Acupuncture for Bell's Palsy and Risk of Bias
ACUPUNCTURE FOR BELL'S PARALYSIS AND THE RISK OF BIAS
ACUPUNCTURE FOR BELL'S PARALYSIS AND THE RISK OF BIAS
By Acupuncture Wu Wei Posted May 14, 2018 In Acupuncture
Bell's palsy
is a transient disorder of the facial nerve, which causes weakness or paralysis of the facial muscles and hinders such essential actions as closing the eye or eating. Symptoms appear suddenly, sometimes after a cold, and are varied due to the multiple functions of the facial nerve. Mainly they are weakness or paralysis on one side of the face, deviation of the mouth, drooping of an eyelid, dry eyes and / or mouth, excessive tearing, among others.
It is a disease that usually has a good prognosis: there are mild cases of this disease that do not need treatment and they resolve on their own in 2 weeks. Most improve gradually over 6 months. Medical treatment focuses on promoting recovery and minimizing complications, usually using drugs and physical therapy. Up to 30% of patients present mild to severe complications or sequelae: alterations in the production of tears and saliva, ulcers or eye infections, permanent deformation of the face.
The cause of this disease is still unknown to science: It is believed that it may be due to an inflammation of the nerve, which may be related to viral diseases. Its annual incidence is between 10 and 40 people out of 100,000. It affects more pregnant women, diabetics, hypothyroidism and the elderly.
From the point of view of Traditional Chinese Medicine, this pathology can be considered a Wei syndrome, or a Wind attack. One of the possible causes of Wei syndrome is the heat in the lung, which fits with the appearance of this disease after a flu or viral infection. And due to the characteristics of its sudden appearance and location on the face, it can be related to a Wind attack on the meridians (Zhong Jin Luo), in which a Yin deficiency may be involved that favors an ascent of Yang, wind and tan (phlegm), heat, among others.
And with acupuncture, can a person with Bell's palsy be helped? Let's see what the scientific evidence:
Study # 1
In 1996 this scientific study was carried out in Cuba, comparing drug treatment with acupuncture treatment in patients with Bell's palsy.
170 patients were studied. They were divided into 2 groups of 85 people: one received steroids and the other acupuncture. In both groups, facial massage and exercises were also indicated.
The highest number of cases with complications and adverse effects occurred in the group with steroids: 23 patients presented moderate and severe complications that implied the abandonment of treatment. In the acupuncture group, only 9 had complications, 8 of which were very mild and no one had to be removed from the study.
Of the group with steroids, 57.5% of the patients had a good recovery. And a poor recovery (symptoms do not change) 28.75%.
Of the group with acupuncture, 73.17% of the patients had a good recovery. Bad recovery: 12.19%.
Conclusions: in this study, acupuncture presents a better recovery and fewer complications than treatment with steroids.
Study # 2
In this other study, also carried out in Cuba and published in 1999, 80 patients between 15 and 65 years of age participated.
They used points 4 IG, 1 V, Tai Yang, 20 IG with manual stimulation every five minutes. 3 sessions per week of 20-30 minutes. Total of 20 sessions.
Of the 80 patients, 23 had received medical treatment before acupuncture. Of these, all improved and 16 had a complete recovery (69.6%).
55 patients only received acupuncture, without medical treatment. Of these, 53 presented a complete recovery (96.4%) and the remaining 2 improved.
They observed that the evolution of the patients was better the earlier acupuncture treatment was started.
Study # 3
In 2013, in Venezuela, this study was carried out on 60 patients.
They used points 4 E, 6 E, 1 V, 2 V, 17 TR on the affected side, 26 DM, 4 bilateral IG.
In patients with more than 15 days of illness, the following reinforcement points were applied: 24 MR, 14 BV and extraordinary points.
Each patient received 3 sessions of 20-30 minutes of acupuncture each week for a total of 10 sessions.
In the study, complete clinical recovery was achieved in 49 patients (81.66%). Incomplete recovery occurred in 11 patients (18.33%). 2 patients dropped out of the study before starting out of fear of acupuncture.
