Pain Measurement and the Assessment of Acupuncture Treatment

Measuring Pain

Accurate outcome measures are important both in clinical practice and in research. Measurement of pain should include intensity, relief-seeking behaviour and changes in function. Beliefs and attitudes to pain are of crucial importance and various instruments for assessing these are discussed. Primary outcome measures used in clinical trials must be valid, reliable, specific and sensitive.

Laser Acupuncture Analgesia: An Overview

In recent years, low power laser therapy has become a popular treatment modality. While its use as an alternative to needles in acupuncture is contentious, the studies reviewed above demonstrate the possibility of analgesic effects with such treatments. However, the majority of the trials conducted to date can be criticised on a number of points. This has contributed to the criticism surrounding the technique. Furthermore, the clinical significance of such treatment parameters as wavelength, energy density and pulsing frequency are poorly understood. Further research is therefore necessary on a number of levels: clinically to validate the claims made on behalf of lasers, and experimentally to identify optimum values for treatment parameters. Hopefully, as research in this field progresses, clinicians will benefit from firm treatment guidelines.

While in the final analysis lasers will probably never be able to replace needles, the potential advantages in their use in HLTVor hepatitis patients are obvious. Squeamish or very young patients may also react more favourably to laser rather than needle acupuncture. To this end, laser acupuncture represents a challenging and interesting field for future research.

The Methodology of Controlled Trials of Acupuncture

The double-blind controlled trial methodology cannot be straightforwardly applied to trials of acupuncture. The double-blind condition, where the clinician is ignorant of the treatment allocation, cannot be sensibly maintained in trials of acupuncture or other physical treatments. The definition of an appropriate control group is also a difficult matter. The great majority of controlled trials of acupuncture so far conducted are seriously flawed by the use of a placebo control that itself has therapeutic effects. Recently more appropriate control groups have been developed, notably mock TENS, which is inert, and minimal acupuncture, which has only a very slight specific effect. As trials can only be single blind, if is especially important to monitor the adequacy of the control procedure, to ensure that it is perceived as being as effective as the true treatment. It is suggested that this can be achieved by assessing the: credibility of the two treatment procedures.

Controlled trials of acupuncture should therefore be single blind, and employ a control condition that has no more than minimal specific effects, but is nevertheless seen as a credible, bona fide treatment by patients.