M. Spencer Green / AP

By Rachael Rettner, MyHealthNewsDaily

Acupuncture may be modestly better than a placebo for the treatment of chronic pain, a new review suggests.

Researchers analyzed information from nearly 18,000 patients with chronic back, neck or joint pain, or headaches.

Patients who received acupuncture experienced a greater reduction in their pain compared with those who received standard pain treatments without acupuncture, and those who received fake acupuncture treatment, called "sham" acupuncture. The benefit of real acupuncture over sham acupuncture was only slight, the researchers said.

The findings suggest that overall, acupuncture is effective, and is a reasonable treatment option for patients with chronic pain, the researchers said.

Because real acupuncture was superior to sham acupuncture, the results suggest that acupuncture is not completely a placebo, or a treatment that benefits patients simply because they believe it will work, the researchers said.

However, because the difference between real and sham acupuncture was small, it's likely that most of the benefit of acupuncture is indeed due to the placebo effect, the researchers said.

In general, "about a third of the effect of any treatment is a placebo effect," said study researcher Andrew Vickers, of Memorial Sloan-Kettering Cancer Center, in New York City. "In acupuncture, it's more like two-thirds, Vickers said.

Many patients with chronic pain who resort to acupuncture have not responded to standard treatments, or experienced significant side effects from them, Vickers said.

About 3 million Americans receive acupuncture each year, and chronic pain is the most common reason for the therapy, the researchers said. Because researchers have not determined how acupuncture could work to reduce pain, its use is controversial.

In the new study, Vickers and colleagues analyzed information from 17,922 patients who participated in 29 studies conducted in the United States, United Kingdom, Germany, Spain and Sweden. Many previous studies of acupuncture were not rigorously designed, the researchers said, and they excluded these from their analysis.

In the included studies, participants with chronic pain were randomly assigned to receive acupuncture, sham acupuncture or no acupuncture. Their pain was assessed at least four weeks after treatment.

In the sham acupuncture procedures, needles were inserted too shallowly to stimulate an acupuncture point, or using a machine with a tip that causes a prickling sensation, but did not actually push a needle into the skin.

Patients who received acupuncture reported less pain after treatment than those who received no acupuncture or sham acupuncture.

After treatment, the percentage of patients reporting their pain was "much better" was 30 percent for those who received no acupuncture, 42.5 percent for those who received sham acupuncture, and 50 percent for those who received real acupuncture, Vickers said.

The new study gives "some robust evidence that acupuncture seems to provide modest benefits over usual care for patients with diverse sources of chronic pain," Andrew Avins, a researcher at Kaiser-Permanente in Oakland, Calif., wrote in an editorial accompanying the study.

However, the benefits of acupuncture seem to come primarily from the placebo effect, Avins said, and acupuncture critics will be sure to point this out. After all, drugs are required to perform better than a placebo before they are approved for use, he said.

Still, the performance of a therapy against a placebo is not the only way to measure the treatment's effectiveness, Avins said.

"At the end of the day, our patients seek our help to feel better, and lead longer and more enjoyable lives," Avins said. "Perhaps a more productive strategy at this point would be to provide whatever benefits we can for our patients, while we continue to explore more carefully all mechanisms of healing," Avins said.

The study and the editorial are published online today (Sept. 10) in the journal Archives of Internal Medicine.

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By Rachael Rettner
MyHealthNewsDaily

The idea of putting maggots into open flesh may sound repulsive, but such a therapy might be a quick way to clean wounds, a new study from France suggests.

Men in the study, all of whom had wounds that wouldn't heal, were randomly assigned to have dead and unhealthy tissue removed from their lacerations by either standard surgical therapy or maggots (that eat dead tissue).

After about a week, men who received the maggot therapy had less dead tissue in their wounds than men who underwent surgery, the researchers said.

However, after two weeks, the immature insects had lost their advantage: Both groups had about an equal amount of dead tissue in their wounds. And in the end, the maggots did not help the wounds heal faster.

Although the effects of maggot therapy were not dramatic, it may be useful in certain cases, such as in patients with diabetes, whose wounds need rapid control, the researchers said. But continuing the maggot therapy beyond one week is not of benefit, they said.

Medical use of maggots was approved in 2004 by the U.S. Food and Drug Administration. However, only a small minority of patients with unhealing wounds receive the treatment, said Dr. Robert Kirsner, a dermatologist at the University of Miami School of Medicine, who was not involved in the new study.

The study included about 100 men with wounds on their lower limbs. About half received maggot therapy and half received surgical treatment. For the maggot therapy, sterile maggots were placed in a small pouch that was placed on top of the wound. The therapy was applied twice a week for two weeks.

Neither the patients nor the doctor evaluating the wounds knew which therapy a patient received (patients wore a blindfold when their bandages were changed.)

After eight days, the percentage of dead tissue in the wounds of patients who received the maggot therapy was 54.5 percent, compared with 66.5 percent in patients who received surgery. But after 15 days and 30 days, the amount of dead tissue in the wounds was about the same for both groups.

The number of patients who reported feeling a crawling sensation in their wound, and the number reporting pain, was also about the same in both groups, according to the study, which was conducted by researchers at the University Hospital Center of Caen , in France.

Maggots secrete an enzyme that dissolves dead tissue but leaves healthy tissue alone, Kirsner said.

Although there are few risks to the treatment, "there is a gross factor to it," Kirsner said. "Patients have to be very psychologically strong," he said.

Another group of patients that may benefit from the therapy are those who cannot undergo surgery, for instance, if they cannot receive anesthesia, Kirsner said.

Future research should determine whether the effects of maggot therapy can be improved using more maggots, and whether an increase in the number of critters would be painful, the researchers said.

The study is published online in the journal Archives of Dermatology.

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Commentary:

An old ethical principle holds that we ought not speak ill of the dead. After all, they can’t defend themselves. That rule is getting kicked around quite a bit just a week after the death of Steve Jobs.

Tabloids and bloggers, citing cancer experts who never treated Jobs and have no access to his medical information, are speculating that Jobs “doomed” himself with alternative medicine.

After Jobs was diagnosed with a rare form of pancreatic cancer in 2003, he allegedly delayed surgery to remove the tumor -- the conventional treatment -- for nine months.

During that time, he also -- allegedly -- attempted treat his cancer with alternative medicine and diet, some news reports claim. 

That choice, the headlines proclaim, may have cost him his life by letting his cancer grow and spread.

 In a detailed post to Quora, an online forum popular among the Silicon Valley crowd, Harvard cancer doc Dr. Ramzi Amri wrote:

Let me cut to the chase: Mr. Jobs allegedly chose to undergo all sorts of alternative treatment options before opting for conventional medicine.

This was, of course, a freedom he had all the rights to take, but given the circumstances it seems sound to assume that Mr. Jobs' choice for alternative medicine could have led to an unnecessarily early death.

There are some major holes in this kind of speculation from Monday-morning medical analysts.

For one, reports that Jobs rejected mainstream medical advice after his diagnosis remain unconfirmed. Very few people know exactly what Jobs chose to do when he found out he had cancer. None of them are blogging. 

Plus, Jobs lived eight years after his diagnosis with a neuroendocrine tumor. As MyHealthNewsDaily explained today, the average life expectancy for someone with a metastatic neuroendocrine tumor is about two years, according to the Pancreatic Cancer Action Network. (It’s unclear when Jobs cancer turned metastatic.)

It’s fair to assume that a person of his means and intelligence could access any and all expertise that existed to decide how best to try and fight his disease. 

Beyond that, it just doesn’t do anybody any good to guess or gossip.