So far you can argue: they are small studies, 60 people, 170 people ... few participants can be considered. And they are studies varied among themselves in methodology, they do not even use the same acupuncture points. You are right. There are three studies that you can read in Spanish. It should also be taken into account that the fact that Bell's palsy is a transitory pathology that improves in many cases without treatment, may have to do with the fact that there is little research on it.
Analysis of 14 studies
In this link, if you understand English, you can read a review and analysis of 14 clinical trials on acupuncture treatment of Bell's palsy, conducted in China between 1996 and 2006 that have involved a total of 1541 participants.
This analysis concludes that current evidence is insufficient
to support that acupuncture is an effective therapy for Bell's palsy, as the studies that have been analyzed are heterogeneous and of poor quality.
Does this mean that acupuncture does not help Bell's palsy? No. It means that these studies that they have analyzed have risk of bias
unclear or loud.
Risk of bias is a concept that is used among others to assess the quality of a clinical study. Bias is defined as a systematic error or deviation from the truth that, if repeated a lot, can lead to underestimating or overestimating the results of a study. The risk of bias is assessed in several domains, for example, that the assignment of each participant to a study group is done randomly. In “double-blind” clinical trials of drugs, there is a low risk of bias when neither the participant receiving the treatment nor the investigator giving the treatment know whether the treatment they are giving is the one being studied or the control. When the treatment is acupuncture, it is clear that the patient realizes that they are doing acupuncture, and the acupuncturist who is practicing it also realizes it, so the performance bias is always going to give a high risk.
The studies are not homogeneous in design: the type of needles, the points selected, the number of sessions, the time of therapy, the puncture and manipulation techniques, whether electrostimulation is used or not, the degree of experience of the acupuncturist ... they are many variables that make it difficult to group and compare the results. The groups studied were small in participants. Control groups also vary: some used drugs, vitamin B, or compared different acupuncture treatments with each other. Studies also varied in how they measured results. And many had insufficient follow-up data on treatment outcomes or complications. For all these reasons, the analysts of these studies conclude that due to all these variables they cannot draw weighty conclusions. They recommend new, better-designed studies with larger patient samples and stricter protocols.
Controversy
There is some controversy from time to time as to whether acupuncture or other natural therapies really work or are a hoax. Its detractors mainly use as an argument the lack of scientific evidence about its effectiveness. There has recently been an article with a very unfortunate headline in the Country with the intention, in my opinion, quite clear to discredit acupuncture, using the conclusions of the analysis of the Cochrane Library.
Cochrane is an independent network of health researchers, practitioners, patients, caregivers, and people from more than 120 countries. If you search for 'acupuncture' in its database they appear to you today 10252 occurrences
of data on reports, analyzes and clinical trials with acupuncture. According to its own evaluation manual: “It is possible to conduct a study with the highest possible standards and still have a significant risk of bias. For example, in many situations it is neither practical nor possible to blind participants or study personnel to the intervention group. It is inappropriate and subjective to describe all these studies as 'poor quality', but it does not mean that they are free from the bias derived from knowledge of the state of the intervention ”.
The information is at our fingertips. Acupuncture is scientifically studied. How we evaluate the data depends a lot on the answer we want to find. And how far we want to go deeper. That the data are reviewed and high quality standards are requested in the studies is positive with a view to improving them in the future. But to imply that, because the studies done so far are small and at risk of bias, the conclusion is that acupuncture does not work, it seems to me not only a mistake, but a deception.
Remember that our treatment with Traditional Chinese Medicine does not replace in any case the treatment of your doctor
If you have any pathology and are interested in trying Traditional Chinese Medicine, we invite you to contact us for a visit in our center
If you want to learn how we do it, find out about our training courses at Chinese traditional medicine
and the Master of Advanced Acupuncture.
Article written by: Laura Pavón, collaborator of Acupuncture Wu Wei
Acupuncture, Scientific Studies, Bell's Palsy, Bias
