Acupuncture and Alexander technique gives superior neck pain relief. A critical look.

Recently The Malay Mail highlighted a study on acupuncture and the Alexander technique in alleviating neck pain. Article here.

It was based on the research reproduced in its abstract form below.

Alexander Technique Lessons or Acupuncture Sessions for Persons With Chronic Neck Pain: A Randomized Trial
Hugh MacPherson, BSc, PhD; Helen Tilbrook, BSc, MSc; Stewart Richmond, BSc, MSc, PhD; Julia Woodman, BSc, PhD; Kathleen Ballard, BSc, PhD; Karl Atkin, BA, DPhil; Martin Bland, BSc, PhD; Janet Eldred, BA, PhD; Holly Essex, MSc, PhD; Catherine Hewitt, BSc, MSc, PhD; Ann Hopton, RGN, BSc, MSc; Ada Keding, BSc, MSc; Harriet Lansdown, MSc; Steve Parrott, BSc, MSc; David Torgerson, MSc, PhD; Aniela Wenham, PhD; and Ian Watt, BSc, MB, ChB, MPH
Ann Intern Med. 2015;163(9):653-662. doi:10.7326/M15-0667 Text Size: A A A

Background: Management of chronic neck pain may benefit from additional active self-care–oriented approaches.

Objective: To evaluate clinical effectiveness of Alexander Technique lessons or acupuncture versus usual care for persons with chronic, nonspecific neck pain.

Design: Three-group randomized, controlled trial. (Current Controlled Trials: ISRCTN15186354)

Setting: U.K. primary care.

Participants: Persons with neck pain lasting at least 3 months, a score of at least 28% on the Northwick Park Questionnaire (NPQ) for neck pain and associated disability, and no serious underlying pathology.

Intervention: 12 acupuncture sessions or 20 one-to-one Alexander lessons (both 600 minutes total) plus usual care versus usual care alone.

Measurements: NPQ score (primary outcome) at 0, 3, 6, and 12 months (primary end point) and Chronic Pain Self-Efficacy Scale score, quality of life, and adverse events (secondary outcomes).

Results: 517 patients were recruited, and the median duration of neck pain was 6 years. Mean attendance was 10 acupuncture sessions and 14 Alexander lessons. Between-group reductions in NPQ score at 12 months versus usual care were 3.92 percentage points for acupuncture (95% CI, 0.97 to 6.87 percentage points) (P = 0.009) and 3.79 percentage points for Alexander lessons (CI, 0.91 to 6.66 percentage points) (P = 0.010). The 12-month reductions in NPQ score from baseline were 32% for acupuncture and 31% for Alexander lessons. Participant self-efficacy improved for both interventions versus usual care at 6 months (P < 0.001) and was significantly associated (P < 0.001) with 12-month NPQ score reductions (acupuncture, 3.34 percentage points [CI, 2.31 to 4.38 percentage points]; Alexander lessons, 3.33 percentage points [CI, 2.22 to 4.44 percentage points]). No reported serious adverse events were considered probably or definitely related to either intervention. Limitation: Practitioners belonged to the 2 main U.K.-based professional associations, which may limit generalizability of the findings. Conclusion: Acupuncture sessions and Alexander Technique lessons both led to significant reductions in neck pain and associated disability compared with usual care at 12 months. Enhanced self-efficacy may partially explain why longer-term benefits were sustained. Primary Funding Source: Arthritis Research UK.

At the outset, there seems to be a clear statistically significant advantage for acupuncture and the Alexander technique.

A few weaknesses here.

1. As pointed out several of the researchers were actually members of the British Acupuncture Society, notably, the lead author Dr MacPherson. Others appeared to be linked to the Society of Teachers of the Alexander Technique.

2. This was not a blinded study. Thus patients and the “interventionists” knew which arm the patients were in. This can lead to significant biases.

3. Usual care alone was not clearly demarcated in this abstract. Apart from pharmacotherapy, there are other interventions e.g. heat therapy and physiotherapy exercises ,which are sometimes incorporated into usual standard of care. So how usual was ‘usual’? We all know that the more one does for a patient, regardless of technique results in perceived better outcomes. So received 600 minutes of extra attention can make a significant difference.