Evidence-based Acupuncture
WHO official position
Author: Bartosz Chmielnicki MD (translation: Elżbieta Torbus)
Introduction
It was June 1979 when World Health Organisation conducted a symposium on acupuncture in Bejing, China. Doctors who participated in this symposium created a list of 43 diseases that might benefit from acupuncture. This list however was not based on well design clinical trials with appropriate control. The need for performing such studies was mentioned.
Almost twenty years later, in 1997, National Institutes of Health published Consensus Statement, summarizing the state of knowledge drawn from clinical trial concerning acupuncture efficacy. The Authors concluded that there were “promising results showing efficacy of acupuncture in adult postoperative and chemotherapy nausea and vomiting and in postoperative dental pain” In other conditions, mostly various kinds of pain, acupuncture “might be useful as an adjunct treatment or an acceptable alternative”
One year before publication of statement mentioned above, the meeting of scientists, called WHO Consultation on Acupuncture, was organized in beautiful Italian town of Cervia. That meeting resulted in creation of official report on the effectiveness of acupuncture based on data from controlled clinical trials. The report was finally published in 2003. The results of 255 trials published before the end of 1998 or beginning of 1999 were included.
Indications
Diseases, symptoms or conditions for which acupuncture has been proved – through controlled trials—to be an effective treatment:
Adverse reactions to radiotherapy and/or chemotherapy
Allergic rhinitis (including hay fever)
Biliary colic
Depression (including depressive neurosis and depression following stroke)
Dysentery, acute bacillary
Dysmenorrhoea, primary
Epigastralgia, acute (in peptic ulcer, acute and chronic gastritis, and gastrospasm)
Facial pain (including craniomandibular disorders)
Headache
Hypertension, essential
Hypotension, primary
Induction of labour
Knee pain
Leukopenia
Low back pain
Malposition of fetus, correction of
Morning sickness
Nausea and vomiting
Neck pain
Pain in dentistry (including dental pain and temporomandibular dysfunction)
Periarthritis of shoulder
Postoperative pain
Renal colic
Rheumatoid arthritis
Sciatica
Sprain
Stroke
Tennis elbow
Diseases, symptoms or conditions for which the therapeutic effect of acupuncture has been shown but for which further proof is needed:
Abdominal pain (in acute gastroenteritis or due to gastrointestinal spasm)
Acne vulgaris
Alcohol dependence and detoxification
Bell’s palsy
Bronchial asthma
Cancer pain
Cardiac neurosis
Cholecystitis, chronic, with acute exacerbation
Cholelithiasis
Competition stress syndrome
Craniocerebral injury, closed
Diabetes mellitus, non-insulin-dependent
Earache
Epidemic haemorrhagic fever
Epistaxis, simple (without generalized or local disease)
Eye pain due to subconjunctival injection
Female infertility
Facial spasm
Female urethral syndrome
Fibromyalgia and fasciitis
Gastrokinetic disturbance
Gouty arthritis
Hepatitis B virus carrier status
Herpes zoster (human (alpha) herpesvirus 3)
Hyperlipaemia
Hypo-ovarianism
Insomnia
Labour pain
Lactation, deficiency
Male sexual dysfunction, non-organic
Ménière disease
Neuralgia, post-herpetic
Neurodermatitis
Obesity
Opium, cocaine and heroin dependence
Osteoarthritis
Pain due to endoscopic examination
Pain in thromboangiitis obliterans
Polycystic ovary syndrome (Stein–Leventhal syndrome)
Postextubation in children
Postoperative convalescence
Premenstrual syndrome
Prostatitis, chronic
Pruritus
Radicular and pseudoradicular pain syndrome
Raynaud syndrome, primary
Recurrent lower urinary-tract infection
Reflex sympathetic dystrophy
Retention of urine, traumatic
Schizophrenia
Sialism, drug-induced
Sjögren syndrome
Sore throat (including tonsillitis)
Spine pain, acute
Stiff neck
Temporomandibular joint dysfunction
Tietze syndrome
Tobacco dependence
Tourette syndrome
Ulcerative colitis, chronic
Urolithiasis
Vascular dementia
Whooping cough (pertussis)
Diseases, symptoms or conditions for which there are only individual controlled trials reporting some therapeutic effects, but for which acupuncture is worth trying because treatment by conventional and other therapies is difficult:
Chloasma
Choroidopathy, central serous
Colour blindness
Deafness
Hypophrenia
Irritable colon syndrome
Neuropathic bladder in spinal cord injury
Pulmonary heart disease, chronic
Small airway obstruction
Diseases, symptoms or conditions for which acupuncture may be tried provided the practitioner has special modern medical knowledge and adequate monitoring equipment:
Breathlessness in chronic obstructive pulmonary disease
Coma
Convulsions in infants
Coronary heart disease (angina pectoris)
Diarrhoea in infants and young children
Encephalitis, viral, in children, late stage
Paralysis, progressive bulbar and pseudobulbar
Described report is the only official WHO opinion about the effectiveness of acupuncture. Nevertheless, the level of evidence existing in 1998 was not high. The Authors included findings from Chinese trials which were not evaluated as highly reliable. For that reason the report and acupuncture itself was criticized by many scholars.
The Authors of first WHO report shall and will be remembered forever as brave scientists who dared to prepare wide review of evidence based data concerning the method which was not thought of as “scientific”. Their work was literally groundbreaking and begun a revolution in the perception of acupuncture. The amount of well-designed, published randomized controlled trials on acupuncture started growing rapidly in XXI c. During last fifteen years the results of many RCTs were published, as well as metaanalyses of the effectiveness of acupuncture in the treatment of various diseases. Existing level of evidence is much higher than in 1999.
Linkage : http://www.evidencebasedacupuncture.org/who-official-position/