THE JOURNAL OF ALTERNATIVE AND COMPLEMENTARY MEDICINE Volume 20, Number 5, 2014, pp. 417–418 ª Mary Ann Liebert, Inc. DOI: 10.1089/acm.2013.0369
Letters to the Editor
Acupuncture for Military Personnel Health and Performance Arya Nielsen, PhD,1 Hugh MacPherson, PhD,2 and Terje Alraek, PhD3
Dear Editor: The recent article, ‘‘Military Report More Complementary and Alternative Medicine Use than Civilians,’’1 reports a higher utilization of alternative medicine and stress reduction therapies by military personnel as compared to general public. In the process, the authors assert that ‘‘Unmonitored use of CAM in the military may have negative consequences on health and military performance,’’ claiming that results of ‘‘large randomized, placebo-controlled trials of.acupuncture have been negative,’’ making the substitution of (this) CAM treatment for proven therapies ‘‘risky.’’ The authors cite two studies in support of this rather alarming statement: a 2006 trial of acupuncture for migraine2 and a 2007 study on patient expectations for chronic pain.3 Goertz et al. do not cite the more recent and positively conclusive Cochrane Systematic Reviews of acupuncture for tension-type headache4 and for migraine prophylaxis5 They also do not cite the recent systematic review with metaanalysis showing that acupuncture is effective for chronic pain beyond placebo.6 These systematic reviews demonstrate that acupuncture is, in fact, effective for tension headache, migraine prophylaxis, and chronic pain conditions; the authors’ claim of negative consequences for acupuncture on military health and performance is not supported by current research. Their conclusion is also not in line with the articles on acupuncture published in Military Medicine. In terms of safety, acupuncture has a ‘‘relative risk’’ that is low. Systematic reviews and surveys have clarified that acupuncture is safe when performed by appropriately trained practitioners,7–13 with infrequent minor side-effects such as feeling relaxed, elated, tired, or having point sensation or itching11 and rare serious complications such as infection or pulmonary embolism directly related to insufficient training.12,13 White12 surveyed 12 prospective studies of more than a million treatments reporting the risk of a serious adverse event with acupuncture estimated to be 0.05 per 10,000 treatments, and 0.55 per 10,000 individual patients, concluding that the risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. Acupuncture is also safe for women who are pregnant14,15 and for children.7,16,17
Finally, it is now policy of the National Institute for Health and Clinical Excellence (NICE) in Great Britain to recommend acupuncture for the treatment of migraine headache.18 Current evidence supports the safe use of acupuncture for the health and performance of military personnel. Disclosure Statement No competing financial interests exist. References 1. Goertz C, Marriott BP, Finch MD, et al. Military report more complementary and alternative medicine use than civilians. J Altern Complement Med 2013;19:509–517. 2. Diener HC, Kronfeld K, Boewing G, et al. Efficacy of acupuncture for the prophylaxis of migraine: A multicenter randomised controlled clinical trial. Lancet Neurol 2006;5: 310–316. 3. Linde K, Witt CM, Streng A, et al. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 2007;128:264–271. 4. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for tension-type headache. Cochrane Database Syst Rev 2009;1: CD007587. 5. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev 2009;1: 001218. 6. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: Individual patient data meta-analysis. Arch Intern Med 2012;172:1444–1453. 7. Adams D, Cheng F, Jou H, et al. The safety of pediatric acupuncture: A systematic review. Pediatrics 2011;128:1575– 1587. 8. Bergqvist D. Vascular injuries caused by acupuncture. Eur J Vasc Endovasc Surg 2008;36:160–163. 9. Ernst E, White AR. Prospective studies of the safety of acupuncture: A systematic review. Am J Med 2001;110:481– 485. 10. MacPherson H, Thomas K, Walters S, Fitter M. A prospective survey of adverse events and treatment reactions
1
Department of Integrative Medicine, Beth Israel Medical Center, New York, NY. Department of Health Sciences, University of York, York, United Kingdom. 3 Department of Community Medicine, National Research Center in Complementary and Alternative Medicine (NAFKAM), The Arctic University of Norway, Tromsø, Norway. 2
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14. 15.
LETTER TO THE EDITOR following 34,000 consultations with professional acupuncturists. Acupunct Med 2001;19:93–102. MacPherson H, Thomas K. Short term reactions to acupuncture—A cross-sectional survey of patient reports. Acupunct Med 2005;23:112–120. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 2004;22:122–133. Yamashita H, Tsukayama H, White AR, et al. Systematic review of adverse events following acupuncture: The Japanese literature. Complement Ther Med 2001;9:98–104. Smith CA, Crowther CA. Acupuncture for induction of labour. Cochrane Database Syst Rev 2004;1:CD002962. Elden H, Ostgaard H-C, Fagevik-Olsen M, et al. Treatments of pelvic girdle pain in pregnant women: Adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. BMC Complement Altern Med 2008;8:34.
16. Jindal V, Ge A, Mansky PJ. Safety and efficacy of acupuncture in children: A review of the evidence. J Pediatr Hematol Oncol 2008;30:431–442. 17. Wu S, Sapru A, Stewart MA, et al. Using acupuncture for acute pain in hospitalized children. Pediatr Crit Care Med 2009;10:291–296. 18. Carville S, Padhi S, Reason T, Underwood M; Guideline Development Group. Diagnosis and management of headaches in young people and adults: Summary of NICE guidance. BMJ 2012;345:e5765.
