki, homeopathy, etc., of course.)

  23. edgar says:

    “So the situation could never arise with pharmaceuticals.”
    Of course it does, all the time in the case of off-label uses.

  24. Scott says:

    The initial problem statement was “If there was a drug that didn’t work in every study but one”. Not “If there was a drug that didn’t work for a particular condition in every study but one”. My reading is that it means that the single study was the ONLY positive safety or efficacy study for ANY condition.

    If interpreted as “established to be safe and effective for other conditions but without much evidence specific to this condition” then the situation indeed changes greatly – but it’s also no longer at all similar to acupuncture.

  25. pmoran says:

    “Since medical science has little to offer for CP/CPPS, is recommending acupuncture ethically justified; and if so, should patients be told it is evidence-based?”

    Thanks for drawing attention to this dilemma. I would present it a little differently.

    Any patient sophisticated enough to be thinking in these terms, will already know that acupuncture is controversial. Yet they may wish to cling to the hope that something, somewhere will ease their suffering. If it “works”, they will not care in the slightest if it is “just a placebo”, and they will not thank you for putting that possibility in their minds in advance.

    Why not just say, “some say that acupuncture helps — would you like to try that?”

    I still can’t buy the slippery slope argument against this. It supposes that the public will always behave like idiots where medicine is concerned. Some admittedly do, but they are hard to protect in any way, and certainly not by denying possibly helpful options to others.

  26. AppealToAuthority says:

    IN situations where medical science has little to offer, particularly where the main symptoms are pain, discomfort, or psychological distress, GP practice is often not science-based. This needs improving where the advice given is actually damaging; but where it is not, and it does not displace any real treatment, the psychological effects of empowerment probably justify the advice.

    But I’m not sure Harriet’s question regarding acupuncture is the most useful:

    “Since medical science has little to offer for CP/CPPS, is recommending acupuncture ethically justified; and if so, should patients be told it is evidence-based?”

    Perhaps it could be better phrased as:

    a) “Since medical science has little to offer for CP/CPPS, what _could_ I say about acupuncture that _is_ evidence-based, or science-based?”

    together with:

    b) “When is it ethically required that I _do_ say anything at all about acupuncture — ie when is it ethical to recommend, recommend against, not recommend, or not recommend against, a treatment for which evidence of effect is not clear, and where there is not currently a plausible mechanism”.

    In all situations, the answer to (a) is fairly clear. Here is my attempt:

    “Acupuncture is a wide-ranging practice, with many different approaches to diagnosis and treatment, some of which are mutually exclusive.

    In terms of the medical evidence, there has not been much rigorous research into effects of acupuncture, and that which has been rigorous has on balance shown little or no physical effect from acupuncture, but some significant psychological effects such as reduced perceived pain or discomfort. Acupuncture has some risks, but these are rare and limited to certain treatments (deep needling in certain areas) or poor practice (hygiene).

    For CP/CPPS in particular, one good study seems to show acupuncture has a useful effect; and one seems to show a reduction in pain using electro-stim of acupuncture points. There is no evidence base as to what acupuncture treatment (ie which points) should be used. No studies have been replicated.

    From a science theory viewpoint, no-one has found a plausible mechanism to explain how acupuncture could work as a general treatment methodology for illness. The origins of most current acupuncture practice are not grounded in medical evidence, scientific theory, or knowledge of the physical nature and biochemistry of the human body. There is a large body of information that overwhelmingly shows that the common explanations used are either not true, or not testable. There is some correlation between nerve layout and some acupuncture points; others have no known physical basis. There are well-known psychological mechanisms which would produce most of the effects reported in relation to pain, and some known mechanisms by which needling near nerves (but not necessarily acupuncture points) may affect nerve function. In short: there is currently no coherent scientific basis for the practice of most forms of acupuncture.”

    Point (b) is much harder, and depends on the basis of your ethics. I believe it requires an analysis of likely outcomes, balanced against the need for accuracy and truth. It is not ethical to lie, or to hide a treatment possibility which might be effective and safe, or to give tacit support to a dangerous practice or choice. But it is ethical to remain silent about potential treatments which are unproven; and also ethical to say that a treatment seems to have little chance of success, but also little chance of harm, when that is the state of current knowledge and scientific belief.

    “I don’t know” or “we don’t know” is an ethical answer.

    “We don’t know but acupuncture proponent’s unsupported claims annoy me so I’m going to say it is an incarnation of the devil” is not ethical – or science-based.

