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/

 

 

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