| čet - 21.05.2009 |
| Akupunktura i čačkalice - još sličnije nego pre pet dana! |
U prethodnom postu o akupunkturi i čačkalicama (Akupunktura i čačkalice - sličnije nego što vam se čini!) , govorila sam o jednoj studiji koja kaže da u lečenju hroničnog bola u deonjem delu leđa akupunktura ima jednaku efikasnost kao i bockanje čačkalicama, a oba imaju veću efikasnost od standardne terapije. Prepričan sadržaj te studije možete videti ovde, ako neko ima original, ja bih ga/je zamolila da mi pošalje.
Da nije sve tako jednostavno, ispostavilo se kasnije, nakon pažljivije analize istraživanja (iskusniji od mene su to učinili već vrlo uspešno, i to Orac i Steven Novella). Na nesreću, ja nemam originalno istraživanje, tako da vas molim, ako neko ima, da mi pošalje pdf.
Istraživanje je bilo sprovedeno tako da je 638 dobrovoljaca sa hroničnim bolom u donjem delu leđa podeljeno u četiri grupe, od kojih je jedna primala standardnu terapiju, druga individualizovanu akupunkturu, treća standardnu akupunkturu i četvrta je bila bockana čačkalicama (koje ne probijaju kožu, naravno, nego samo pružaju isti osećaj kao igle za akupunkturu).
Ali sad ono ključno, što u članku na strani (LINK) nisu rekli. Svaki ispitanik je mogao da nastavi sa svojom dosadašnjom terapijom. Svaki ispitanik je, dakle, mogao da pije lekove u toku akupunkturnog tretmana.
To dovodi u pitanje svaki zaključak koji smo mogli da izvedemo.
Naime, grupa 1 je primala samo lekove, a grupe 2, 3 i 4 su primale akupunkturu i pseudo-akupunkturu (čačkalice), ali su pritom mogli i da nastave da primaju lekove. Nisu naterani da prestanu da piju lekove! (http://www.sciencebasedmedicine.org/?p=500#more-500)
I šta je zapravo ovo istraživanje utvrdilo?
- standardizovana akupunktura + lekovi > lekovi
- individualizovana akupunktura + lekovi > lekovi
- pseudo-akupunktura + lekovi > lekovi
- standardizovana akupunktura = individualizovana akupunktura = pseudo-akupunktura
Sve navedeno nas dovodi do zaključka da je efekat akupunkture i čačkalica-akupunkture ipak saglasan sa placebo efektom. Studija nije pokazala da je bilo koja od ovih metoda efikasnija od neke druge u tolikoj meri da može da se primenjuje sama.
Dakle, kako sada gledati na rezultate istraživanja? Iako sam u prethodnom članku navela kako bi to akupunktura mogla da radi (gate control theory of pain), sve moje spekulisanje je palo u vodu, jer se pokazalo da akupunktura, kao metoda, kao drevna veština, kao način lečenja - ne radi.
Još sumnjivije mi je što su nešto toliko važno, kao što je uporedno lečenje lekovima i akupunkturom, "zaboravili" da naglase, kako u svom radu, tako i u vestima o njemu. |
| sa mnogo ljubavi i samopregora orkucala i poslala u blogosferu stetoskop_sa_slagom@ 21. maj 2009 9:19:52 |
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| 2 Komentari: |
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http://scienceblogs.com/insolence/2009/05/another_acupuncture_study_misinterpreted.php #13
Expectancy and treatment interactions: A dissociation between acupuncture analgesia and expectancy evoked placebo analgesia
Author(s): Kong J (Kong, Jian)1,2, Kaptchuk TJ (Kaptchuk, Ted J.)3, Polich G (Polich, Ginger)1, Kirsch I (Kirsch, Irving)4, Vangel M (Vangel, Mark)2,5, Zyloney C (Zyloney, Carolyn)1, Rosen B (Rosen, Bruce)2, Gollub R (Gollub, Randy)1,2,3
Source: NEUROIMAGE Volume: 45 Issue: 3 Pages: 940-949 Published: APR 15 2009
Abstract: Recent advances in placebo research have demonstrated the mind's power to alter physiology. In this study, we combined an expectancy manipulation model with both verum and sham acupuncture treatments to address: 1) how and to what extent treatment and expectancy effects - including both subjective pain intensity levels (pain sensory ratings) and objective physiological activations (fMRI) - interact; and 2) if the underlying mechanism of expectancy remains the same whether placebo treatment is given alone or in conjunction with active treatment. The results indicate that although verum acupuncture+high expectation and sham acupuncture+high expectation induced subjective reports of analgesia of equal magnitude, fMRI analysis showed that <b>verum acupuncture produced greater fMRI signal decrease in pain related brain regions</b> during application of calibrated heat pain stimuli on the right arm. We believe our study provides brain imaging <b>evidence for the existence of different mechanisms underlying acupuncture analgesia and expectancy evoked placebo analgesia</>. Our results also suggest that the brain network involved in expectancy may vary under different treatment situations (verum and sham acupuncture treatment). (c) 2008 Elsevier Inc. All rights reserved.
