Since 2007, statutory health insurance companies have been covering acupuncture for chronic pain in the lumbar spine and knee joint for up to ten sessions within six weeks. In the meantime, treatments that go beyond the classic diagnoses – i.e. low back pain and knee arthrosis – are also being paid for. On a voluntary basis, the health insurers subsidize treatments related to pregnancy and birth preparation, for example. This may include: Treatment of morning sickness and vomiting, back pain and coccyx pain. Or – as in my case – chronic pain disorders such as migraines.
The basis for these decisions were extensive clinical studies with names such as German Acupuncture Trials (GERAC), Acupuncture in Routine Care (ARC) and Acupuncture Randomized Trials (ART) – financed by consortia of German health insurance companies. The focus was on chronic pain of various causes, in addition to the aforementioned, for example, headaches caused by tension and migraines. More than 300,000 people with various underlying diseases and pain took part in the ART and ARC studies alone.
To find out if acupuncture helped them, the participants were randomly divided into different groups: one received acupuncture while another received no treatment. Such a study design is called a randomized controlled study. But there was another group who underwent a sham treatment, sometimes called minimal acupuncture. Instead of pricking deep and at classic acupuncture points, the needles are only placed superficially and away from these places. The patients did not know to which group they belonged.
For all three diagnoses examined—knee, headache, and back pain—the acupuncture group showed an improvement in symptoms over those who received no treatment. However: It made no difference whether the pricking was done at randomly chosen points or at acupuncture points, neither for the headache nor for the back pain. Only in osteoarthritis of the knee was there a minimal advantage of acupuncture over sham treatment. The effect of the needles is nothing more than a placebo effect, say critics of the procedure.
Stefanie Joos does not accept this argument. The medical director of the Institute for General Medicine and Interprofessional Care at the University Hospital in Tübingen researches acupuncture and offers it for various ailments. “Inserting a needle anywhere in the body can stimulate local blood flow, strengthen local immune reactions and trigger analgesic reactions.” It is therefore wrong to speak of “placebo” in this context. According to Joos, one has to differentiate between pure placebos and those that she describes as active placebos. “The latter result in more or less desired reactions in the body, the extent and direction of which cannot be precisely estimated,” says the doctor. This is the case with minimal acupuncture, when the skin is punctured at non-acupuncture points. The needling triggers a reaction, but – in contrast to acupuncture – it is non-specific.
This is indeed a dilemma. Because in order to prevent belief about the effect alone from influencing the study results, actual and sham treatment must feel completely the same. In the best case, neither the subjects nor the treating person know whether the condition is the real one or the control one. This is impossible with acupuncture, because at least the doctor knows whether the needles are hitting the acupuncture points. They can unconsciously influence the patient’s well-being.