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J Thorac Cardiovasc Surg 2008;136:1470-1471
© 2008 The American Association for Thoracic Surgery

General Thoracic Surgery

Acupuncture to relieve the pain of thoracotomy: Commentary on randomized, controlled trial

^a National Collaborating Centre for Acute Care, Clinical Effectiveness Unit, Royal College of Surgeons, London, UK
^b Clinical Operational Research Unit, Department of Mathematics, University College London, London, UK

Received for publication August 14, 2008; accepted for publication August 23, 2008.

^_* Address for reprints: Tom Treasure, MD, MS, FRCS, FRCP, Clinical Operational Research Unit, UCL (Department of Mathematics), 4 Taviton St, London WC1H 0BT, UK. (Email: tom.treasure@gmail.com).

The first 20% of the full text of this article appears below.

See related article on page 1464.

 

There are two fundamental principles that in our view should underpin the adoption or continuation of any medical practice. First, we prefer interventions to be based on scientific principles with understandable and demonstrable mechanisms. Second, we expect the beneficial effects to be reproducible and, when tested in a suitably designed study, attributable to the intervention.

If a proposed therapy passes both these tests, we will accept it, whether it is a drug found in nature (herbal remedy) or a physical therapy (massage or manipulation). Thus if a therapy that is new (or new to us) has a large effect that is closely related in time with a cogent mechanism, it is likely to be accepted readily.¹ If it fails the first criterion, we could still accept it according to the second, but then the standard of unbiased evaluation required would probably be higher. If it cannot pass either form of scrutiny, why should we accept it? An assertion by the practitioner that it works or by patients that they perceive benefit is insufficient. All proposed treatments should be amenable to evaluation, and if effective they should be accepted whatever their origins. We could then drop the labels "alternative" and "complementary." When there are strong associations between the therapy and the therapist, this creates problems in blinding and in interpreting the treatment effect, but these problems already have to be addressed for trials of surgery, physiotherapy, and psychotherapy.²

Acupuncture can be considered according to these principles. Is there a mechanism that, on the basis of present knowledge, makes acupuncture a likely means of diminishing thoracotomy pain? It is quite plausible . . . [Full Text of this Article]

Related Article

Randomized controlled trial of a special acupuncture technique for pain after thoracotomy

Gary Deng, Valerie Rusch, Andrew Vickers, Vivek Malhotra, Pamela Ginex, Robert Downey, Manjit Bains, Bernard Park, Nabil Rizk, Raja Flores, Simon Yeung, and Barrie Cassiletha
J. Thorac. Cardiovasc. Surg. 2008 136: 1464-1469. [Abstract] [Full Text] [PDF]