Remember the choices Mary was considering for her pain from her osteoarthritis? She has completed research on acupuncture and herbal ointments. We will use these as examples of evaluating the process.
What is the evidence about acupuncture?
What is acupuncture?
The term "acupuncture" describes a family of procedures involving the stimulation of points on the body using a variety of techniques. The acupuncture technique that has been most often studied scientifically involves penetrating the skin with thin, solid, metallic needles that are manipulated by the hands or by electrical stimulation. Practised in China and other Asian countries for thousands of years, acupuncture is one of the key components of traditional Chinese medicine.11
Does acupuncture work?
- People who had acupuncture had reduced pain compared to a placebo.12, 13
- In 100 people: 30 improve on their own, six improve due to acupuncture and 64 don't.12
Is acupuncture safe?
Acupuncture can cause some bruising, but it is considered a very safe treatment with serious side effects being very rare.14 Mary also has to consider that acupuncture involves seeing a practitioner regularly and she will be paying for these treatments.
What is the evidence about arnica gel?
What is arnica gel?
Arnica gel is a herbal medicine. Herbal medicines are defined as finished, labelled medicinal products that contain as active ingredients aerial or underground parts of plants, other plant material, or combinations thereof, whether in the crude state or as plant preparations (for example oils, tinctures).15
Does arnica gel work?
Arnica gel probably improves pain and function as well as non-steroidal anti-inflammatory drugs do.16
Is arnica gel safe?
A greater proportion of people who applied arnica reported side effects than those who applied ibuprofen (a type of non-steroidal anti-inflammatory drug (NSAID)). Arnica is POSSIBLY SAFE when used in the amounts commonly found in food or when applied to unbroken skin short-term. Arnica is associated with allergies and can cause increased heart rate and blood pressure.16, 17
Mary's evaluation of the evidence
Mary summarises the evidence and her objectives to reduce pain and remain active in the following way. There is evidence that acupuncture can reduce pain and improve function and appears to be safe.12, 13, 14 There is some evidence that arnica can reduce pain and improve function but may not be safe for Mary due to increased blood pressure.15, 16, 17
How each person balances the evidence gathered with their personal situation, values and beliefs and objectives is unique. This process may change over the course of an illness. What is important to an individual when first diagnosed may change over time.
Each person also needs to consider how much time, money and energy they are able to commit to their treatment choices.
Some individuals may approach their complementary medicine therapy decision in a very scientific and rational manner, while others may feel more comfortable with a gut feeling.
Given the evidence about effectiveness and safety, Mary decides to use acupuncture. Mary decides against arnica because of the risk of increasing her blood pressure. Mary will inform her general practitioner about her decision to use acupuncture. She will explore other options for managing pain if it is needed. Mary will monitor her pain relief to help decide if the treatment is working for her. For example, Mary decides to rate her pain out of 10 before starting treatment, and based on the advice of her acupuncturist and general practitioner, she will re-rate her pain out of 10 at the end of an eight-week course of treatment.
Recap: How will you decide?
Working with people you trust, use a careful process that helps you evaluate:
- The evidence you found.
- Your comfort with what is known and not known about a therapy.
- The safety of each choice.
- Your priorities.
- Your beliefs and personal values.
- Your ability to access and use a therapy, including whether you have the resources to support your need.
Moving forward with your decision
Once you have decided on which choices you would like to use, it is time to take action
- Create a plan to make it happen:
- Outline what you need to do to put your choice into action.
- Follow up with any people whose help you will need to take action on your decision .
- How much time will you need for your choice?
- Think of barriers and make plans to manage them.
- Monitor your progress.
- Notify the people who need to know about your decision.
This module has presented a step wise process of evaluating all factors that are involved in making a decision, including evidence (finding it, as per Module Three) along with your personal objectives goals and beliefs.
- National Center for Complementary and Integrative Health. Acupuncture (opens in a new window)
- Manheimer E, Cheng K, Linde K, Lao L, Yoo J, Wieland S, van der Windt DAWM, Berman BM, Bouter LM. Acupuncture for peripheral joint osteoarthritis. Cochrane Database of Systematic 27 Reviews 2010, Issue 1. Art. No.: CD001977. DOI:10.1002/14651858.CD001977.pub2
- White A, Foster NE, Cummings M, Barlas P. Acupuncture treatment for chronic knee pain: asystematic review. Rheumatology. 2007;46(3):384-90.
- White AR. A cumulative review of the range and incidence of significant adverse events associated with acupuncture. Acupuncture in Medicine. 2004;22(3):122-133
- World Health Organization (WHO) Expert Committee on Specifications for Pharmaceutical Preparations - WHO Technical Report Series, No. 863, Annex 11 (Guidelines for the Assessment of Herbal Medicines) - Thirty-fourth Report (1996; 8 pages).
- Cameron M, Chrubasik S. Topical herbal therapies for treating osteoarthritis. Cochrane Database of Systematic Reviews 2013, Issue 5. Art. No.: CD010538. DOI: 10.1002/14651858. CD010538
- Dattner AM. Herbal and complementary medicine in dermatology. Dermatologic Clinics. 2004;22:325–332