    Though it is my first reaction…

  27. Dr Benway says:

    As for recommending a treatment what is wrong with “The jury is still out, there have been two studies showing that it works, but I have some reservations about how these were conducted. However, I cannot forsee the harm (if that is indeed the case), and so it might be a ‘can’t hurt, might help’ thing. ”

    At least we know the outcome of the “can’t hurt” argument, given about ten years or so. Alt med is now a $40,000,000,000 per year industry.

    Newly flush with cash, the alties have recently bought their way into mainstream medicine. They’ve invented fake peer review, fake journals, and fake board certifications that look just like the real thing. They are proudly licensed by their respective states, and have convinced lawmakers that it would be unfair to discriminate against any practitioner so licensed.

    Soon a chiroprator or a naturopath will be serving as your primary care doctor. And our tax dollars will support this travesty.

  28. ernie.bornheimer says:

    I’m not surprised acupuncture and sham acupuncture are equally effective. I think what makes it work (to the extent it does) is that it’s a form of therapeutic touch (in the literal meaning of that phrase). Acupuncture’s efficacy (assuming it exists) is a social phenomenon, more than a purely physical one. Like primate grooming. I think this also explains part of the efficacy of massage and chiropractic. An important ingredient is that the patient percieves that another human is paying attention to their body. It wouldn’t work with a robot sticking the needles in.

  29. vasiln says:

    There’s at least one treatment that’s supported by evidence for the treatment of CP/CPPS (and for lots of other things as well): placebo.

    I think that sometimes we get distracted by our talk about whether things outperform placebo. We think of placebo as somehow not being real– and of course it is, whether the mechanisms by which it works are understood well or poorly. And our patients react angrily to the suggestion that they might be helped by placebo, because to them, that suggests that the problem lies, not between their hips, but between their ears. (I think that our distrust and rejection of placebo is intricately entwined with our stigmatization of mental illness, but that’s another conversation.)

    I find nothing unethical in the statement, “Some people have reported relief of symptoms following acupuncture.” It’s wholly supported by evidence. For those that feel that this statement is straying dangerously close to a lie by omission, it’s not hard to add, “But studies have failed to convincingly demonstrate a benefit over placebo,” without too much risk of reducing the effectiveness of the treatment.

    Obviously, this isn’t the same thing as advocating for public funding of CAM. Different people respond best to a diversity of placebos. While I’m not sure if there is any evidence regarding ideal choice of placebo, theory suggests that patient preference would be a good criterion. So, additionally, while I would be happy to encourage an interested patient to seek acupuncture, I would not feel good about initiating that conversation.

  30. marleneo says:

    Three case reports: two mixed-breed dogs and my father 1. My dog, age 8, and 45 pounds, on x-ray, had two dorsal spinal processes that met over her hips – the anterior process grew posteriorly, the posterior process grew anteriorly. When she archer her back to get up, they would rub together and cause dire pain. I had to lift her hind legs so she would rise to go outside to the bathroom. Eighteen months after acupuncture, suggested by a friend who raised purebred Pekingese to a skeptical me, both spinal processes had resorbed on x-ray. The orthpedic veterinarian had seen this “phenomenon” previously. She lived until almost age eighteen, with “maintenance” acupuncture treatments administered every month or two until she died. 2. Second dog, eighty-nine pounds was, on x-ray, diagnosed with ankylosing spondylitis. Seven months after an initial few chiropractic treatments, joint-supporting herbal supplements, losing twelve pounds and numerous acupuncture treatments, she has no more ankylosing spondylitis. At age ten (diagnosed at age 9), she now acts more like a puppy. 3. My father, age 89, a retired pharmacist, had severe arthritis to the point that my mother had to button his shirt from chest to neck level. After only one acupuncture treatment (he witnessed what happened with the dog) he was able to raise his arm straight up over his head for two years, until he died at age 91 of undiagnosed heart disease. NOTES: 1. Dogs have no knowledge of “placebo effect” 2. Anecdote: both dogs would run up to the outer office door and into the inner office treatment room for their acupuncture therapy

  31. Richard Schultz says:

    Has anyone ever tried the following protocol for double-blinding an study on the efficacy of acupuncture for a given condition? (Let’s call it Condition A)

    1. Find a group of patients, all of whom suffer from Condition A, and none of whom suffer from a second condition (let’s call it condition B).

