Stimulated by Han et al 2019.
I was very pleased to see this huge (n>100 000) retrospective cohort study publish online yesterday in Acupuncture in Medicine. I have commented on a couple of similar papers from Taiwan on the blog this year: one on CHD in RA, and the other on hospitalisation in PSCI. There was also a similar one on CHD incidence in fibromyalgia.
This is the first such paper that I have seen from Korea, and it looks at a very common problem, hence the huge numbers involved. The data comes from the Korean National Health Insurance Service National Sample Cohort (NHIS-NSC) database – a bit of a mouthful! The authors looked for patients with neck pain between the years 2004 and 2010. They found over 150 thousand, and a third of them had received acupuncture treatment. They then went on to see how many had neck surgery within a two-year period. They wanted to see if those having acupuncture had a different rate of subsequent surgery. In order to do this fairly they had to match the 50 171 who had been identified as having acupuncture for their neck pain, with a similar number from those that did not – the number identified with neck pain between 2004 and 2010 but who did not receive acupuncture was 128 556. The matching (so called propensity matching) was performed by sex, age, income and Charlson comorbidity index (CCI).
The CCI is a short list of serious illnesses plus age categories over 50 (17 items) that predicts 10-year survival. You can find it here and see how you fair. I was happy enough to come up with 96%, and then I was reminded of getting the same mark in a physics exam and my father asking which 4 questions I got wrong! I dropped 2% by virtue of my age, and I guess the other 2% is down to chance.
Back to the paper then. They matched 50 161 from the two cohorts – from the 50 171 who had received acupuncture and the 128 556 who had not. The paper demonstrates the differences in demographics before and after matching. It is quite convincing!
So what did they find? Well forgive me for doing some Big Pharma showboating by first presenting the relative figures rather than the absolute ones. The number of cases having cervical surgery was 60% lower in the group that had received acupuncture. In absolute terms the 2-year incidence of cervical surgery was 0.13% in the acupuncture cohort and 0.33% in the matched controls, and the real absolute figures were 67 and 168 respectively.
This is retrospective observation data, so we cannot imply cause and effect, but we can only go on to hypothesise that acupuncture for neck pain may reduce the numbers who go on to have cervical surgery.
Vickers et al (2017) found a large effect size for acupuncture over sham in neck pain (0.8), and I discussed more technical aspects of this on a previous blog.
Well I am excited to see the potential of this sort of retrospective analysis of huge databases from the East, where acupuncture use is very common. This is a great way of generating potential hypotheses to test prospectively and could even be helpful in deciding to stop its use where there is therapeutic redundancy.
1 Han D, Koh W, Shin J-S, et al. Cervical surgery rate in neck pain patients with and without acupuncture treatment: a retrospective cohort study. Acupunct Med Published Online First: 20 August 2019. doi:10.1136/acupmed-2018-011724
2 Wu M-Y, Huang M-C, Liao H-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with rheumatoid arthritis in Taiwan: a Nationwide propensity score-matched study. BMC Complement Altern Med 2018;18:341. doi:10.1186/s12906-018-2384-5
3 Shih C-C, Yeh C-C, Yang J-L, et al. Reduced use of emergency care and hospitalization in patients with post-stroke cognitive impairment treated with traditional Chinese medicine. QJM An Int J Med Published Online First: 18 February 2019. doi:10.1093/qjmed/hcz044
4 Wu M-Y, Huang M-C, Chiang J-H, et al. Acupuncture decreased the risk of coronary heart disease in patients with fibromyalgia in Taiwan: a nationwide matched cohort study. Arthritis Res Ther 2017;19:37. doi:10.1186/s13075-017-1239-7
5 Vickers AJ, Vertosick EA, Lewith G, et al. Acupuncture for Chronic Pain: Update of an Individual Patient Data Meta-Analysis. J Pain 2017;19:455–74. doi:10.1016/j.jpain.2017.11.005