By David Kiefer, MD
Clinical Assistant Professor, Department of Family Medicine, University of Wisconsin; Clinical Assistant Professor of Medicine, Arizona Center for Integrative Medicine, University of Arizona, Tucson
Dr. Kiefer reports no financial relationships relevant to this field of study.
- This was a randomized, controlled trial examining acupuncture’s effect on the perception of stress by 112 people with high amounts of baseline stress who worked at or attended a large university. The verum acupuncture group fared better than the sham acupuncture group.
SYNOPSIS: A verum acupuncture group led to a greater reduction in the perception of stress when compared to a sham acupuncture group.
SOURCE: Schroeder S, Burnis J, Denton A, et al. Effectiveness of acupuncture therapy on stress in a large urban college population. J Acupunct Meridian Stud 2017;10:165-170.
Stress seems to be both ubiquitous and tied pathophysiologically to many health conditions. For some people, it can be difficult to treat, leading those to turn to integrative therapies for relief. Various modalities have shown some efficacy in stress management, including mind-body techniques like mindfulness meditation and tried-and-true approaches such as exercise. The authors of this clinical trial studied acupuncture for its effects on stress and stress management.
In this study, 112 college faculty, students, or staff were randomized to receive either verum (true) acupuncture or sham acupuncture once weekly (a 30-minute session) for 12 weeks. The participants described themselves as being stressed and also were interested in acupuncture. Inclusion criteria included age at least 18 years, no prior experience with acupuncture, and a score of at least 16 on the Cohen’s global measure of perceived stress. The stress scale includes 14 questions about stress that are rated 0 (for “never”) to 4 (for “very often”). Exclusion criteria, in addition to age and Cohen scores outside of above, were pregnancy or inability to give consent. The verum acupuncture used eight points, and four auricular (ear) points, the same for each participant in that arm of the study. The sham group received three needles placed in an area distant from known acupuncture points and meridians (the channels through which acupuncture is thought to work).
The Cohen score was measured at baseline, six weeks, and 12 weeks (the end of the study), and six and 12 weeks post-study completion. Of the 112 study participants, 21 never started the study and 28 withdrew before completion. Of the 62 remaining, it is unclear whether intention-to-treat analysis was done. Interestingly, more participants completed the verum arm (n = 36) than the sham arm (n = 26). The statistical methods used were a mixed-model approach to analyze fixed and random effect from such variables as the treatment and time, as well as a Wilcoxon signed-rank test. The Cohen score changes, and corresponding P values are detailed in Table 1.
The authors noted that the low numbers of study participants created a situation of potential type II error, or false-negative results, and that the high dropout rate also potentially compromised study results. Furthermore, P values and the reporting of statistics was not consistent, prohibiting a close read of the results. Despite these methodological flaws, a few interesting conclusions can be drawn. First, at baseline, this population had high stress levels. Second, even with one 30-minute treatment weekly, the stress levels in both groups dropped markedly. The authors asserted that a more typical twice-weekly treatment would have even further benefited the study participants. Only further research can corroborate that. Third, there are lingering positive effects from acupuncture, beyond the study completion, and more so for the verum acupuncture group. Other acupuncture research has demonstrated similar “long-lasting” effects, a very interesting positive effect, unlike many allopathic treatments that tend to cease in their activity when the therapy is removed.
This study needs to be repeated, and adverse effects mentioned to best determine the risks and benefits for this population. But, for now, this is a hint of significant benefit for a minimal, and likely safe, intervention addressing the epidemic of stress in our society.