In addition to practising full time in Toronto, Dr. ShawnThistle is founder and president of Research Review Service inc., an online, subscription- based service designed to help busy practitioners integrate current, relevant scientific evidence into their practice (www.researchreviews- ervice.com). Shawn also recently launched The Epicurean Scholar, which offers continuing education seminars combined with gour- met food and wine events (www.Epicureanscholar.com). Dr. Thistle graduated from CMCC (where he lectures in the Orthopedics Depart- ment) and holds an Honours De- gree in Kinesiology from McMaster University. He also holds a certificate in Contemporary Medical Acupunc- ture from McMaster University, and is a Certified Active Release Tech- niques (ART®) Provider and Func- tional Range Release®/Functional Anatomical Palpation® instructor and provider. Acupuncture for Chronic Pain Study Title: Acupuncture for chronic Pain – Individual Patient Data Meta-Analysi Author(S): Vickers AJ, Cronin AM, Maschino AC et al. Publication Information: Archives of Internal Medicine 2012; 172(19): 1444-1453 BACKGROUND INFORMATION Acupuncture is a popular treatment employed by many chiropractors. Insertion and stimulation of acupuncture needles at certain locations on the body is done to facilitate pain reduction, improve circulation or induce other beneficial health effects. Many Dcs successfully utilize acupuncture in a contemporary, physiological/anatomical fashion, with little or no reference to acupuncture’s pre-modern concepts. One of the most common reasons patients seek acupuncture treatment is to relieve chronic pain. Although known to produce physiological effects that are related to analgesia, no consensus exists on the exact mechanism(s) involved in acupuncture. A large number of randomized controlled trials (RCTs) have investigated the effects of acupuncture on chronic pain. Unfortunately, most of them are of low methodological quality, making meta-analyses of this literature of questionable interpretability and value. The authors of this study attempted to improve on this by presenting an individual patient data meta-analysis of RCTs on acupuncture for chronic pain, and by including only high-quality studies. CONCLUSIONS AND PRACTICAL APPLICATIONS After reviewing data from almost 18,000 patients, this study provides the most robust evidence, to date, that acupuncture is effective for the treatment of chronic pain. Even after excluding a set of outlying studies, the meta-analytic results remained consistent across pain conditions. The authors demonstrated a significant difference between acupuncture and sham control that can be distinguished from bias, indicating that acupuncture is more than a placebo, as many detractors consistently imply. However, these differences were relatively modest, suggesting specific effects of needling may be enhanced by other factors that contribute to the therapeutic effects of acupuncture. Demonstrating even a modest difference between sham and true acupuncture advances beyond the prior literature, making this study both clinically and scientifically relevant. Several have suggested that acupuncture (whether real or sham) is associated with more potent placebo or context effects than other interventions. This makes many clinicians, not to mention insurance companies and third-party payers, uncomfortable. Is it reasonable to withhold a potentially beneficial treatment because we are unsure of, or uncomfortable with, its mechanism? When the mechanism of benefit is unknown, we often label it “non-specific,” or more damningly, “placebo.” Acupuncture is an intervention that causes activation of the endogenous opioid system, modulating the processing of cortical pain signals, thus attenuating the perception of pain. Should we abandon this because we don’t fully understand it? The finding here that acupuncture has effects over and above those of sham acupuncture is therefore very important for clinical practice. Even though these effects are small (on average), the clinical decision made by clinicians and patients is not between true and sham acupuncture, but between whether or not acupuncture treatment will be implemented directly or via referral. To read the full review, including study methods, strengths and weaknesses; systematic review results; and additional references, please visit the Current Issue page at www.canadianchiropractor.ca. •