    2. Divide the group in two (group X and group Y).

    3. Either (a) find a group of practitioners and tell half of them that Group X is being treated for condition A and tell the other half that Group Y is being treated for condition B, and that the control is the other group following the treatment for the other condition, or (b) find at least one practitioner and tell the practitioner(s) that the study is for the efficacy of acupuncture against condition *B* with the control being treatment for condition A.

    4. Require the practitioners and the patients *not* to discuss the condition for which treatment is being sought or for which they are being treated.

    I realize that this protocol isn’t perfect (if condition A is leg pain and condition B is arm pain, it will be hard for the patients to hide from the practitioners whether or not they are being treated for the right condition), but at least it would eliminate the problem of the acupuncturist performing sham acupuncture cuing the patient.

  32. wac0 says:

    A prostatitis patient recovered experience
    http://www.prostatitis1.org

    ——————————————————————————–

    I was ever been a prostatitis patient for seven years . The prostate expand and pain sharply. My waist pain, dizzy and weak. I had seen many famous doctors in china , had used the microwave, infrared ray scan, acupoint injection , squeeze medicine into anus to cure the disease. But I failed. I had taken many kinds of Chinese herb medicine secret recipe and used many kinds of specific medicine that advertised Chinese medicine from one Chinese prostate hospital medicine every day, it only can relieve my pain ,I wasn’t cured. Recently ,I visited a famous prostate disease research institute. (They said that the cure rate is 85%. ) I was aroused by their method. And I used new cured plan which I synthesized seven years experience. By this way ,I was recovered only in one month .All the symptom disappear, and the prostate secretion test wasn’t found bacteria. The whole body felt relaxed ,the idea of committing suicide all gone. And I felt the life is so beautiful and valuable. It is said that a prolonged illness makes a doctor of patient. When you have this illness, you can learn from experience, and choose the best cured way. Absorb the good points of the every doctors ,and create the new way. As a recovered patient, I know the pain of prostatitis patient deeply. So I like to share my experience with the cyber acquaintance.

    My cure method include seven parts. (It is specialize in chronic prostatitis. The acute prostatitis is very easy to cure, if you eat portalaca olerrcea for ten some days continuously, you can recover.)

      The picture of portalaca olerrcea

    Point and whole synthetical balance treatment

    1. Eat four kinds of nature product every day . Bee honey, royal jelly, bee pollen and propolis. Building up your health, increasing sexual activity and enhancing immunity ,etc. Increasing the content of zinc element in prostate. I can guide you how to use them together.

    2. Use Chinese medicine powder ( involve scolopendra subspinipes mutilans, phellodendron, Chinese schneid, elaphe moellendorffi,etc) Ten kinds of ingredient powder mix a kinds of special vinegar product , external use to cover two acupoints that connect everyday. Prostatitis is so difficult to cure because eating medicine is very difficult permeate prostate. The medicine consistency can’t last for a long time. External use covering acupoints can effect the prostate all the time and maintained high consistency.

    3. Take a Chinese herb medicine prescription everyday . This prescription can attack prostate and kill the germ in urinary organ. But the medicine will not sap your vitality. There isn’t side effect. I can provide this prescription.

    4. Boil some Chinese medicine , pour into a basin, and sit on the basin’ s medical water for ten minutes before bath every day. So the medicine can kill germ in urethra and scrotum, effect to prostate directly. The medicine won’t be absorbed by intestines and stomach. There is no side effect. I can provide the prescription.

    5. Practise Qi Gong (a system of deep breathing exercise) I can guide you to practise . Stimulate the circulation of the blood and cause the muscles and joints to relax. Increase immunity, impact the focus. This kinds of Qi Gong is very safe and there is no deviation. But you can’t practise other kinds of QiGong freely , because some kinds of Qi Gong aren’t corresponding to prostatitis.

    6.Use K-01 prostate rehabilitator for half an hour when you go to bed every day . K–01 prostate rehabilitator is a help-yourself physiotherapy apparatus which cures BPH . Employing the alternative operation of the high frequency non-thermal effect and magnetic kick. It serves to diminish inflammation, relieve pain, destroy harmful microorganisms, improve local micro-blood circulation and is very effective in curing frequent micuition, urgency of urination, painful urinary stuttering , and dysuria caused by prostatitis. It only need to put it on perineum.

