Is acupuncture effective if the needle is inserted anywhere along the involved segment or motor points for specific disorders?
Background
The results of many clinical trials and experimental studies regarding acupoint specificity are contradictory. This review aims to investigate whether a difference in efficacy exists between ordinary acupuncture on specific acupoints and sham acupuncture controls on non-acupoints or on irrelevant acupoints.
Methods
Databases including Medline, Embase, AMED and Chinese Biomedical Database were searched to identify randomized controlled trials published between 1998 and 2009 that compared traditional body acupuncture on acupoints with sham acupuncture controls on irrelevant acupoints or non-acupoints with the same needling depth. The Cochrane Collaboration’s tool for assessing risk of bias was employed to address the quality of the included trials.
Results
Twelve acupuncture clinical trials with sham acupuncture controls were identified and included in the review. The conditions treated varied. Half of the included trials had positive results on the primary outcomes and demonstrated acupoint specificity. However, among those six trials (total sample size: 985) with low risk of bias, five trials (sample size: 940) showed no statistically significant difference between proper and sham acupuncture treatments.
Conclusion
This review did not demonstrate the existence of acupoint specificity. Further clinical trials with larger sample sizes, optimal acupuncture treatment protocols and appropriate sham acupuncture controls are required to resolve this important issue.
Are acupoints specific for diseases? A systematic review of the randomized controlled trials with sham acupuncture controls.
Zhang H, Bian Z, Lin Z.
Chin Med. 2010 Jan 12;5:1. Open Access article.
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Review Article
Acupoints, Sham Acupuncture
A placebo is a sham medical intervention.
Placebo-control of acupuncture is used to evaluate and distinguish between the specific effects and the non-specific ones. During ‘true’ acupuncture treatment in general, the needles are inserted into acupoints and stimulated until deqi is evoked. In contrast, during placebo acupuncture, the needles are inserted into non-acupoints and/or superficially (so-called minimal acupuncture).
A sham acupuncture needle with a blunt tip may be used in placebo acupuncture. Both minimal acupuncture and the placebo acupuncture with the sham acupuncture needle touching the skin would evoke activity in cutaneous afferent nerves. This afferent nerve activity has pronounced effects on the functional connectivity in the brain resulting in a ‘limbic touch response’. Clinical studies showed that both acupuncture and minimal acupuncture procedures induced significant alleviation of migraine and that both procedures were equally effective. In other conditions such as low back pain and knee osteoarthritis, acupuncture was found to be more potent than minimal acupuncture and conventional non-acupuncture treatment. It is probable that the responses to ‘true’ acupuncture and minimal acupuncture are dependent on the aetiology of the pain. Furthermore, patients and healthy individuals may have different responses. In this paper, we argue that minimal acupuncture is not valid as an inert placebo-control despite its conceptual brilliance.
Minimal acupuncture is not a valid placebo control in randomised controlled trials of acupuncture: a physiologist’s perspective
Chin Med. 2009 Jan 30;4:1. Open Access article.
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Research Article
Deqi, Minimal acupuncture, Placebo, Sham Acupuncture
A brain imaging study of acupuncture analgesia in women with fibromyalgia from the University of Michigan:
What is the mechanism of pain reduction of traditional Chinese acupuncture compared to sham acupuncture? Is the reduction of pain with acupuncture just a placebo effect?
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Research Article
Fibromyalgia, PET scan, Sham Acupuncture