What is GERAC?
Since its introduction to the Western world, acupuncture has been a source of controversy and debate in medical circles. This has largely been a result of some of the theories upon which the practice was based and developed, and on the complications presented by acupuncture during attempts to scientifically investigate the efficacy of the treatment.
In light of these various factors, GERAC was organised and eventually conducted. GERAC stands for German Acupuncture Trials, and refers to a large scale study performed to investigate the effects of acupuncture as a treatment for a variety of different maladies.
What were the German Acupuncture Trials?
GERAC was initiated as a result of a growing need to understand acupuncture’s roles in treating a variety of different conditions. Acupuncture is a treatment with ancient origins, and many aspects of its practice have struggled in the Western world where many practitioners have attempted to re-interpret the practice in light of our understanding of the body’s workings.
The trials were funded by six different German health insurance companies, and the purpose was to determine whether acupuncture was a viable treatment for a number of common conditions. GERAC investigated acupunctural treatments for osteoarthritis in the knee, lower back pain, tension headaches, and as a preventative measure for migraine sufferers. Part of these trials was an investigation into the adverse effects of acupuncture.
GERAC was a very large scale series of trials involving several thousand patients who were involved in randomised trials. Patients being treated for each of the four conditions investigated by the trial were split into 3 groups, a control group receiving fake (sham) acupuncture, a treatment group receiving real acupuncture, and a group receiving conventional treatment for the condition in question. This accounted for the possibility that acupuncture’s effects were due to the placebo effect, and gave a point of comparison between acupuncture and conventional methods of treatment.
Acupuncturists involved in the trial were all medical doctors with a qualification in acupuncture and a minimum of two years’ experience in acupuncture was necessary as well. The sham control group received needles that were shallowly inserted at random points on the body, and once needles were within the skin there was no manipulation as there would be with standard acupunctural practice.
After treatment the effectiveness of the procedure was assessed through interviews performed by ‘blinded’ researchers. This means that the researchers in question were not aware of whether a patient received sham or real acupuncture.
What were the results of GERAC?
GERAC revealed a number of interesting results that were considered reliable because of the quality of the study design and the number of people involved.
In assessments of acupuncture’s efficacy in the treatment of lower back pain, 1267 sufferers were studied and the effectiveness of the therapy was evaluated through a number of questionnaire’s assessing pain and functionality. The results showed that both sham and true acupuncture were more effective than standard treatment with physical therapy and drugs, however there was no significant difference between the control and treatment group.
1039 people were assessed in the trial investigating the effects of knee osteoarthritis on patients, and in this investigation similar results were found. Acupuncture and sham acupuncture were not significantly different from one another, but the difference between both these groups and traditional therapy (medication) was considerable.
In the migraine trial a large number of patients withdrew from the study reducing the number of people involved to about 840. In this set there was no significant difference between any of the groups according to reports from patients. The trial investigating tension headaches was much smaller with only 409 patients, and these reported no significant difference between the sham and real acupuncture groups.
Finally the investigation into the adverse effects of acupuncture assessed about 2.6 million people who received acupunctural treatment between 2001 and 2005. From these 190,924 were randomly chosen for the study, and it was found that about 7.5% of these reported some manner of adverse effect after treatment. In most cases these effects were minor, however, 45 cases from those investigated reported more serious side effects. The most common side effects of treatment were minor bruising at needle insertion sites, a temporary worsening of the condition being treated, and vasovagal episodes.
Consequences of GERAC
GERAC showed that large scale research into acupuncture and its effects could be performed to determine the therapy’s effectiveness in treating a variety of different conditions. After the publication of these results, the insurance companies funding the research revised their position on acupuncture as a service covered by statutory health insurance in Germany. As such, this system now include acupuncture for the treatment of lower back pain and knee pain caused by osteoarthritis.
GERAC is a good example of the large scale studies needed to better understand acupuncture and its effects. Other large scale investigations are now underway, and in the years to come our understanding of acupuncture’s usefulness will undoubtedly be improved.
GERAC is one of a number of investigations which have also caused NICE, the UK’s National institute for Clinical Excellence, to include acupuncture as a recommended method of treating back pain here in the UK.
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