Key study points:
1. Acupuncture provides a statistically significant and clinically relevant benefit for chronic pain relief over usual medical care.
2. The benefit of acupuncture is mediated by both specific and placebo effects.
Primer: There have been many RCTs and meta-analyses aimed at determining if acupuncture provides a specific benefit for pain relief, or whether it is merely a placebo effect.
This [meta-analysis]: The authors identified 31 high-quality RCTs of acupuncture for four chronic pain conditions: back and neck pain, osteoarthritis, chronic headache and shoulder pain. One of the key eligibility criteria for studies was that there be adequate allocation concealment to prevent bias. They analyzed the raw data from 29 of the eligible studies, representing individual data from 17,922 patients.
Acupuncture produced a statistically significant reduction in pain scores for all comparisons. Compared to usual medical care, patients receiving acupuncture had pain scores that were lower by 0.55 (95% CI 0.51-0.58), 0.57 (95% CI 0.50 – 0.64) and 0.42 (95% CI 0.37-0.46) SDs for back and neck pain, osteoarthritis and chronic headache respectively. The effect sizes were smaller for acupuncture vs. sham acupuncture: here acupuncture pain scores were lower than sham acupuncture pain scores by 0.23 (95% CI, 0.13-0.33), 0.16 (95% CI, 0.07-0.25), and 0.15 (95% CI, 0.07-0.24) SDs for the same four conditions.
In sum: Acupuncture produces pain scores that are modestly but significantly lower than those with usual medical care. The meta-analysis of studies comparing acupuncture to sham acupuncture shows that acupuncture does have a specific effect on pain. However, this effect is smaller than the effect observed in the aforementioned meta-analysis of studies comparing acupuncture to usual medical care. This suggests that some of the benefit associated with acupuncture is derived from a placebo effect. The authors allude to the interesting question of whether there may be a place for placebo effects in the clinic, if patients do derive benefit from them.
Written by T.J. and M.P.
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