I have written extensively about acupuncture and the scientific evidence concerning it, even going so far as to complete a certification course in acupuncture myself. This extensive examination has convinced me that while there are a few effects of electrical nerve stimulation done under the umbrella of acupuncture that might be clinically useful, overall the evidence does not support acupuncture as a powerful, widely useful therapy. Most of the apparent responses seen in humans are likely due to placebo effects or mild non-specific reactions to the minor trauma of needling. Since acupuncture is pretty safe when done properly, it is not unreasonable to try needling with electrical stimulation in specific cases where all other conventional means have been used appropriately or there are no available therapies with better evidence, and as long as clients understand the lack of evidence to support significant objective effects.
I also think that the limited potential for benefits from needling are often swamped by the risks from the nonsense associated with some schools of thought in the acupuncture field, particularly the so-called Traditional Chinese Veterinary Medicine (TCVM) approach. Unlike the medical acupuncture model, which at least attempts to ground needling therapies in established anatomic and physiologic principles, TCVM is effectively a religious belief system that is inconsistent with science-based medicine, and as such it does more harm, in terms of inflicting unproven therapies and mystical diagnostic and treatment practices on patients, than it can do good even if a few needling practices have some clinical benefits.
Given this position, I agree with the recent decision of the American Veterinary Medical Association (AVMA), following the recommendation of the American Board of Veterinary Specialties (ABVS), to deny a petition by an association of acupuncturists, dominated by the TCVM approach, to certify acupuncture as a legitimate medical specialty in veterinary medicine. Such certification requires that the area designated as a specialty be a legitimate, scientific discipline, not simply that it be a complex collection of beliefs and practices accepted by adherents regardless of the scientific evidence. Homeopathy is not a medical specialty any more than shamanism or ritual sacrifice to Apollo are medical specialties, because it has failed to prove it can or does work through scientific testing. While some non-TCVM approaches to acupuncture are more plausible and compatible with science than homeopathy or TCVM, even these approaches have failed to generate the kind of robust, consistent body of positive research evidence needed to justify creating an entire medical specialty within the veterinary profession.
In addition, any specialty in acupuncture would almost certainly include the majority of veterinary acupuncturists who practice faith-based, TCVM acupuncture. This would mislead animal owners into believing that the body of knowledge mastered by these practitioners was scientifically valid and equivalent to that mastered by specialists in cardiology, internal medicine, oncology, and other recognized specialties. This is clearly untrue, and it is encouraging that even such a political organization as the AVMA, which has refused to condemn homeopathy in the past despite acknowledging it is ineffective.
Of course, this decision doesn’t prevent anyone from offering acupuncture treatment of any kind. It simply makes clear that acupuncture advocates have not been able to generate reasonable scientific proof for their claims despite decades of trying. The decision appropriately challenges the trend towards integrating alternative therapies into veterinary practice even when there is not good evidence for their safety or efficacy.
My veterinary clinic recently sent me a form letter saying that they would no longer be prescribing Tramadol for pain management.
“We recommend alternative medication and therapies including gabapentin, acupuncture, and rehabilitation.”
Well, I generally agree that oral tramadol is probably ineffective and the evidence for it is not much better than that for acupuncture, but that doesn’t make acupuncture a reasonable substitute. Gabapentin is probably effective for at least some kinds of pain. And rehabilitation, which is the veterinary version of physical therapy, should be helpful given that it clearly is in human medicine, but there is virtually no research in veterinary patients yet to show efficacy.
Rimadyl seems to be keeping him comfortable (he’s elderly) and wouldn’t be able to tolerate anything aggressive. I thought the tramadol had a bit of a sedative effect.
Thanks for your reply.
Wait, really? Does that mean my dog is on no pain control at all- she’s on 200mg/day of tramadol for her arthritis. Should I go back to the vet and discuss this? Is there any evidence you are aware of that I should bring in?
My vet explained to me that the Tramadol works in humans cause it converts to an opiate, however the latest research on canines proves that they don’t convert it….so it may still have some sedative qualities. Anything that helps with anxiety decreases pain a little.
Hope this helps. I’m sure the doctor can explain it better than I did.
There is research evidence that injectable tramadol has analgesic effects in dogs. However, as L pointed out, in humans oral tramadol works via a metabolite that dogs don’t make, so it’s unclear if it does anything given orally through other metabolites. Subjectively, many vets (myself included) feel it doesn’t work very well in practice, though this is difficult to assess. It may be appropriate to ass on to other pain control medications, but it really shouldn’t be used as the sole agent for pain control in my opinion.
Hi SkeptVet,
I appreciate that we need to be careful about accepting claims for the efficacy of things; there’s always misguided, ignorant, superstitious or downright deceptive people out there touting all sorts of quackery. But I also want us to be careful with statements like “the evidence does not support acupuncture” or “lack of adequate scientific evidence …” or “lack of evidence to support significant objective effects.” None of these statements says that there IS evidence that acupuncture is not effective (or has maybe limited effectiveness in a few cases). The same goes for many other treatments, products, and feeding approaches. The lack of scientific evidence could just mean that nobody did the research. Purina isn’t going to fund a clinical trial to test balanced home-cooked diets against Dog Chow. The holistic vets don’t have the money to run extensive head-to-head trials on different diets or treatments, and the commercial Big Pet Food/Pharma companies, who have the money, have NO incentive to do that … it might take a bite out of their profits!! So, bottom line, when you state that “there is no evidence” for the effectiveness of a diet or treatment, you really should tell us clearly whether that means that there IS evidence that it is NOT effective, or just the research hasn’t been done. Thanks.
Actually, that isn’t how science works. You can’t ever provide evidence something doesn’t work, you can only test it and either find evidence it does or fail to find such evidence. Proving a negative is a near impossibility.
What often happens when you test something and it fails is that proponents of that therapy say that something was done wrong- the test, the procedure, the dose, etc. Fair enough, but then you have to do another test that takes that issue into account. You can do that a million times and never prove the treatment can’t ever work in some way on some patient. The problem is that this is a tremendous waste of time and resources, and medicine advances faster and more surely if we decide that after a reasonable amount of effort to find evidence something works, if we are unsuccessful then further testing and use of that therapy isn’t justified.
Here’s a much longer discussion of the issue that, at some point, absence of evidence is evidence of absence.