44
Focus on Alternative and Complementary Therapies
March 2011 16(1)
Laser acupuncture trial shows no effect on menopausal symptoms DOI 10.1111/j.2042-7166.2010.01070_5.x
O’Brien KA, Varigos E, Black C, Komesaroff PA. Laser acupuncture does not improve menopausal symptoms. Menopause 2010; 17: 636–41.
Aim To investigate the effectiveness of laser acupoint stimulation in relieving menopause-related symptoms.
laser. All treatments were carried out by a trained medical acupuncturist, who also completed the case history (including tongue and pulse diagnosis), and selected acupoints from 10 relevant acupoints.
Design Double-blind, randomised, placebo-controlled trial with two parallel arms.
Main outcome measures Number of diurnal and nocturnal flushes, and nonflushing symptom score (on a scale of 0–5).
Setting A university hospital, Melbourne, Australia. Participants Forty women, aged 40–65 years, who experienced up to 10 hot flushes per day, were not taking hormonal therapies and had no other serious medical conditions, were enrolled in the study. Intervention Participants assigned to the active (‘laser on’) group received laser acupuncture treatment fortnightly for 12 weeks. Participants in the control (‘laser off’) group followed the same protocol, using the same equipment with identical flashing lights, but without
Main results There were no significant differences between the active and placebo treatment groups in numbers of diurnal or nocturnal flushes or in the non-flushing symptom score. Authors’ conclusion ‘Laser acupoint stimulation chosen from a fixed set of acupoints is no more efficacious than manual stimulation with an inert laser probe in altering menopausal symptoms.’ Address P Komesaroff, Monash University Department of Medicine, Alfred Hospital, Victoria 3181 Australia. E-mail:
[email protected]
............................................................................................................
Commentary A recent mixed methods study, incorporated into an RCT design, suggests a significant perceived benefit for women receiving individualised traditional acupuncture for menopausal symptoms.1 Of the 112 women (from 134 randomised) who were asked about their experiences, 74% related improvements in symptoms with treatment, 11% were unsure if their improvement was due to the treatment, 13% felt they had experienced no improvement and 2% felt worse. The quantitative outcomes reflected these experiences.2 Notwithstanding, recent systematic reviews on the effectiveness of acupuncture for the treatment of menopausal hot flushes conclude that there is no effect above that of placebo,3,4 which reflects the results of the laser acupuncture trial reported in the present study. So what does this mean? One of the challenges of conducting trials of acupuncture is finding a credible control or sham treatment. Studies to date have used a range of approaches,
including sham needles, superficial needling and needling of unrelated sites;5 all of which present problems. Laser acupuncture should overcome these problems. Whilst the current trial had a credible control intervention, one has to wonder about the differences in physiological effect that lasers have in comparison to needling a point. The mixed method RCT mentioned at the beginning of this commentary compared traditional acupuncture plus self care, to self care alone, and found a positive result for acupuncture in terms of vasomotor symptom reduction. This again presents another treatment approach. In all the trials previously mentioned, it is difficult to differentiate between the physiological effects the various acupuncture or ‘placebo’ acupuncture treatments are having, and the psychological effects the entire therapeutic encounter may be giving the patient. For evidence-based research, this complex issue is of continuing interest and importance; however, it is suspected that this issue is slightly
Summaries/Commentaries less important for women who experience benefits from such treatments. Alyson Huntley, Bristol University, UK
Conflict of interest None declared. References
1 Alræk T, Materund K. Acupuncture for menopausal hot flashes, a qualitative study about patient experiences. J Comp Ther Med 2009; 15: 153–8.
45
2 Borund EK, Alræk T, White A et al. The Acupuncture on Hot Flushes among Menopausal Women (ACUFLASH) study, a randomised controlled trial. Menopause 2009; 16: 484– 93. 3 Cho SH, Whang WW. Acupuncture for vasomotor menopausal symptoms: a systematic review. Menopause 2009; 16: 1065–73. 4 Lee MS, Shin BC, Ernst E. Acupuncture for treating menopausal hot flushes: a systematic review. Climateric 2009; 12: 16–25. 5 Borud E, White A. A review of acupuncture for menopausal problems. Maturitas 2010; 66: 131–4.
............................................................................................................
Authors’ reply The pathophysiology of menopausal symptoms and the mechanisms of action underlying hormonal therapy are poorly understood. There is suggestive but inconclusive evidence for the efficacy of needle acupuncture in the treatment of these symptoms. Low-intensity laser acupuncture has become increasingly popular in the treatment of this and other conditions. Our study is the first to investigate the effects of lowintensity infrared laser acupuncture for the relief of menopausal symptoms. We employed a randomised, doubleblind, placebo-controlled design with rigorous outcome variables. The treatment protocol, including the choice of acupuncture points, was decided by a panel of experts in needle acupuncture on the basis of traditional theory and published research. Consistent with traditional practice, discretion was given to the operator to individualise treatment in accordance with clinical judgement. The study
was powered to detect differences in the outcome measures of 25–30% with a 5% Type 1 error. On the quality criteria applied by the major systematic review in the field,1 our study exceeded all previous assessments of this technique. Using this rigorous approach, our study showed that laser stimulation was no more effective than manual stimulation with an inert probe in altering menopausal symptoms. Whether the same result applies to conventional needle acupuncture remains to be determined in future studies.
Reference
1 Baxter GD, Bleakley C, McDonough S. Clinical effectiveness of laser acupuncture: a systematic review. J Acupunct Meridian Stud 2008; 1: 65–82.
