I have wanted to post a commentary ever since I’ve been seeing ads in the Ann Arbor Observer advertising acupuncture for pets by non-veterinarians. Recently, AnnArbor.com has hosted a couple pieces on acupuncture for pets including one from Lorrie Shaw and Dr. Taryn Clark and Dr. Jessica Franklin, two local veterinarians. The piece by Dr. Clark and Dr. Franklin will do nicely for deconstruction and a game of name that logical fallacy.
Acupuncture has been practiced for a long time — estimates range from 3,500-5,000 years, with written records dating to the second century B.C., though its origins are unclear.
The obvious reason for such a statement is to make the implication that since it’s been around for so long, it must therefore also be effective (logical fallacy: appeal to antiquity). However, longevity doesn’t argue for efficacy, otherwise everyone would likely agree that astrology can determine a person’s destiny based the position of celestial bodies; astrology has been practiced for many more years than acupuncture.
Despite ancient sources showing acupuncture being applied to animals, it has only started to catch on in modern veterinary medicine in the last few decades.
Obviously, proponents of complementary and alternative medicine (CAM) want their ideas to be viewed as being widely used and accepted. Even though the popularity of an idea does not reliably indicate how whether or not the idea is true (logical fallacy: Argumentum ad populum), it is natural to think there is at least some truth to it if a lot of people believe in it. Despite the historical claim that veterinary acupuncture has been around for a long time, more than likely, it’s not what you think.
Whether the explanation for its effect comes from contemporary medicine (it stimulates nerves and releases endorphins) or traditional Chinese (it restores the flow of Qi through the area), the purpose of acupuncture is to relieve pain and stimulate the healing process.
Here’s an instance of ‘you can’t have it both ways’ (logical fallacy: inconsistency fallacy). Acupuncture is based on pre-scientific concepts of a vitalistic entity (Qi) and of meridians and acupuncture points unknown to anatomists. More scientific explanations have been offered as to how it might work, including a counterirritant effect or the gate control theory of pain. There is evidence that acupuncture can stimulate endogenous endorphin production, but there is evidence that placebo pills can do that as well. Acupuncture has been studied for decades but the results are inconsistent. If a treatment is truly effective, studies tend to produce more convincing results as time passes and the weight of evidence accumulates. In fact, taken as a whole, the published (and scientifically rigorous) evidence leads to the conclusion that acupuncture is no more effective than placebo.
Benefits include: Drug-free; Surgery-free; Immediate results
Applications for acupuncture include: Treatment of arthritis, degenerative joint disease, or hip dysplasia; General pain management; Post-surgery pain; Cancer chemotherapy/radiation support; Immune support; Treatment of nerve dysfunction
There is good evidence that the therapeutic ritual of acupuncture has some symptomatic benefit for such indications, at least in humans. This is almost certainly a non-specific treatment effect (aka “placebo”). It does not seem to matter where needles are inserted or if they are inserted at all, and acupuncture therapy does not appear to measurably affect the course of any actual disease. (The Skeptic’s Dictionary has a clear and concise review). The term ‘support’ used above does not even having any useful meaning. Immune support… it sounds like the immune system is sagging against gravity due to age and needs a lift.
Acupuncture can be administered at any time and is frequently tried after other types of treatments, such as non-steroidal anti-inflammatory drugs (NSAIDs), have failed to produce the desired results or have undesirable side effects. In cases of degenerative nerve disease, it actually works better than drugs because it stimulates nerve function.
Acupuncture has been studies extensively in humans and it seems that the ritual of acupuncture is what provides the perception of pain reduction. In animals, there is no reliable, high-quality research evidence for the benefits of acupuncture. The studies that have been done have found both positive and negative results, but the poor quality and lack of replication make the existing evidence insufficient to recommend acupuncture therapy. And what does ‘stimulate nerve function’ mean? I can poke someone in the arm with a pencil and that person should be happy since I just stimulated their nerve function.
Electroacupuncture, a variation on traditional acupuncture, also involves needles being inserted at specific locations. The difference is that an electric pulse is applied, through two needles at a time, in sessions typically lasting 20 minutes.
Electroacupuncture has been referred to as a bait-and-switch, because it is arguably not acupuncture at all. Obviously, the ancient Chinese lacked electricity, so the theories and guidelines developed for acupuncture in humans are not really relevant to the effects of electricity on the body.
An informative study was published in the Journal of the American Veterinary Medical Association (JAVMA) on June 1, 2010, about intervertebral disk disease (IVDD) — a common though difficult and painful disease we see in dogs — and the use of electroacupuncture to treat it. The study showed a significantly higher success rate for dogs who underwent electroacupuncture than for dogs that received decompressive surgery.
Electroacupuncture alone saw success in 15 of 19
Decompressive surgery saw success in 4 of 10
Surgery followed by acupuncture saw success in 8 of 11
Here’s a closer look at this study. To sum it up, there were major methodological problems (no blinding, no subjective way to characterize and compare the quality of treatments, small study size). Although it is possible that electrical stimulation can have some effect on various parts of a dog, much better designed studies would be necessary to legitimately claim the same conclusions as this paper did.
A case study from Ann Arbor Animal Hospital
We have seen a lot of wonderful old pets who are generally healthy but in pain, like Maggie, a 15-year-old cat.
Maggie, my beloved 15 year old feline has had a relatively healthy life. But when she started having problems, even though I suspected they were part of the aging process, I became alarmed. Last winter, I noticed Maggie was limping, which was followed by her inability to groom herself in the meticulous way she always had. Then as time went on, I noticed she had stopped playing and going up and down the stairs was becoming difficult for her. Then, it seemed that I could not even pick her up without her flinching from pain and crying when I put pressure on her lower spine.
Presenting these problems to Maggie’s veterinarian, Dr. Jess Franklin, Maggie was eventually given a diagnosis of arthritis. I knew Dr. Franklin was also an animal acupuncturist, so I asked her if she thought acupuncture would help and could she do it for her. She said the Ann Arbor Animal Hospital has had good outcomes with other animals and she would certainly try to help Maggie.
After weeks of acupuncture sessions combined with Dasuquin (a Glucosamine for cats), my Maggie is back to her near meticulous grooming and she no longer cries when I pick her up. She is moving a bit slower and she still has a slight limp, but Maggie is back to being the queen of the household and she won’t let anyone forget it!
Maggie is a great example of how well acupuncture and natural products can be integrated into the care of our animals. Maggie also takes Amlodipine for high blood pressure; Standard Process Renal Support, a whole food supplement; and uses Hill’s Prescription K/D for ongoing kidney disease.
Case studies are among the lowest forms of evidence and rank just above anecdotal evidence. I would venture to say that the above example is anecdotal evidence. Basically, it does not prove acupuncture was the treatment that worked for Maggie and it should be pointed out that acupuncture was not the sole treatment used. In fact, Dasuquin is marketed as a treatment for joint pain like arthritis in both dogs and cats.
Around 85% of our acupuncture patients are older dogs with musculoskeletal ailments. Some signs that your dog is experiencing pain that acupuncture may be able to assuage:
Abnormal sitting or lying posture; Restlessness; Whining, groaning or other vocalizing; Limping, unable to get up or lie down; Difficulty getting into car or down stairs; Lack of grooming; Won’t wag tail; Licking or biting area; Lack of appetite; Trembling
Obviously, if something appears off with your pet, see the vet, but the evidence that acupuncture works in humans, let alone, animals, is questionable at best. Personally, I’ve been looking for a vet that’s a little closer since I moved a few months ago to Ann Arbor. Ann Arbor Animal Hospital has been crossed off my list permanently.