The meaning of "Energy"

[pozorvlak]

Last night a friend of mine retweeted this:
.@marzillk What energy!? Some completely unobservable thing? Energy is simply the ability to do work. Nothing more, nothing less.
-- rhysmorgan
It turned out that this was in response to the following:@AlabasterC My sister recommends homeopathic aconite and tapping various energy points. It is helping a

Comments

[susannahf]

I found three meta-analyses and one report of linked studies on acupressure. All RCTs.
1) Role of acupressure in symptom management in patients with end-stage renal disease: a systematic review (http://www.ncbi.nlm.nih.gov/pubmed/20636160). "CONCLUSION: No definitive conclusion is available. Future trials should adhere to standards of trial methodology and explicitly report relevant information for evaluation of efficacy and safety of acupressure in patients with ESRD." My translation: the studies were either done badly or reported badly, or both. No information either way
2) Do Japanese style acupuncture and moxibustion reduce symptoms of the common cold? (http://www.ncbi.nlm.nih.gov/pubmed/18955215) Not the same technique, but the same illness... "In conclusion, the safety of Japanese acupuncture or moxibustion was sufficiently demonstrated; however, a series of clinical trials could not offer convincing evidence to recommend the use of Japanese style acupuncture or moxibustion for preventing the common cold. Further studies are required as the present trials had several limitations." My translation: no evidence of effect.
3) Meta-analysis of acustimulation effects on nausea and vomiting in pregnant women. (http://www.ncbi.nlm.nih.gov/pubmed/16979105) "CONCLUSIONS: This meta-analysis demonstrates that acupressure and ETS had greater impact than the acupuncture methods in the treatment of NVP. However, the number of acupuncture trials was limited for pregnant women, perhaps because it is impossible to self-administer the acupuncture and thus inconvenient for women experiencing NVP as chronic symptoms." My translation: acupressure may work for nausea in pregnant women. (A placebo effect was also noted, but was a lesser effect than acupressure)
4) Metaanalyses of acustimulations: effects on nausea and vomiting in postoperative adult patients. (http://www.ncbi.nlm.nih.gov/pubmed/16781643) "CONCLUSIONS: This metaanalysis demonstrated that AS is just as effective as medications in reducing NVS and that acupressure is just as effective as acupuncture or electrical stimulation in reducing NVS for postoperative adult populations." My translation: not just pregnant women...

Overall, I'd say there is a lack of information generally. Most of the literature is published in journals I've never heard of, but they are in pubmed, which doesn't accept *everything*, so maybe they're ok. Or maybe not. Certainly a lot of the papers I turned up started on the assumption that it works, and then reported correlates. However, one thing that did consistently turn up is that they are *safe*. If you're going to use a treatment with no evidence for it, I'd much rather you use one that is at least known to be safe ;)

[pozorvlak]

Thanks! So, it might have some symptom-relieving effect after all?

[susannahf]

at least in some situations, yes, it would seem so.
I'd be fascinated to see if the physiological mechanism for this could be elucidated. I haven't had time to read the papers, so no promises about their methodological accuracy...

[susannahf]

Also, I should declare a competing interest that I didn't *want* to find any evidence that it might work. But I did, and academic integrity demands that I not pretend otherwise.
I still don't think I'd pay for acupressure/puncture unless I was a) unable to use conventional (ideally evidence-based) medicine, and b) was really suffering. And then I'd put anything down to placebo effect. But that's my prejudice I guess.

[pozorvlak]

Also, I should declare a competing interest that I didn't *want* to find any evidence that it might work. But I did, and academic integrity demands that I not pretend otherwise.

Likewise :-)

[ext_300285]

That mechanical stimulation relieves pain is well established (rubbing an injury, for e.g.). The 'gate control theory of pain' provides a good physiological explanation for this.
In that context, that acupuncture relieves pain is banal. The needles and mystical explanations are just theatre.

[pozorvlak]

Intuitively, it's surprising that sticking a needle in someone would make them hurt less. But thanks for the pointer to the gate control theory - reading now.

[pozorvlak]

Having read this, it's not at all clear to me how gate control theory accounts for a thirty-minute acupuncture session every few days having an effect on chronic pain. Am I missing something?

[ext_300285]

Can't read the link (browsing on my phone, which makes jumping around links more bother than it's worth!) but I'm pretty sure I know what you're getting at.

It's a good question. Purely hypothesising, I could imagine that the immediate benefit received during the sessions reinforces the idea that the acupuncture is 'working'. And it's well known that pain responds strongly to expectation and placebo. So we might imagine that acupuncture, presented as a long-term solution, has only short-term objective effects (through gate control) but this carries over into a subjective long-term response (through placebo).

[pozorvlak]

I can believe that's part of what's going on, but I somehow doubt it's the whole story. Not sure what experiment you'd do to test it, but there must be some way of finding out...

acupuncture doesn't use gate control

[susannahf]

Electroacupuncture does though. Man that shit is awesome. I love it. TENS is gate stuff too.

Standard acupuncture* has a measurable effect on the human body. If you put someone in an MRI machine and needle them, their brain lights up in a way it doesn't under acupressure or nothing. Manipulated needles cause a measurably greater effect than not.

Acupuncture is not very well understood. That doesn't stop it working very well for chronic pain relief. Every physiotherapist I've seen (which is a lot) does acupuncture. There's got to be a reason for that above the placebo effect - which is, admittedly, very powerful.

The meridians/energy stuff is the theatre. The needling is not.

Problem is it's very hard to study acupuncture using standard methods. How do you placebo sticking a needle in someone?

--mmmmat.

* by this I mean some form of needling therapy. meridians and chi are not involved.

Re: acupuncture doesn't use gate control

[pozorvlak]

The meridians/energy stuff is the theatre. The needling is not.

That was definitely what I took away from the 2007 study. And I'm fascinated by Susz's links to the nausea stuff. I don't suppose you have links to the MRI studies you're thinking of?

Re: acupuncture doesn't use gate control

[susannahf]

I know studies exist from speaking to physios, but haven't read them myself. Some BBC popsci show put a presenter in a scanner a few years ago and needled them - that I saw.

[susannahf]

The two nausea ones looked at both "controls" (no placebo), and placebo (i.e. not on the "meridian"). And the "right" method still worked....
Although I'm prepared to be convinced that there are areas with more of the right sensory receptors, resulting in a better response in that area.

if you have acupuncture by a physiotherapist

[susannahf]

they don't use traditional chinese points, generally. Depending on the physio, you'll usually get a needle in your upper calf - the so-called "physiotherapist's point" and often one between thumb and forefinger (I hate that one, hurts like crazy), but the rest of the placement is based on nerves.

I have an upper-back-related issue, and I usually get needles either side of my thoracic vertebrae. Which makes perfect sense to me, and provides excellent pain relief. The one time I had chinese acupuncture, I got needles in places which - mostly - corresponded with the same nerves, just lower down (so, places like the inner elbow, upper shoulder, etc.) That also worked very well.

It is perhaps vaguely relevant that a chinese meridian chart for acupuncture looks more than a little like a nerve map. Which again, makes sense - if you spend 3000 years poking needles in people and taking note of where they work best...

My chinese acupuncturist spent seven years studying for his acupuncture degree.

All this talk (and typing) is making me jones for some needling... :)

-mmmat