We thank Dr. Dodes for his commentary on our review of CAM use for treating chronic facial pain, and Dr. Jeffcoat for this opportunity to respond. It appears that Dr. Dodes disagrees with two aspects of our conclusion that "acupuncture was at least comparable to other conservative dental treatment (for example, intraoral appliance and self-care instruction) and warranted further study."
First, he disputes the implication that acupuncture is conservative treatment, on the basis of its "potentially far greater risks." While needle acupuncture is more invasive than intraoral appliance or self-care instruction, with regard to potential risks and benefits of acupuncture, we refer the reader to the 1997 statement1 from the Acupuncture NIH Consensus Development Conference: "One of the advantages of acupuncture is that the incidence of adverse effects is substantially lower than that of many drugs or other accepted medical procedures used for the same conditions. As an example, musculoskeletal conditions, such as fibromyalgia, myofascial pain and tennis elbow, or epicondylitis, are conditions for which acupuncture may be beneficial.
"These painful conditions are often treated with, among other things, anti-inflammatory medications (aspirin, ibuprofen, etc.) or with steroid injections. Both medical interventions have a potential for deleterious side effects but are still widely used and are considered acceptable treatments. The evidence supporting these therapies is no better than that for acupuncture."
Dr. Dodes states that a more appropriate conclusion than the one we reached would be that acupuncture has not been shown to be an effective alternative to conventional, non-invasive temporomandibular disorder pain therapies. There are at least two ways to understand his statement.
One is that published studies conclusively demonstrate that acupuncture is not an effective alternative to conventional, non-invasive temporomandibular disorder pain therapies (that is, that the procedure is ineffective). We did not find this to be the case in our review of the literature.
The second suggests that we need more studies before we can make definitive statements regarding the effectiveness (or lack thereof) of acupuncture, and for whom it is effective, which is consistent with our conclusion that further research is warranted.
Dr. Dodes submits that the results for acupuncture, biofeedback and relaxation therapies were equivocal, pointing to the need for cost-benefit analysis. However, before pursuing cost-effectiveness or cost-benefit analyses, one is obliged to establish the effectiveness of a given therapy, whether it is CAM or convention.
Such economic analyses help us explicitly compare the costs and consequences of two or more interventions. Given the limited effectiveness data and the relative absence of cost data, economic evaluations of these interventions are premature.
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