Jamie Gisby

Acupuncture is significantly superior to all controls for chronic pain

Acupuncture is significantly superior to all controls.

Controls and Trials

Researchers studying the effects of acupuncture want to assess the benefit of acupuncture against that of a control.  This is done to mitigate the effects of placebo – the tendency for people to get better when they are given any sort of treatment.

A secondary analysis of data from the Acupuncture Trialists’ Collaboration has shown that acupuncture is significantly superior to control, irrespective of the type of control used. Data came from a large individual patient data meta-analysis of acupuncture trials involving patients with headache and migraine, osteoarthritis and back, neck and shoulder pain. Twenty-nine trials met the inclusion criteria, 20 involving sham controls (n=5,230) and 18 non-sham controls (n=14,597).

In other words, the researchers went back to data from a large number of previous trials and pooled the results to get a good amount of data.  Several different sorts of chronic pain were included in the study.

Types of control

Controls were sham or non-sham.  A sham control is where the patients are treated with a pretend needle.  For example a non-penetrating sham needle is a telescopic needle that appears to penetrate the body.  Non-sham care is where acupuncture is compared to, for example, standard care.  Standard care could be drugs, physiotherapy or some other intervention.

Sham controls included non-needle sham, penetrating sham needles and non-penetrating sham needles. Non-sham controls consisted of non-specified routine care and protocol-guided care. The results showed that acupuncture was significantly superior to all categories of control group. For trials that used penetrating needles as sham control, acupuncture had smaller effect sizes than for trials with non-penetrating needles or with control without needles. In trials with non-sham controls, larger effect sizes were associated with acupuncture vs. non-specified routine care than vs. protocol-guided care.

Authors conclusions

The authors conclude that penetrating needles appear to elicit important physiological activity and recommend that this type of sham be avoided in acupuncture studies.This has been my view for many years.  Whilst acupuncture is most effective when performed at the classical acupuncture points, it will still have an effect when performed elsewhere.

(Influence of control group on effect size in trials of acupuncture for chronic pain: a secondary analysis of an individual patient data meta-analysis. PLoS One. 2014 Apr 4;9(4):e93739).

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