FOR IMMEDIATE RELEASE
On behalf of the Australian Acupuncture
and Chinese Medicine Association (AACMA)
and the Acupuncture Now Foundation (ANF)
The United Kingdom’s National Institute for Health and Care Excellence (NICE) recently published an update to its guidelines for the management and treatment of low back pain that removes acupuncture as a recommended treatment. This decision reverses the recommendations of the 2009 committee who recommended it on the basis of robust evidence. The guidelines govern which treatments Primary Care Physicians in the National Health Service (NHS) can offer their patients suffering from back pain. Removing the recommendation means Primary Care Physicians will need to rely more on riskier treatments like painkillers or less effective treatments like exercise.
The evidence supporting acupuncture treatment for low back pain is strong
According to the Australian Acupuncture and Chinese Medicine Association (AACMA) and the Acupuncture Now Foundation (ANF), the about-face by this NICE committee goes against the trend of medical institutions in other countries, such as Australia, New Zealand, United States, Canada and Germany, which are increasingly recommending acupuncture as a safe, effective, non-pharmacological treatment for low back-pain. In ‘Acute Pain Management: Scientific Evidence’ published by the Australian and New Zealand College of Anaesthetists and Faculty of Pain Medicine in 2015, NHMRC Level 1 evidence was identified supporting acupuncture treatment of back pain. The Scottish Intercollegiate Guidelines Network (SIGN) guideline for the Management of Chronic Pain (2013), also recommended acupuncture for chronic low back pain (Grade A recommendation). In February 2016, the US government’s Agency for Healthcare Research and Quality compared over 20 therapies and concluded that acupuncture was the most effective non-pharmacological treatment available for low back pain. A review of 16 systematic reviews found that acupuncture alone, or when added to usual care, provided short-term improvement in pain and function for chronic low back pain (medium to large clinical effects) and hence ‘should be advocated in routine clinical practice’. Two reviews have also found that acupuncture is a cost-effective treatment option for low back pain.
So why is NICE recommending less effective, less safe or more expensive treatment options over acupuncture?
The rationale for the decision from NICE was based on studies comparing acupuncture treatment to ‘sham-acupuncture’, an acupuncture-like treatment that also uses acupuncture needles but is not considered to be an inert placebo control. Guideline developers in other countries have increasingly steered away from using these sham studies, which have little to no clinical relevance for Primary Care Physicians or their patients. In fact, the National Institute of Health (NIH) (the peak medical research funding body in the US) has now declared real versus sham acupuncture trials a low funding priority and is instead advocating comparative trials and trials to better understand the mechanism which underpins how acupuncture works. “It is very troubling that even though the NICE committee found that acupuncture was more effective than conventional care for ‘pain, function and quality of life,’ they still recommended against it,” said Matthew Bauer, President of the non-profit Acupuncture Now Foundation. “If the NICE committee that gathered and interpreted the evidence included experts in acupuncture research they would have been informed that sham studies for acupuncture are no longer recommended due to the fatal flaws in their methodology.”
All other manual therapies reviewed and recommended by NICE, such as manipulation, massage or exercise, were primarily compared to usual care and generally were not shown to be better than placebo. By requiring acupuncture to outperform sham treatment, but not exercise or manual therapies, for example, represents a bias in deviation in recognised guideline development practice, where great lengths are normally taken to compare treatments using the same measuring stick. NICE did not adequately justify why acupuncture alone was singled out in this way. It is interesting to note, that in a network meta-analysis on sciatica (which was included in this NICE review) that acupuncture outperformed almost all other therapies including exercise, manipulation, surgery, anti-inflammatory medications and opioid medications in terms of both reducing pain intensity and global effect. Radio frequency treatment which has been recommended by the NICE review was the least effective of all therapies tested and costs around £8,000 per treatment. A recent Cochrane systematic review on radio frequency treatment found it to be ineffective and unsafe. According to Australian acupuncture researcher, Dr John McDonald, PhD: “The extraordinary recommendations of this NICE review appear to defy rather than follow the best available evidence on effectiveness, safety and cost-effectiveness.”
According to Professor Hugh MacPherson of the University of York, “The criteria that NICE used to evaluate acupuncture for low back pain are not the same as those used for other physical therapies, and therefore the recommendations are founded on evidence-biased medicine rather than on evidence-based medicine.”
NICE’s recommendation are likely to lead to less effective, less safe and more expensive treatment options being available on the NHS. This is unethical!
The updated NICE recommendations could mean reduced choice for patients and their health care providers as they lose access to acupuncture on the NHS when it has one of the best combinations of benefit to harm ratio of any treatment evaluated by NICE, leaving them with less effective options that often carry a much greater risk. Opioid medications and NSAIDs (non-steroidal anti-inflammatory drugs) both carry some serious risks. “As addictions to, and deaths from prescription opioids such as oxycodone, hydrocodone, and methadone continue to rise, raising awareness on effective, non-pharmacological, non-invasive therapies like acupuncture is more important than ever,”
said Kory Ward-Cook, PhD, MT(ASCP), CAE, CEO of the US-based National Certification Commission for Acupuncture and Oriental Medicine. The NHS in the UK spends over £300 million pounds treating injuries caused by NSAID use, such as GI bleeds and heart failure, resulting in two thousand preventable deaths every year in the UK. On the basis of “First do no harm”, safer and more effective treatments for low back pain such as acupuncture should be recommended over less safe and less effective interventions.
References available
For more information, visit the Acupuncture Now Foundation website
About the Australian Acupuncture and Chinese Medicine Association Ltd (AACMA)
The Australian Acupuncture and Chinese Medicine Association Ltd (AACMA) is Australia's peak professional association for acupuncturists and Chinese medicine practitioners. Established in 1973, AACMA represents the professional interests of the majority of qualified acupuncturists. AACMA has successfully represented the profession in obtaining provider recognition under private health insurance schemes and WorkCover schemes nationally. AACMA liaised successfully with the government in the implementation of the GST in 2000 which resulted in the removal of GST from acupuncture services.
Visit the AACMA website for more information.
About Acupuncture Now Foundation (ANF)
Acupuncture Now Foundation (ANF) was founded in 2014 by a diverse group of people from around the world who were concerned about common misunderstandings regarding acupuncture and wanted to help acupuncture reach its full potential. With a mission to elevate acupuncture’s impact on easing suffering and enhancing health through accurate information about its best practices, the organisation seeks recognition as a leader in the collection and dissemination of unbiased and authoritative information about the practice of acupuncture. For more information, visit The Acupuncture Now Foundation website.
MEDIA CONTACT:
Dr John McDonald,PhD
0416251690
twindragon@bigpond.com
ENDS