    7. No smoking (If you can’t stop, try not to smoke so much ). Stop drinking, stop piquancy foods (such as capsicum ,ginger ,garlic, pepper ,etc) , stop eating fried foods, bacon, and flame broiled meat.( because the temperature is about 300 celsius degree, so the protein had been denaturalization , the protein had been hot. If you cook it by water , the temperature will not exceed 100 celsius degree. If you use the micro-wave oven to cook the meat, the temperature will exceed 100 celsius degree too, so it is hot.) Stop eating chanticleer, dog, pig’s knuckle, donkey, tortoise ,cow, sheep, ginseng, pilose antler, Equus asinus L,longan,lichee , bamboo shoot,onion,mushroom( mushroom kinds of food will cause prostate swell),areca and all the sea and river animal ( such as fish, tortoise, shrimp, crab, etc). Stop eating all the hot chinese medicine. After you recover, you have to continue to stop eating these food for 3 months, in order to solidify. This is the whole body treatmnet, regard the whole body ‘s the former feminine and negative, don’t eat the food that make against prostatitis recovered. The foods that I suggest you eating is : (1) You can eat meat involve the pig’s muscle, heart, kidney, lung, tongue, stomach, the duck, the chicken and hen, egg, the quail, the pigeon, the snake, the cat, milk, animal blood (after boiling). (2)Vegetable: except the leek, the cushaw , the onion , the aubergine ,the bamboo shoot and the garlic , you can eat all the others vegetable.(3) Fruit: except the lichee, the longan, the mango, the durian and the tree pineapple, you can eat all the others fruit.(4)All the corn and the legume foods can be eated. Such as cereals, rice, potato, pasta, sugar and tea can be eaten. But the coffee and chocolate is a little hot.The sea animals can’t be eated, but the sea plants can be eated, such as the kelp and the laver can be eated.(5)Bread in particular is cooked at a high temperature by baking, but the bread primary ingredient is amylum , amylum is not easy to change into hot food in high temperature, and the protein is easy change into to hot food in high temperature. If the bread is not very burnt, so you can eat the bread. If the bread is very burnt (such as it it had been black), it will be hot food too. (6) Do some cooking method: when you cook rice, pork, etc, you have to pour water to boil, the water is boil at 100 celsius degree, the temperature won’t above 100 celsius degree. If you boil with heavy-fisted boiler, there are so much water in it, although the temperature is above 100 degree, the protein will not change its quality. Protein is easy be burnt in high and dry condition, if the meat turn black and yellow , it must be hot food, such as barbecue chicken. If you stir-fry the pork by plant oil, because the oil is under the pork, the oil can suffer very high temperature and won’t change its quality, so the oil protect the pork not to change its quality. Such as you can stir-fry the vegetable with peanut butter . You can make a stew with chicken ,rice and vegetables . The oil can suffer very high temperature and never change it’s quality, the amylum take second place suffer temperature, such as you can eat the hamburger (the bread main component is amylum), but if the bread had been baked to black, it will be hot food too. And the protein can’t suffer high temperature without water, such as you bake the chicken , the protein is easy change its quality. Peanut oil , olive oil ,canola oil, soybean oil, palm fruit, can be eaten with do some cooking.

    The treatment of prostatitis is a difficult problem, in the world .If the patient can do the seven part that I summarized and undergone experience in seven years, the patient can recover in one or two months.

    The modern science can fly to space, array gene, but can’t deal with prostatitis. There is a strong membrance wrap up prostate. If the germ infect it ,it is a garden of eden for germ. All the antibiotic can’t kill germ in prostate thoroughly. And the germ is easy to resistant antibiotic. With the science develop, suppose the patient can be freezing to –10 degree for some days , and rise the temperature to bring back the patient to life. The germ had been killed by the low temperature. So it can cure the prostatitis quickly. But now , the prostatitis patients have to use the seven part of Chinese medicine “point and whole symthetical balance treatment” to cure . I think, except the patient who have other serious disease and suffer from general debility, every body can recover . Others BPH (Benign Enlargement of the Prostate) is easier to cure. You can according to the “point and whole synthetical balance treatment”. There is no side effect in the way . I am an English teacher in Gao Zhou Normal College of China . So it is very convenient for me communicate with you in English. If you need help and more detail, you can send an E-mail to me , drop me a line , or telephone me.

    E-mail: wu@wac.sina.net

    wac@vip.sina.com

    International Tel: (0086-668)6610050 (home)
    Mobilephone:

    (0086-668)3678325(wujiang)

    Mail address: mrwujiang ,Gaozhou Normal college ,Gao Zhou City , Guang Dong Province, Pr.China .

    Postcode:525200

    My webside:
    http://www.prostatitis1.org

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