Acupuncture is ineffective for chronic low back pain? A critical analysis and rethinking

Wei, Xuqiang; Liu, Baoyan

doi:10.1007/s11684-020-0785-6

Cited by 4 publications

(5 citation statements)

References 48 publications

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“…These results are consistent with other studies that find it is almost impossible to remove the placebo effect of acupuncture through a sham acupuncture control design because there are too many factors related to the physiological activity of acupuncture, including needle insertion, psychological factors, acupuncture points, and acupuncture manipulation. 8,13,37 However, our results should be interpreted carefully because blinding of participants was not possible between the acupuncture, SATV, and SATS groups and the waiting list, and therefore the results were susceptible to nonspecific effects. In addition, in the pairwise meta-analysis, there was no significant difference in function between the SATS and waiting list.…”

Section: Discussionmentioning

confidence: 94%

“…[5][6][7] Although many randomized clinical trials (RCTs) evaluating the outcomes of acupuncture on CLBP have been performed, the results continue to be controversial, and questions about the appropriateness of sham acupuncture control have been raised. 8 Accordingly, clinical practice guidelines for CLBP have promoted inconsistent recommendations on acupuncture due to a lack of what has been deemed high-quality evidence. [4][5][6][9][10][11] In RCTs evaluating the efficacy of acupuncture, it is very important to set up a physiologically inert control that has the potential to serve as a true placebo.…”

Section: Introductionmentioning

confidence: 99%

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Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain

Lee,

Kwon,

Lee

et al. 2023

JAMA Netw Open

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ImportanceWhen sham acupuncture is set as a control in evaluating acupuncture, the sham needling technique is usually different from acupuncture. However, the sham procedure is conducted either at the same points that are used for the acupuncture group or at nonindicated points.ObjectiveTo assess whether the outcome of sham acupuncture varies according to the needling points in sham-controlled trials of acupuncture for chronic nonspecific low back pain (CLBP) as an example.Data sourcesSearches of MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and the Allied and Complementary Medicine Database were conducted on February 12, 2023.Study selectionRandomized clinical trials (RCTs) assessing the outcomes of acupuncture in sham acupuncture–controlled or waiting list–controlled trials on CLBP were included.Data extraction and synthesisTwo researchers independently extracted data on study characteristics and outcomes and assessed quality. Sham acupuncture was classified according to whether it was conducted at the same acupuncture points used in the acupuncture group, referred to as sham acupuncture therapy (verum) (SATV) or at different points, referred to as sham acupuncture therapy (sham) (SATS). Clinical similarity, transitivity, and consistency tests were conducted, followed by a random-effects frequentist network meta-analysis (NMA).Main outcomes and measuresThe primary outcome was pain, and the secondary outcome was back-specific function. The first assessment after the end of treatment was chosen for analysis. Effect sizes are reported as standardized mean differences (SMD) with 95% CIs. The risk of bias was assessed using the Cochrane risk of bias tool, and the certainty of evidence for findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation approach.ResultsTen RCTs involving 4379 participants were included. In comparison with SATS, acupuncture was significantly associated with improvements in both pain (SMD, −0.33; 95% CI, −0.52 to −0.15) and function outcomes (SMD, −0.13; 95% CI, −0.25 to −0.02); however, there were no differences between acupuncture and SATV. In comparison with SATS, SATV was significantly associated with better pain (SMD, −0.45; 95% CI, −0.88 to −0.03) and function outcomes (SMD, −0.30; 95% CI, −0.56 to −0.05). The risk of bias that could affect the interpretation of the results was usually low, and the certainty of evidence was moderate to low.Conclusions and relevanceIn this NMA, sham acupuncture needling at the same points as those in acupuncture was not a true placebo control for assessing the efficacy of acupuncture for CLBP and might underestimate the outcome of acupuncture in clinical settings.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain

