Scrutable

This was not on my 2020 medical science bingo card. Emphasis added:

Doctors are being advised not to prescribe common painkillers, including paracetamol and ibuprofen, for patients with chronic pain not caused by an injury or other medical condition.

The National Institute of Health and Care Excellence (NICE) said there was little evidence they help.

And it suggests there is evidence long-term use can be harmful.

Its draft guidance for England recommends antidepressants, acupuncture or psychological therapy instead.

Before I read the actual guidelines, I'm going to knee jerk and suggest that this is more indicative of a lack of access to the kind of emotionally therapeutic support a lot of people (not just with chronic pain) might need.*

I'm not going to dig my heels in if anyone can demonstrate evidence to the contrary but if that's what it is and we are in a situation where that's the best we can do for people then that's pretty poor imo.


*OK I cheated, this was my initial assumption and I then very briefly skimmed the intro to the evidence review, which seemed to tally up with my hunch.

The draft guideline is here.

That includes a link to " a short explanation of why the committee made the recommendations on acupuncture and how they might affect practice".

First off, "draft" so out for consultation. Comment away...Here y'go

It's pretty limited recommendation for pretty short term "treatment", which doesn't, to me, rule out that the placebo element is being manipulated (ethical issue alert!).

I need to have a better look at the evidence they used, which, of course, they haven't included nor linked to...Off to the NICE website...Aaaah, yer 'tis

Oh, FFS!

Table 2, the summary of studies used, is not promising: only 4 of them get to over 100 participants in any of the wings; many are in single figures; many have no "non-treatment" group; a number used NSAIDS or paracetamol in addition to needling; some use exercise regimes in addition to needling; it's all over the place as to whether traditional needles or electro or combinations are used, let alone which model of where the needles go; at least one did not use sham needles, but a laser pointer as comparison...At which point I lost the will to live...

This is piss poor and any recommendations based on this shower of sh.t should be thrown forcefully in the direstion of away.

WTAF are NICE playing at?

There's an overview of Cochrane reviews (is Cochrane still in favour?) here, which suggests (I've only read the abstract*) that acupuncture may actually be effective for some forms of pain.


* I last did statistics forty years or so ago - so probably wouldn't understand the details...

Even more FFS!

NONE (as in not any at sodding all) of the evidence used is graded by NICE as more than "moderate" quality and the bulk is "low" or "very low" - this is by their own f.cking admission and definitions...And the economic "research" is described as having "potentially serrious limitations".

Someone is bending over backwards to find in favour of sticking needles into folk.

Yes, my understanding was that the needling itself has demonstrated pain-relieving benefits above placebo, but the placement of them according to chakras etc. doesn't stand up to scrutiny.

Wasn't there an Ernst paper about 'sham' acupuncture?

This wouldn't have anything to do with fears we might run short of meds after we drive over Johnson's Cliff on NYE would it?

Bird on a Fire wrote: ↑

Tue Aug 04, 2020 5:36 pm

Yes, my understanding was that the needling itself has demonstrated pain-relieving benefits above placebo, but the placement of them according to chakras etc. doesn't stand up to scrutiny.

Wasn't there an Ernst paper about 'sham' acupuncture?

Of course, any pain relieving effects would have to be weighed against the risk of infection and physical damage from sticking needles in people. Just like drug side effects are weighed against efficacy for real treatments.

Edzard Ernst wass invoked earlier, so here yer go