The relevance of needling parameters and participant experience for acupuncture research
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NO FULL TEXT AVAILABLE. Access is restricted indefinitely. ----- Although acupuncture has been practiced for over 2,000 years, it is only in the last four decades that Western medical science has begun to investigate its mode of action and clinical efficacy. Since the mid 1960s, there has been a steadily increasing number of acupuncture clinical trials published in the Western scientific literature. However the quality of research has generally been poor. This has been partly due to general methodological problems such as small sample size and partly due to problems that specifically relate to the nature of practice of acupuncture. The present research involves two studies that were designed to clarify three specific problems associated with acupuncture research: a questionnaire designed to compare the beliefs and expectations of both naive and experienced subjects concerning the 'acupuncture experience' and the implications for acupuncture research methodology; and an experimental needling study whose aims were to determine the optimal needling parameters for eliciting analgesia in acupuncture pain studies and the use of an appropriate control placebo intervention in acupuncture clinical trials. The survey (called study one) found that naive and experienced acupuncture subjects hold different beliefs and expectations of what constitutes an acupuncture experience. These differences related to the credibility of laser as an alternative to needling, the expectation of feeling needle insertion and a dull ache during treatment, the appearance of the needle while in situ, the number of acupoints needled, the placement of the needles and the likelihood of using the same acupoints over a course of treatment. Study two, the needling study, compared the effect of six needling parameters combinations, as well as laser stimulation, on pressure pain threshold. A visual analogue scale (VAS) was also used to assess levels of pain, needling sensation, level of tension during, and anxiety prior to, the intervention period. The study found that the optimum needling parameters to elicit an analgesic response involve deep needling with manipulation at an acupoint. Difference in VAS scores were found for: pain, (both interventions to Large Intestine 4 (LI4) that involved manipulation were reported as significantly more painful than both the non acupoint (NAP) interventions and the two LI4 interventions without manipulation); needling sensation, (all the LI4 needling interventions produced similar scores except for the LI4 intervention that involved shallow needling and no manipulation, which was significantly lower); and tension (subjects reported higher scores for the LI4 intervention that involved shallow needling and manipulation than for the LI4 that involved shallow needling and no manipulation, and the two NAP and laser interventions). No significant differences were found for subjects reporting levels of anxiety prior to receiving acupuncture and the behaviour of the acupuncturist during the study. The study also supports the concept that an invasive sham needling technique may function as a feasible control intervention for pain conditions provided that manipulation is not applied to the inserted needle. It is hoped that the results of the two studies are incorporated into the design of future acupuncture clinical trials and that this will ensure a better understanding of acupuncture and facilitate the development of the evidence based practice of acupuncture.
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