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Accupuncture needle and model ©1998, Seirin International Inc.


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Can acupuncture reduce leg pain in AIDS?
Neuropathy -- a failure of motor nerves caused by deterioration of their long fibers -- frequently occurs in infection with HIV, the AIDS virus. Neuropathy causes feelings of burning, numbness and aching that usually start in the feet and move up the legs. The condition is quite difficult to treat. Some AIDS patients seek relief in acupuncture, but nobody knows whether it works. stick it to me

Acupuncture -- the insertion of fine needles to specific points of the body -- is an ancient Chinese system of health. Although acupuncture is inexplicable to Western science, it's been proven to kill pain in surgery and ease the side effects of chemotherapy. Acupuncture diagnoses have no counterpart in Western medicine, and patients with a single Western diagnosis may be diagnosed and treated in many ways.

Acupuncture is also hard for Western medicine to evaluate. Patients know when they're being stuck with needles, raising the likelihood of a placebo effect. And treatments are supposed to be tailored to the individual -- a major roadblock to crafting statistically valid experiments.

A nettlesome problem
When Judith Shlay and colleagues at the Denver Community Programs for Clinical Research on AIDS wanted to study acupuncture for AIDS patients, they tried to sidestep some of these hazards. To avoid the placebo effect, the acupuncturists "treated" the control group with needles at points not considered active.

And they standardized the treatment, to pin down exactly what they were testing. "We didn't allow the acupuncturists to perform individual therapy, which is what they would do normally," Shlay says. Individual therapy is, she points out, "much harder to standardize."

Individual treatments, she adds, can't be replicated -- a critical standard for checking scientific work.

It turned out that needles at acupuncture points worked no better than needles at supposedly inactive points: Patients reported no significant change in quality of life, pain or adverse events.

But standardizing the treatment raised a major question. David Hassert, an acupuncturist in Middleton, Wis., insists that the treatment must be tailored to the individual. "Western doctors like to have one thing to fix one thing. In natural medicine, no treatment is done like that. You always treat the person, not the symptom, and using one standard treatment is treating the symptom, not the person."

Although Shlay says the test only proves that stimulating certain acupuncture points did not treat AIDS neuropathy, she adds that another lesson was learned. "You can study alternative practice of medicine using rigorous controlled trials, but you won't make everybody happy in the process."

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