For example the following study (From Medline!)

Lu W, Matulonis UA, Doherty-Gilman A, Lee H, Dean-Clower E, Rosulek A, Gibson C, Goodman A, Davis RB, Buring JE, Wayne PM, Rosenthal DS, Penson RT.

Leonard P. Zakim Center for Integrative Therapies, Dana-Farber Cancer Institute, 44 Binney Street, Boston, MA 02115, USA. Weidong_lu@dfci.harvard.edu

OBJECTIVES: The objective of this study was to investigate the effect of acupuncture administered during myelosuppressive chemotherapy on white blood cell (WBC) count and absolute neutrophil count (ANC) in patients with ovarian cancer. DESIGN: This study is a pilot, randomized, sham-controlled clinical trial. Patients received active acupuncture versus sham acupuncture while undergoing chemotherapy. A standardized acupuncture protocol was employed with manual and electrostimulation. The frequency of treatment was 2-3 times per week for a total of 10 sessions, starting 1 week before the second cycle of chemotherapy. SETTING: The setting was two outpatient academic centers for patients with cancer. SUBJECTS: Twenty-one (21) newly diagnosed and recurrent ovarian cancer patients were the subjects. OUTCOME MEASURES: WBC count, ANC, and plasma granulocyte colony-stimulating factor (G-CSF ) were assessed weekly. RESULTS: The median leukocyte value in the acupuncture arm at the first day of the third cycle of chemotherapy was significantly higher than in the control arm after adjusting for baseline value (8600 cells/microL, range: 4800-12,000 versus 4400 cell/microL, range: 2300-10,000) (p = 0.046). The incidence of grade 2-4 leukopenia was less in the acupuncture arm than in the sham arm (30% versus 90%; p = 0.02). However, the median leukocyte nadir, neutrophil nadir, and recovering ANC were all higher but not statistically significantly different (p = 0.116-0.16), after adjusting for baseline differences. There were no statistically significant differences in plasma G-CSF between the two groups. CONCLUSIONS: We observed clinically relevant trends of higher WBC values during one cycle of chemotherapy in patients with ovarian cancer, which suggests a potential myeloprotective effect of acupuncture. A larger trial is warranted to more definitively determine the efficacy of acupuncture on clinically important outcomes of chemotherapy-induced neutropenia.

The report says that NICE are saying that “anyone whose [back] pain persists for more than six weeks and up to a year should be given a choice of several treatments, because the evidence about which works best is uncertain.” I love he last bit!

Story here: http://www.guardian.co.uk/society/2009/may/24/back-pain-sufferers-acupuncture-nhs

Interestingly, The Guardian/Observer’s website had a story, on 12 May only, to the effect that simulated acupuncture using toothpicks pressed against skin was just as effective as “real” acupuncture:
http://www.guardian.co.uk/lifeandstyle/besttreatments/2009/may/12/acupuncture-needles-can-improve-back-pain-and-so-can-toothpicks

This appears to be based on a different BMJ paper than the 2006 one that Ben discusses above, but evidently with the same results. I wonder what NICE will have to say about this (if, indeed, The Observer report is accurate, not something I’d bet the farm on, given that paper’s previous form).

Now that we have got that out of the way, let me explain my place in this circus. I am a physiotherapist with a particular interest in Low Back Pain (co-author of ‘The Management of Low Back Pain in Primary Care’ ISBN 0 7506 4787 6 – now out of print, but available in many medical libraries).

IMHO, physiotherapy is simply about motivating patients to follow the best available guidelines and advice on self care. It’s that simple.

However many physiotherapists have spent a great deal of time and money learning quasi-medical treatments and thus have a vested interest in making treatment care complicated and full of gobbledygook.

The good news is that this way of thinking is thankfully changing, albeit slowly.

I don’t know if they are doing a formal analysis of the effectiveness, but they certainly could.

And I note that there is no evidence being presented here that acupuncture has helped these arthritic monkeys – so I don’t know what the talk of cortisol has to do with anything.

http://www.todaysthv.com/news/news.aspx?storyid=53832

Now you may argue that that wasn’t what you said, but that’s certainly what a lot of people will have heard.

Then you use the word “psychosocial”, which most people, even clever Radio 4 listeners, won’t have heard, but they will know the word “psychosomatic” and they might conclude that this is just a euphemistic way of saying the same thing.

The examples of risk factors and interventions you gave may have sounded clear to you, but less so for the layperson. Take the advice to be active, instead of resting – this doesn’t sound like a social intervention, or a psychological one. It sounds like a physical intervention.

Citing depression as a risk factor, on the other hand, sounds like another way of saying “Depressed people are more likely to imagine they have back pain.”

Thus you end up with a whole bunch of confused listeners. Which is probably why you need a half hour programme to explain this stuff, not two minutes on the PM programme.

Ben – I don’t think you can really blame people for being confused about the difference between psychosocial and psychosomatic. The Concise Oxford Dictionary (8th edition) has these definitions:

psychosocial: of or involving the influence of social factors or human interactive behaviour.

psychosomatic: 1 (of an illness, etc.) caused by or aggravated by mental conflict, stress, etc. 2 of the mind and body together.

Now, Table 1 in the BMJ paper you cited lists the following risk factors as “psychosocial”:
Stress; anxiety; negative mood or emotions; poor cognitive functioning; pain behaviour.

Number 1 in this list of “psychosocial” risk factors is “stress”, which is specifically mentioned in the Oxford dictionary’s definition of “psychosomatic”: according to this definition, an illness that is caused by or aggravated by stress is “psychosomatic”. I realise that there may be subtle differences between a “risk factor” and a “cause” or “aggravating factor”, but I don’t think you could blame anyone for thinking that the terms “psychosocial” and “psychosomatic” are virtually synonymous.

Perhaps medical professionals like yourself use a different definition of “psychosomatic” from that used in everyday language typified by the Oxford Dictionary definition (like the way “significant” has a precise meaning to statisticians which can be at odds with the definition used in ordinary language)?

It would be really helpful if you could explain how your definition of “psychosomatic” differs from “psychosocial”.

psychosocial: of or involving the influence of social factors or human interactive behaviour.

psychosomatic: 1 (of an illness, etc.) caused by or aggravated by mental conflict, stress, etc. 2 of the mind and body together.

Now, Table 1 in the BMJ paper you cited lists the following risk factors as “psychosocial”:
Stress; anxiety; negative mood or emotions; poor cognitive functioning; pain behaviour.

Number 1 in this list of “psychosocial” risk factors is “stress”, which is specifically mentioned in the Oxford dictionary’s definition of “psychosomatic”: according to this definition, an illness that is caused by or aggravated by stress is “psychosomatic”. I realise that there may be subtle differences between a “risk factor” and a “cause” or “aggravating factor”, but I don’t think you could blame anyone for thinking that the terms “psychosocial” and “psychosomatic” are virtually synonymous.

Perhaps medical professionals like yourself use a different definition of “psychosomatic” from that used in everyday language typified by the Oxford Dictionary definition (like the way “significant” has a precise meaning to statisticians which can be at odds with the definition used in ordinary language)?

It would be really helpful if you could explain how your definition of “psychosomatic” differs from “psychosocial”.