Blogging with Parkinson's

A personal perspective on Young Onset Parkinson's

Acupuncture as a treatment for Fatigue

8 Comments

Not an acupuncture needle.

Personally, I seem to be escaping fatigue at the moment, but it’s a very common symptom in Parkinson’s. The Michael J. Fox Foundation is sponsoring a study on how acupuncture might help Parkinson’s patients who suffer from fatigue.

To test the effects of acupuncture on fatigue in Parkinson’s disease we will randomly assign Parkinson’s disease patients to either receive real or placebo acupuncture twice a week for six weeks. We will measure patients’ fatigue and other measures of quality of life and disease status prior to starting acupuncture, half-way through treatment, at the completion of treatment and six weeks following their last treatment. We are interested to examine whether patients receiving either real or placebo acupuncture had improvements in their fatigue and whether there are differences between these two groups. We are also interested to see if acupuncture has any benefits on quality of life or other Parkinson’s symptoms.

[from the Grant Abstract for “Acupuncture as a Symptomatic Treatment for Fatigue in Parkinson’s Disease”]

I hope it does prove to be useful, although I can’t help but wonder how you can have placebo acupuncture. Surely a needle is a needle?

(My best guess as to how placebo acupuncture works is that they still stick needles in, just not in the approved points. I’m not entirely convinced, because – well, maybe the “wrong” point is just an undiscovered “right” point. Assuming, of course, that acupuncture works how they say it does. And I’m trying to be open-minded on that one.)

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8 thoughts on “Acupuncture as a treatment for Fatigue

  1. I am hugely disappointed to learn that time and money is being spent on testing acupuncture for anything. It’s been studied a lot, with no convincing non-placebo benefits found. Nobody can find the so called meridians that it is supposed to depend on, either, and people have looked hard. So there are apparently no “right” places, and we can reliably expect that this study will consume time and money getting the same results as the overwhelming majority of well constructed acupuncture studies – that putting needles into people generates a benefit, and it doesn’t matter where you put them, since it is the good old placebo effect. See
    http://www.badscience.net/category/complementary-medicine/acupuncture/
    and
    http://www.dcscience.net/?p=4439
    for some pop science refs.

  2. [Speaking from the semi-informed position of an acupuncturist’s husband…] You’re right: placebo acupuncture involves sticking needles in miles away from any actual points. The assumption is that the long tradition of Chinese medicine has identified all significant points, so you’re not going to hit anything important by mistake.

    This has always been one of the major problems in conducting proper tests of the claims of acupuncture; you can’t easily hit the gold standard of double-blind testing. That is to say, the patient won’t know whether real points are being used or not, but either the acupuncturist will (and so may accidentally signal this to the patient) or you have to use a non-acupuncturist who’s just been told where to stick the needles, who might not be especially good at it…

  3. If we are talking of references to the long tradition of Chinese medicine, it’s worth reading
    http://www.sciencebasedmedicine.org/index.php/puncturing-the-acupuncture-myth/
    for a sceptic’s viewpoint. Frankly I find this account entirely credible.
    I accept the point about the difficulty of getting good double blind studies on acupuncture, but this is a defence claimed by most proponents of alternative medicine – “it hasn’t been shown to be better than placebo, so the problem must lie in the testing”. I think it likely that people have spotted this problem and made a good stab at getting round it, and yet the lack of supporting evidence is still striking.
    I honestly wish acupuncture worked. But lots of testing seems to give the answer that it doesn’t, and the concept of sticking needles into meridiens (that nobody can find) and hoping to get positive results just seems weird.

  4. The problem, as I see it, is that people do think that these things help, and – with something as subjective as fatigue – if you feel better, then you probably are better.

    There has been a bit of noise about the placebo effect being “real” – with a certain emphasis, it seems, on Parkinson’s. The following paper (2001) refers to a placebo in drug studies and talks about “Expectation-related dopamine release”.
    http://www.sjsu.edu/faculty/gerstman/StatPrimer/delaFeunte-Fernandez.pdf

    It concludes:
    “Expectation-related dopamine release might
    be a common phenomenon in any medical
    condition susceptible to the placebo effect.
    PD patients receiving an active drug in the
    context of a placebo-controlled study benefit
    from the active drug being tested as well as
    from the placebo effect. By contrast, in the
    usual clinical practice setting, active drugs
    may be devoid of placebo effect. We found
    no evidence to suggest that the placebo effect
    synergistically augments the action of active
    drugs (in fact, a trend for the opposite was
    observed), so positive conclusions derived
    from placebo-controlled studies are not impugned
    by our findings.”
    So… the placebo effect is real, but it ocurs with real treatment too, and only in a study situation.

  5. I’m all for mobilising placebo; don’t get me wrong. It is real and it’s incredibly powerful. I’m just against (i) deceipt, which seems to be involved somewhere along the line since the practioner and/or the patient needs to be convinced that something that doesn’t work, does, and (ii), money being spent on something with such poor credentials (IMHO) as acupuncture. If people believe acupuncture or any one of a hundred other alternative medicine things work despite studies that indicate otherwise, and gain benefit from them, fine – I’d just rather that the Michael J Fox Foundation money be spent on something with better prospects.
    The same argument applies where there is a placebo effect on top of an active/effective drug.

  6. Talking of placebo and Parkinson’s, there’s what I thought was an interesting passing mention by Dr Ben Goldacre at about 17.30-17.50 in his talk at

  7. You’ll probably find they won’t committ megabucks to it…I’m an advocate btw

    • No, it probably isn’t a very expensive study. I’ve come across the term “advocate” a number of times but I’m not sure what it means. What do you do, as an advocate?

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