A recent report commissioned by Arthritis Research UK reviewed 25 so-called “alternative” therapies for arthritis. They found, not surprisingly that there is little evidence to support most the studied treatments.

“There’s either no evidence that they’re effective or there’s some evidence that they are not effective.

Says lead author, Dr Gareth Jones.  It is important to note that we are not just talking about that these treatments are poorly studies, but also that to the extent they are studied the evidence is mixed or shows lack of efficacy.

I want to discuss, however, the exceptions – the treatment the report found were effective. They include acupuncture, tai chi, yoga, and massage.  Tai chi and yoga are basically forms of exercise and stretching, so it is not surprising that they are helpful in treating musculoskeletal disorders. It is deceptive, in my opinion, to even consider them “alternative” and lump them into the same artificial category as copper bracelets and magnet therapy. Exercise is not alternative – it is a very basic form of science-based activity for health, conditioning, and for musculoskeletal symptoms. The same is essentially true for massage, which is known to relax muscles (at least temporarily). Relaxation therapy should also not be considered “alternative” and existed long before this category was invented.

The only item on the list of treatment modalities that the report concluded showed some efficacy that is reasonably defined as “alternative” was acupuncture. This claim caught my attention because other reviews of the literature indicate that acupuncture is not effective for arthritis (or anything else). The report itself is not published in a peer-reviewed journal (at least not yet), but the lead author, Gareth Jones, has published prior systematic reviews.

For example, a 2012 review of acupuncture for low back pain found:

Three studies found a significant difference in pain scores when comparing acupuncture, or sham acupuncture, with conventional therapy or no care. Two studies demonstrated a significant difference between acupuncture treatment and no treatment or routine care at 8 weeks and 3 months. Three studies demonstrated no significant difference between acupuncture and minimal/sham acupuncture with no difference in pain relief or function over 6 to 12 months.

This is a consistent pattern for acupuncture research in general. When compared to no treatment or usual care (which is necessarily an unblinded comparison) there is a difference in outcome. This is sufficiently explained as placebo effects, which can be entirely bias and expectation. There is probably also some non-specific benefit from the kind attention of the practitioner. When acupuncture is compared to sham or placebo acupuncture, however, there is no difference. Since acupuncture is the insertion of needles into alleged acupuncture points, and the research shows it does not matter where or even if you insert needles, the only reasonable conclusion is that acupuncture does not work. There are placebo effects from the ritual surrounding acupuncture – but no effect from acupuncture itself.

What about acupuncture for rheumatoid arthritis? A recent review of systematic reviews concluded:

In conclusion, penetrating or non-penetrating sham-controlled RCTs failed to show specific effects of acupuncture for pain control in patients with RA.

Same outcome – no specific effects from acupuncture.

A 2010 systematic review of acupuncture for osteoarthritis showed:

Sham-controlled trials show statistically significant benefits; however, these benefits are small, do not meet our pre-defined thresholds for clinical relevance, and are probably due at least partially to placebo effects from incomplete blinding. Waiting list-controlled trials of acupuncture for peripheral joint osteoarthritis suggest statistically significant and clinically relevant benefits, much of which may be due to expectation or placebo effects.

Different wording, but same meaning – there is no compelling evidence that acupuncture has effects beyond placebo. I would add again that comparing acupuncture to “wait list control” (which means no treatment, and of course this means unblinded) is worthless and misleading.

The report also considered fibromyalgia – so here is a recent review of acupuncture for fibromyalgia:

A small analgesic effect of acupuncture was present, which, however, was not clearly distinguishable from bias. Thus, acupuncture cannot be recommended for the management of FMS.

To summarize, published reviews of acupuncture for back pain, rheumatoid arthritis, osteoarthritis, and fibromyalgia all show that acupuncture is no better than placebo. Reviewers vary slightly as to wording , but they all add up to the same thing. There are small effects when comparing acupuncture to essentially no treatment, but specific effects of acupuncture cannot be separated from placebo effects. In other words – acupuncture does not work.

It is surprising, then, that the UK report concluded that acupuncture is useful for arthritis. I can only presume that they consider superiority over no treatment as justification for acupuncture – which is usually the case. This is profoundly unscientific, however. This same standard would never be applied to conventional treatments, not shrouded in the distortion field of  “alternative” medicine. When a treatment only seems to work when it is looked at in an unblinded fashion, and proper blinding causes any effect to evaporate – that treatment does not work.

Posted by Steven Novella

Founder and currently Executive Editor of Science-Based Medicine Steven Novella, MD is an academic clinical neurologist at the Yale University School of Medicine. He is also the president and co-founder of the New England Skeptical Society, the host and producer of the popular weekly science podcast, The Skeptics’ Guide to the Universe, and the author of the NeuroLogicaBlog, a daily blog that covers news and issues in neuroscience, but also general science, scientific skepticism, philosophy of science, critical thinking, and the intersection of science with the media and society. Dr. Novella also contributes every Sunday to The Rogues Gallery, the official blog of the SGU.