Address correspondence to: Arya Nielsen, PhD Department of Integrative Medicine Beth Israel Medical Center New York, NY 10016 E-mail: [email protected]
Letters to the Editor
Acupuncture for Military Personnel Health and Performance Arya Nielsen, PhD,1 Hugh MacPherson, PhD,2 and Terje Alraek, PhD3
Dear Editor: The recent article, ‘‘Military Report More Complementary and Alternative Medicine Use than Civilians,’’1 reports a higher utilization of alternative medicine and stress reduction therapies by military personnel as compared to general public. In the process, the authors assert that ‘‘Unmonitored use of CAM in the military may have negative consequences on health and military performance,’’ claiming that results of ‘‘large randomized, placebo-controlled trials of.acupuncture have been negative,’’ making the substitution of (this) CAM treatment for proven therapies ‘‘risky.’’ The authors cite two studies in support of this rather alarming statement: a 2006 trial of acupuncture for migraine2 and a 2007 study on patient expectations for chronic pain.3 Goertz et al. do not cite the more recent and positively conclusive Cochrane Systematic Reviews of acupuncture for tension-type headache4 and for migraine prophylaxis5 They also do not cite the recent systematic review with metaanalysis showing that acupuncture is effective for chronic pain beyond placebo.6 These systematic reviews demonstrate that acupuncture is, in fact, effective for tension headache, migraine prophylaxis, and chronic pain conditions; the authors’ claim of negative consequences for acupuncture on military health and performance is not supported by current research. Their conclusion is also not in line with the articles on acupuncture published in Military Medicine. In terms of safety, acupuncture has a ‘‘relative risk’’ that is low. Systematic reviews and surveys have clarified that acupuncture is safe when performed by appropriately trained practitioners,7–13 with infrequent minor side-effects such as feeling relaxed, elated, tired, or having point sensation or itching11 and rare serious complications such as infection or pulmonary embolism directly related to insufficient training.12,13 White12 surveyed 12 prospective studies of more than a million treatments reporting the risk of a serious adverse event with acupuncture estimated to be 0.05 per 10,000 treatments, and 0.55 per 10,000 individual patients, concluding that the risk of serious events occurring in association with acupuncture is very low, below that of many common medical treatments. Acupuncture is also safe for women who are pregnant14,15 and for children.7,16,17
Finally, it is now policy of the National Institute for Health and Clinical Excellence (NICE) in Great Britain to recommend acupuncture for the treatment of migraine headache.18 Current evidence supports the safe use of acupuncture for the health and performance of military personnel. Disclosure Statement No competing financial interests exist. References 1. Goertz C, Marriott BP, Finch MD, et al. Military report more complementary and alternative medicine use than civilians. J Altern Complement Med 2013;19:509–517. 2. Diener HC, Kronfeld K, Boewing G, et al. Efficacy of acupuncture for the prophylaxis of migraine: A multicenter randomised controlled clinical trial. Lancet Neurol 2006;5: 310–316. 3. Linde K, Witt CM, Streng A, et al. The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain. Pain 2007;128:264–271. 4. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for tension-type headache. Cochrane Database Syst Rev 2009;1: CD007587. 5. Linde K, Allais G, Brinkhaus B, et al. Acupuncture for migraine prophylaxis. Cochrane Database Syst Rev 2009;1: 001218. 6. Vickers AJ, Cronin AM, Maschino AC, et al. Acupuncture for chronic pain: Individual patient data meta-analysis. Arch Intern Med 2012;172:1444–1453. 7. Adams D, Cheng F, Jou H, et al. The safety of pediatric acupuncture: A systematic review. Pediatrics 2011;128:1575– 1587. 8. Bergqvist D. Vascular injuries caused by acupuncture. Eur J Vasc Endovasc Surg 2008;36:160–163. 9. Ernst E, White AR. Prospective studies of the safety of acupuncture: A systematic review. Am J Med 2001;110:481– 485. 10. MacPherson H, Thomas K, Walters S, Fitter M. A prospective survey of adverse events and treatment reactions
1
Department of Integrative Medicine, Beth Israel Medical Center, New York, NY. Department of Health Sciences, University of York, York, United Kingdom. 3 Department of Community Medicine, National Research Center in Complementary and Alternative Medicine (NAFKAM), The Arctic University of Norway, Tromsø, Norway. 2
417
418
11.
12.
13.
14. 15.
LETTER TO THE EDITOR following 34,000 consultations with professional acupuncturists. Acupunct Med 2001;19:93–102. MacPherson H, Thomas K. Short term reactions to acupuncture—A cross-sectional survey of patient reports. Acupunct Med 2005;23:112–120. White A. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupunct Med 2004;22:122–133. Yamashita H, Tsukayama H, White AR, et al. Systematic review of adverse events following acupuncture: The Japanese literature. Complement Ther Med 2001;9:98–104. Smith CA, Crowther CA. Acupuncture for induction of labour. Cochrane Database Syst Rev 2004;1:CD002962. Elden H, Ostgaard H-C, Fagevik-Olsen M, et al. Treatments of pelvic girdle pain in pregnant women: Adverse effects of standard treatment, acupuncture and stabilising exercises on the pregnancy, mother, delivery and the fetus/neonate. BMC Complement Altern Med 2008;8:34.
16. Jindal V, Ge A, Mansky PJ. Safety and efficacy of acupuncture in children: A review of the evidence. J Pediatr Hematol Oncol 2008;30:431–442. 17. Wu S, Sapru A, Stewart MA, et al. Using acupuncture for acute pain in hospitalized children. Pediatr Crit Care Med 2009;10:291–296. 18. Carville S, Padhi S, Reason T, Underwood M; Guideline Development Group. Diagnosis and management of headaches in young people and adults: Summary of NICE guidance. BMJ 2012;345:e5765.
Address correspondence to: Arya Nielsen, PhD Department of Integrative Medicine Beth Israel Medical Center New York, NY 10016 E-mail: [email protected]
