Research: ERNST and PITTLER,

Listed in Issue 30

Abstract

ERNST and PITTLER, Department of Complementary Medicine, Postgraduate Medical School, University of Exeter, Exeter UK conducted a systematic review of the literature to assess the effectiveness of acupuncture for dental pain.

Background

Methodology

Computerised literature searches were performed of Medline, Embase, CISCOM and Cochrane Library databases additionally, experts were solicited to contribute their own published and unpublished material. All studies were evaluated and rated according to a standardised criteria with particular attention to the methodological quality (Jadad score) of the research performed.

Results

16 trials, mostly using acupuncture in a clinical situation, predominantly for pain relief during dental procedures, were assessed. The majority of these investigations suggested that acupuncture is more effective than control treatment only 4 trials implied the contrary. All the experimental studies were positive. Of the more recent 11 trials which were randomised, only 4 were negative. In 8 randomised trials, in which there was present some degree of blinding, only 1 was negative. In the 7 studies which were sham controlled in addition to being blinded and randomised, all but 1 were positive. In one of the studies with the highest Jadad score, with 40 volunteers receiving ear or sham acupuncture, the real acupuncture group experienced an 18% increase in their pain threshold to experimental pain. In another study with a high Jadad score, in which electroacupuncture or sham was used while drilling, a remarkable placebo-response of 100% of patients resulted, with no differences between the acupuncture and sham groups.

Conclusion

These data from these studies suggest that acupuncture is effective for pain relief for dental operations following surgery or during experimentally induced dental pain. The mechanisms for this may relate to the blocking afferent pathways, effects upon endogenous opioids and inhibitory effects upon efferent pathways. The methodological details and heterogeneity across this literature limits the conclusions which can be made. Further research should consider optimal acupuncture technique and acupunctures relative efficacy compared to conventional pain relief methods.

References

Ernst E and Pittler MH. The effectiveness of acupuncture in treating acute dental pain: a systematic review. British Dental Journal 184(9): 443-7. 9 May 1998.

Comment

It was not very long ago that certain respected authorities were disputing and even ridiculing the notions of acupuncture meridians and the clinical efficacy of acupuncture. Regular readers of this research section will be familiar with the considerable volume of research, mainly emanating from China, regarding the application of acupuncture for many important diseases, including stroke, hypertension, diabetes, emesis and pain relief. The mechanisms for acupunctures efficacy are being researched in earnest, so that before long, we may be understand why acupuncture works, which may help to convince extreme doubters who can not believe anything unless a rational explanation is advanced.

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