Reprint Address: Kong, J (reprint author), Massachusetts Gen Hosp, Dept Psychiat, Bldg 149,13th St,Suite 2661, Charlestown, MA 02129 USA
Addresses:
1. Massachusetts Gen Hosp, Dept Psychiat, Bldg 149,13th St,Suite 2661, Charlestown, MA 02129 USA
2. MGH MIT HMS Athinoula A Martinos Ctr Biomed Imagi, Charlestown, MA USA
3. Harvard Univ, Sch Med, Osher Res Ctr, Boston, MA USA
4. Univ Hull, Kingston Upon Hull HU6 7RX, N Humberside England
5. MGH CRC Biomed Imaging Core, Charlestown, MA USA
E-mail Addresses: kongj@nmr.mgh.harvard.edu
Posted by: wp | May 13, 2009 11:00 AM
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ovo zvuči obećavajuće! imaš li pristup radu u celosti?
to pitam jer nam je potrebno što više informacija da procenimo njegovu vrednost i verodostojnost.
kao, na primer, koje metode su koristili? koliki im je uzorak? koji su statistički parametri?
abstrakt ne govori mnogo o studiji, ukoliko ne pročitamo samu studiju. recimo, ako je ovde učestvovalo 20 ispitanika, studija nije dovoljno jaka, sve je to moglo da se pronađe i potpuno slučajno. ako je učestvovalo, recimo, 1000, to je već sila sa kojom treba računati.
plus, čitala sam da fMRI, iako obećava, nije naročito pouzdana metoda, ali to nije moje polje ekspertize, pa verujem da će neko drugi znati bolje od mene.
sve u svemu, vrlo me zanimaju detalji!
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Ime: stetoskop_sa_slagom
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O meni: stetoskop sa šlagom će kad poraste biti doktorka. Za sada je samo studentkinja i sem ljubavi prema lupkanju štiklama niz hodnik, nema ništa lekarsko u sebi. Još je i polumaratonac polupočetnik, samozvani ekspert za vanbasco karaoke i srpsko-kinesku kuhinju, savetodavac i majstor kvariša. Za recepte garantuje da valjaju, za sve ostalo ne baš.
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http://scienceblogs.com/insolence/2009/05/another_acupuncture_study_misinterpreted.php #13
Expectancy and treatment interactions: A dissociation between acupuncture analgesia and expectancy evoked placebo analgesia
Author(s): Kong J (Kong, Jian)1,2, Kaptchuk TJ (Kaptchuk, Ted J.)3, Polich G (Polich, Ginger)1, Kirsch I (Kirsch, Irving)4, Vangel M (Vangel, Mark)2,5, Zyloney C (Zyloney, Carolyn)1, Rosen B (Rosen, Bruce)2, Gollub R (Gollub, Randy)1,2,3
Source: NEUROIMAGE Volume: 45 Issue: 3 Pages: 940-949 Published: APR 15 2009
Abstract: Recent advances in placebo research have demonstrated the mind's power to alter physiology. In this study, we combined an expectancy manipulation model with both verum and sham acupuncture treatments to address: 1) how and to what extent treatment and expectancy effects - including both subjective pain intensity levels (pain sensory ratings) and objective physiological activations (fMRI) - interact; and 2) if the underlying mechanism of expectancy remains the same whether placebo treatment is given alone or in conjunction with active treatment. The results indicate that although verum acupuncture+high expectation and sham acupuncture+high expectation induced subjective reports of analgesia of equal magnitude, fMRI analysis showed that <b>verum acupuncture produced greater fMRI signal decrease in pain related brain regions</b> during application of calibrated heat pain stimuli on the right arm. We believe our study provides brain imaging <b>evidence for the existence of different mechanisms underlying acupuncture analgesia and expectancy evoked placebo analgesia</>. Our results also suggest that the brain network involved in expectancy may vary under different treatment situations (verum and sham acupuncture treatment). (c) 2008 Elsevier Inc. All rights reserved.
Reprint Address: Kong, J (reprint author), Massachusetts Gen Hosp, Dept Psychiat, Bldg 149,13th St,Suite 2661, Charlestown, MA 02129 USA
Addresses:
1. Massachusetts Gen Hosp, Dept Psychiat, Bldg 149,13th St,Suite 2661, Charlestown, MA 02129 USA
2. MGH MIT HMS Athinoula A Martinos Ctr Biomed Imagi, Charlestown, MA USA
3. Harvard Univ, Sch Med, Osher Res Ctr, Boston, MA USA
4. Univ Hull, Kingston Upon Hull HU6 7RX, N Humberside England
5. MGH CRC Biomed Imaging Core, Charlestown, MA USA
E-mail Addresses: kongj@nmr.mgh.harvard.edu
Posted by: wp | May 13, 2009 11:00 AM