Stimulated by Chaabna et al 2024.[1]
WMA – Western medical acupuncture
key to acronyms
SR – systematic review
SM – sports medicine
TCA – traditional Chinese acupuncture
TCM – traditional Chinese medicine
I spent the last weekend teaching on a WMA course in a sports clinic in Porto (HP Clinics), so this paper, which had been resting in my ‘recent’ folder on Zotero, seemed like an appropriate choice.
It is an SR from a group in Qatar. We do not often see WMA mentioned in acupuncture papers, and rarely in the title. This is probably the first SR with Western medical acupuncture in the title. It focusses on the perception of WMA and its use by athletes.
They included 11 studies, of which, 3 were clinical trials, one was a cohort study, two were longitudinal studies, and five were cross-sectional studies.
The results revealed the rate of WMA prescription by SM health professionals varied from 15.4% in the UK in 1999 (n=13) to 58.4% in the US in 2022 (n=257). Acupuncture use by athletes varied from 2.2% among college athletes in Palestine (n=227) to 61% among professional football players in the Netherlands (n=28).
These results are less than inspiring, and the authors conclude that there is a research gap in evaluating the practice and perception of WMA among health professionals and athletes. They go on to conclude that WMA is prescribed by health professionals and used by athletes for a variety of MSK pain conditions, and that it is generally perceived positively in terms of effectiveness. So, I am left wondering about the motivation for this SR.
In the abstract of the paper the ‘Western’ from WMA is set in double inverted commas twice, which makes me think they are trying to make a point. In the main paper it appears 28 times and 13 times in double inverted commas. In their introduction, they suggest the term evidence-based acupuncture would be better than WMA. I understand this point, but I disagree.
They have referenced the book where WMA was mentioned for the first time, but they did not reference the specific chapter with that title.[2] They referred to geography, which reminded me of what I wrote in the first ever reference to WMA:[2]
‘Western acupuncture’ is a term with a variety of potential meanings. The most literal interpretation invokes thoughts of geographical boundaries, but the term was probably introduced to distinguish a developing system of needle therapy from its traditional philosophical roots which happened to be in the east.
The authors of this text prefer to interpret ‘western medical acupuncture’ as the scientific application of acupuncture as a therapy following orthodox clinical diagnosis, whereas ‘traditional Chinese acupuncture’ (TCA) is an integral part of ‘traditional Chinese medicine’ (TCM) and therefore encompasses the multiple and often conflicting processes of diagnosis and treatment. It is important to note that the scientific evaluation of acupuncture is not restricted to the west (Han, 1987) and therefore adherence to a geographical definition is inappropriate. Probably a more accurate definition of western medical acupuncture is a modern scientific approach to therapy involving dry needling of tissues, which has developed from the introduction and evaluation of TCA in the west.
The term evidence-based is problematic because there are differences in interpretation of what evidence-based actually means. I always refer to Sackett et al from the BMJ in 1996 –Evidence based medicine: what it is and what it isn’t.[3] Here are some quotes from the editorial:
Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.
The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research.
By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine…
Good doctors use both individual clinical expertise and the best available external evidence, and neither alone is enough.
Without clinical expertise, practice risks becoming tyrannised by evidence…
Evidence based medicine is not restricted to randomised trials and meta-analyses.
So, to be clear, WMA refers to acupuncture as a technique practiced as a part of western medicine rather than as part of TCM. It is not necessarily more evidence based than TCM, unless basic science and physiology is included within the evidence base. As far as NICE is concerned, basic science is not included in their considerations during guideline development. WMA is a philosophical approach that differs from TCM but often overlaps with TCM in terms of application. I think we all need to avoid the term evidence based until we can agree on what it actually means, and to what extent basic science and clinical experience is allowed to re-enter.
References
1 Chaabna K, Jithesh A, Cheema J, et al. Western Medical Acupuncture Perception and Use for Pain Management Among Athletes: A Systematic Review. J Pain Res. 2024;17:357–66.
2 Filshie J, Cummings M. Western medical acupuncture. In: Ernst E, White A, eds. Acupuncture – A Scientific Appraisal. Butterworth Heinemann 1999:31–59.
3 Sackett DL, Rosenberg WM, Gray JA, et al. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–2.
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