Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study)

Abstract

BackgroundMedically unexplained physical symptoms (MUPS) are common and difficult to treat. AimTo investigate the effectiveness of adding fiveelement acupuncture to usual care in 'frequent attenders' with MUPS. Design and settingRandomised controlled trial in four London general practices. MethodParticipants were 80 adults with MUPS, consulting GPs ≥8 times/year. The intervention was individualised five-element acupuncture, ≥12 sessions, immediately (acupuncture group) and after 26 weeks (control group). The primary outcome was 26-week Measure Yourself Medical Outcome Profile (MYMOP); secondary outcomes were wellbeing (W-BQ12), EQ-5D, and GP consultation rate. Intention-to-treat analysis was used, adjusting for baseline outcomes. ResultsParticipants (80% female, mean age 50 years, mixed ethnicity) had high health-resource use. Problems were 59% musculoskeletal; 65% >1 year duration. The 26-week questionnaire response rate was 89%. Compared to baseline, the mean 26-week MYMOP improved by 1.0 (95% confidence interval [CI] = 0.4 to 1.5) in the acupuncture group and 0.6 (95% CI = 0.3 to 0.9) in the control group (adjusted mean difference: acupuncture versus control -0.6 [95% CI = -1.1 to 0] P = 0.05). Other between-group adjusted mean differences were: W-BQ12 4.4 (95% CI = 1.6 to 7.2) P = 0.002; EQ-5D index 0.03 (95% CI = -0.11 to 0.16) P = 0.70; consultation rate ratio 0.90 (95% CI = 0.70 to 1.15) P = 0.4; and number of medications 0.56 (95% CI = 0.47 to 1.6) P = 0.28. All differences favoured the acupuncture group. Imputation for missing values reduced the MYMOP adjusted mean difference to -0.4 (95% CI = -0.9 to 0.1) P = 0.12. Improvements in MYMOP and W-BQ12 were maintained at 52 weeks. ConclusionThe addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months.

Traditional acupuncture for people with medically unexplained symptoms: a longitudinal qualitative study of patients’ experiences

“…[35][36][37] Consequently, a randomised trial was carried out with a nested qualitative study to investigate the effect of adding five-element acupuncture -a type of traditional acupuncture -to usual care for people who attend frequently with MUPS. The quantitative trial findings (published in this issue of the BJGP) 38 showed that a programme of 12 acupuncture sessions was acceptable and resulted in an improvement in wellbeing and individualised or health status, but no change in generic functional health or GP consultation rates.…”

“…38 The trial participants were adults, who were frequent attenders (eight or more consultations a year) with MUPS; they were were informed about the trial by participating London GPs. Participants were offered up to 12 individualised sessions of five-element acupuncture over a 6-month period, which was timed to meet their personal needs.…”

Methodological issues in pragmatic trials of complex interventions in primary care

“…Pragmatic trials, however, are more likely to test the complex intervention as it would normally be delivered in clinical practice (for example, Paterson et al 9 ). Blinding, or the masking of patients, practitioners, outcome assessors, and statisticians about the treatment to which an individual patient has been allocated is the traditional approach to try to prevent performance and ascertainment bias in trials.…”

Conventional and Complementary Approaches to Chronic Widespread Pain and Its Comorbidities

“…43 44 A trial investigating the effects of five-element acupuncture on patients with mainly chronic pain and 'medically unexplained symptoms' reported improvements in subjective wellbeing and, on some occasions, lifestyle changes of participants, but no change in healthcare utilisation or quality of life measures. 45 HOLDING WORK: CO-CREATING HEALTH OR FOSTERING DEPENDENCE?…”