Building an Evidence Base: Clinical Research Progress
“Our goal is to build a house of evidence,” explains long-time NCCAM grantee Brian Berman, M.D., director of the Center for Integrative Medicine at the University of Maryland School of Medicine.
To date, much of the progress in clinical research on acupuncture has come from an interdisciplinary approach that includes experts in acupuncture, clinical trial methodology, biostatistics, and relevant diseases such as osteoarthritis or carpal tunnel syndrome.
“What we’ve learned so far is that the most promising area for using acupuncture is pain,” says Dr. Nahin. Clinical studies are showing acupuncture’s efficacy for some types of pain, such as back, osteoarthritis, and postoperative pain. For example, a systematic review supports the use of acupuncture for postoperative pain management. An NCCAM-supported Phase III clinical trial led by Dr. Berman showed that acupuncture relieved pain and improved function in patients with knee osteoarthritis when it was used with standard medical care, including anti-inflammatory medications and opioid pain relievers. In a large study published in 2009, researchers found that people suffering from chronic low-back pain who received acupuncture or simulated acupuncture treatments fared better than those receiving only conventional care. Pilot studies have looked at acupuncture in posttraumatic stress disorder and chemotherapy-induced nausea and vomiting. And, the Cochrane Collaboration reviewed 11 randomized trials and found that acupuncture may be a valuable option for patients suffering from tension headaches.
But these clinical outcomes may involve more than acupoints and needles. Other aspects of the acupuncture experience may play important roles in healing, including reassurance provided by the practitioner, expectation of benefit, and the sensory experience elicited by acupuncture needling, which has been called de qi and variously described as aching, dull pain, tingling, or a heaviness. In several recent studies researchers have carefully designed their studies to compare true acupuncture to simulated acupuncture and have tried to mimic the sensory experience of true acupuncture so that patients would be unaware of whether they were receiving true or simulated acupuncture. In some of these studies, such as the 2009 study on low-back pain, both simulated acupuncture and real acupuncture produced greater benefit than standard therapy.

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NationalNCCAM, National Institutes of Health
Bethesda, Maryland 20892 USA

Key Points

• Federal regulations for dietary supplements are very different from those for prescription and over-the-counter drugs. For example, a dietary supplement manufacturer does not have to prove a product’s safety and effectiveness before it is marketed.
• If you are thinking about using a dietary supplement, first get information on it from reliable sources. Keep in mind that dietary supplements may interact with medications or other dietary supplements and may contain ingredients not listed on the label.
• Tell your health care providers about any complementary and alternative practices you use, including dietary supplements. Give them a full picture of what you do to manage your health. This will help ensure coordinated and safe care.

About Dietary Supplements

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Dietary supplements were defined in a law passed by Congress in 1994 called the Dietary Supplement Health and Education Act (DSHEA). According to DSHEA, a dietary supplement is a product that:

• Is intended to supplement the diet
• Contains one or more dietary ingredients (including vitamins, minerals, herbs or other botanicals, amino acids, and certain other substances) or their constituents
• Is intended to be taken by mouth, in forms such as tablet, capsule, powder, softgel, gelcap, or liquid
• Is labeled as being a dietary supplement.

Herbal supplements are one type of dietary supplement. An herb is a plant or plant part (such as leaves, flowers, or seeds) that is used for its flavor, scent, and/or therapeutic properties. “Botanical” is often used as a synonym for “herb.” An herbal supplement may contain a single herb or mixtures of herbs.

Research has shown that some uses of dietary supplements are effective in preventing or treating diseases. For example, scientists have found that folic acid (a vitamin) prevents certain birth defects, and a regimen of vitamins and zinc can slow the progression of the age- related eye disease macular degeneration. Also, calcium and vitamin D supplements can be helpful in preventing and treating bone loss and osteoporosis (thinning of bone tissue).

Research has also produced some promising results suggesting that other dietary supplements may be helpful for other health conditions (e.g., omega-3 fatty acids for coronary disease), but in most cases, additional research is needed before firm conclusions can be drawn.

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