Lee,

Kwon,

Lee

et al. 2023

JAMA Netw Open

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“…It should have a similar acupuncture response, but the exact neuroanatomical divisions here are cognitively divergent and the individual differences are great, adding more variables. The selection of control points for acupuncture research is still an unresolved issue [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Reflex Auriculo-Cardiac (RAC) Induced by Auricular Laser and Needle Acupuncture: New Case Results Using a Smartphone

Chen

Lan

Hou

et al. 2023

Life

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The reflex auriculo-cardiac (RAC), dynamic pulse reaction (Nogier reflex), or vascular autonomic signal was proposed by Nogier. It refers to the pulse changes that can occur in the radial artery immediately after auricular acupuncture is performed. RAC is helpful for the clinical practice of auricular acupuncture, but there is a lack of objective verification methods. Photoplethysmography (PPG) has been used to objectively calculate radial artery blood flow. This study used PPG via a smartphone to measure RAC induced by auricular acupuncture. Thirty subjects without major diseases were recruited to receive traditional needle and laser acupuncture. The Shen Men ear point and control points were stimulated for 20 s. PPG was continuously measured during the acupuncture. The PPG data were tested for differences with a paired t-test. The results showed that there were no statistical differences in the frequency and amplitude of PPG obtained before and after acupuncture, either with a traditional needle or laser acupuncture. However, interestingly, it was found that one patient with insomnia, one patient with viral respiratory symptoms, and two menstruating females exhibited changes in PPG within five seconds of needle placement. We hypothesized that RAC might be induced by auricular acupuncture and could be quantified by PPG, even among subjects suffering from mild diseases; however, auricular acupuncture might not induce a measurable RAC in totally healthy subjects.

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“…In this case, the overall therapeutic effect of acupuncture may be greatly underestimated if it is compared with sham acupuncture, especially in trials that aim to evaluate the effect of acupuncture for treating pain conditions (48). Therefore, some scholars debate that the complex and multielement characteristics of acupuncture doom the design of sham acupuncture and that the great effort to control the psychological (non-specific) factors through currently available modalities of sham acupuncture might be unnecessary and unsuccessful (49). In this scenario, we do not set up a sham acupuncture group as the control in our study.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy and Safety of Acupuncture for Prophylaxis of Vestibular Migraine: A Study Protocol for a Randomized Controlled Trial

Feng

et al. 2021

Front. Neurol.

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Introduction: With a high incidence rate and low diagnosis rate, vestibular migraine (VM) can seriously affect the quality of life of patients, but it remains difficult to manage by current treatment options. Acupuncture may be a potential treatment option for VM prophylaxis, but the currently available evidence is still uncertain. Therefore, this trial aims to evaluate the efficacy and safety of acupuncture for VM prophylaxis.Methods: This is a 28-week parallel, randomized, controlled clinical trial including 4 weeks of baseline, 8 weeks of treatment, and 16 weeks of follow-up. A total of 72 participants will be randomly assigned to two groups. The participants will receive acupuncture in the experimental group, while the participants in the control group will be treated with venlafaxine. The primary outcome measures are change in vertigo/migraine days and vertigo/migraine attacks, vertigo severity, and migraine intensity per 4 weeks from baseline. The secondary outcome measures are change in doses of rescue medication, anxiety level, depression level, and quality of life per 4 weeks from baseline. Adverse events will be recorded for safety evaluation.Discussion: This study will investigate the efficacy and safety of acupuncture for VM prophylaxis. The results will contribute to determining whether acupuncture can serve as an optional treatment strategy for treating VM.Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT0464088.

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Acupuncture is ineffective for chronic low back pain? A critical analysis and rethinking

Cited by 4 publications

References 48 publications

Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain

Needling Point Location Used in Sham Acupuncture for Chronic Nonspecific Low Back Pain

Reflex Auriculo-Cardiac (RAC) Induced by Auricular Laser and Needle Acupuncture: New Case Results Using a Smartphone

The Efficacy and Safety of Acupuncture for Prophylaxis of Vestibular Migraine: A Study Protocol for a Randomized Controlled Trial

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