Acupuncture: evidence-based practice

This review article, published by researchers from the University of São Paulo School of Medicine, marks an important historical moment in the scientific recognition of acupuncture in Brazil. The authors present a comprehensive analysis of recent studies that demonstrate the efficacy of acupuncture in various clinical conditions, evidencing its transition from a practice considered alternative to a scientifically validated therapeutic modality. The historical context is fundamental to understanding the importance of this review. In 2000, the British Medical Association (BMA) officially recognized the efficacy of acupuncture for low back pain, dental pain, vomiting, and migraine, recommending its inclusion in the British public health system.

This institutional recognition paved the way for more rigorous research and greater acceptance of acupuncture in the international medical community. The review highlights four major studies that exemplify the growing quality of acupuncture research. The study by Vickers et al., a randomized controlled clinical trial involving 401 patients with chronic headache, demonstrated significant reductions in symptoms: the acupuncture group showed a 34% reduction in symptoms compared with 16% in the control group, with 22 fewer headache days and a 15% reduction in medication use. These results not only confirm the efficacy of acupuncture but also suggest important economic benefits for health systems.

The extensive study by Witt et al. on low back pain, involving 11,600 patients, used a sophisticated methodological design that included both randomized groups and an observational cohort. The results showed significantly greater functional improvement in the acupuncture group (74.5 vs. 65.1 points), with a favorable cost-effectiveness ratio of €10,526 per quality-adjusted life year.

This research is particularly relevant for its robust sample size and the inclusion of economic analyses. The application of acupuncture in arterial hypertension, investigated by Flachskampf et al. in 140 patients, represents an important expansion of the therapeutic scope of the technique. The study demonstrated clinically significant reductions in blood pressure: 6.4 mmHg in systolic and 3.7 mmHg in diastolic pressure in the true acupuncture group compared with placebo.

Although the effects were temporary, returning to baseline levels after 3 to 6 months, these findings suggest therapeutic potential for cardiovascular conditions. The meta-analysis by Manheimer et al. on in vitro fertilization, including 1,366 women from seven studies, revealed statistically significant improvements in pregnancy rates (OR 1.96), ongoing pregnancy (OR 1.87), and live births (OR 1.99). The number needed to treat of 9 to 10 patients indicates relevant clinical efficacy, suggesting that acupuncture can be a valuable adjunct in assisted reproduction treatments.

The clinical implications of this review are substantial. The authors convincingly argue that acupuncture is transitioning from the realm of complementary and alternative medicine to conventional medicine. This paradigm shift requires health professionals to become familiar with the new indications and evidence, expanding their understanding beyond traditional pain applications. The growth of academic interest is evidenced by the popularity of the optional acupuncture course at the FMUSP, which since 2002 has been one of the most sought-after at the university.

This phenomenon reflects a generational change in the perception of acupuncture among future physicians, who are being exposed to rigorous scientific evidence from their training. The main limitations of this review include its narrative nature, without systematic study selection criteria, and the focus on predominantly positive studies. In addition, some of the studies presented have their own methodological limitations, such as the difficulty of maintaining adequate blinding in acupuncture interventions and variability in treatment protocols. The heterogeneity of the conditions studied, although demonstrating the versatility of acupuncture, makes it difficult to draw generalizable conclusions about mechanisms of action or protocol standardization.

The future perspective outlined by the authors suggests a growing integration of acupuncture into conventional medicine, with important implications for medical education, professional regulation, and health policies. This process of scientific legitimization represents a model for other integrative practices seeking validation through rigorous evidence.