“…A few trials reported up to four different rationales. Endorphin-mediated mechanisms were identified in 12 trials, 3,[19][20][21][22]26,[28][29][30]32,34,43 the gate-control theory was reported in eight trials, 19,20,22,34,36,37,42,43 TCM theory was described in six trials, 19,20,27,32,33,43 DNIC in two trials, 30,34 neuroendocrine effect in five trials, 29,32,[39][40][41] placebo effect based on endogenous opioid mechanism in one trial, 28 and long-term depression (LTD) effect in one trial. 28 Six RCTs offered no discernible physiologic rationale.…”