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Letters
April 14, 1999

Acupuncture and Amitriptyline for HIV-Related Peripheral Neuropathic Pain

Author Affiliations
 

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(14):1270-1272. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-14-jac90002

To the Editor: From a scientific perspective, the trial by Dr Shlay and colleagues1 on the use of acupuncture and amitriptyline to treat peripheral neuropathy related to infection with the human immunodeficiency virus (HIV) is well executed and designed. Indeed, acupuncture may be of no value for pain due to this condition. Nonetheless, I do not believe that this trial presents credible evidence for this hypothesis. The problem is with the acupuncture component of the trial. The "active" standardized acupuncture regimen (SAR) is more suitable as a placebo treatment. The authors raise the issue of whether they chose the wrong "active points," but they reject this possibility because consensus on these points was reached by 8 acupuncturists. As a teacher of acupuncture and a practitioner who has treated patients with HIV neuropathy, I would never have even considered 2 of the 3 points (spleen 7 and 9) used in this experiment. I have consulted with experienced colleagues who agree that the active treatment makes no sense. More important, after checking both Chinese-2 and English-language3 acupuncture texts, I can find no source materials that these 2 points have a clear rationale or justification. (I suspect that the SAR combination of points belongs to an idiosyncratic family tradition of a particular practitioner and is generally unrecognized and unknown in the mainstream acupuncture corpus. And it should be remembered that acupuncture and Chinese medicine are a written medical tradition.) Is it possible that somehow the 8 acupuncturists were the wrong choice?

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