Is acupuncture no more than a placebo? Extensive discussion required about possible bias

Abstract

Abstract. Numerous randomized controlled trials (RCTs) of acupuncture have been conducted in recent years. The results of several studies implied that acupuncture was only a powerful placebo; however, certain studies demonstrated that verum acupuncture had a greater effect than placebo and the mechanisms between a verum acupuncture group and a placebo/sham group were different. Researchers attempted to investigate the inherent factors that may potentially influence the results of trials. Certain problems observed in acupuncture RCTs also occurred in RCTs in other fields, including insufficient sample size, high dropout rates, inadequate follow-up and randomization. The study of acupuncture is so complex that specific methodological challenges are raised, which are frequently overlooked, including sham interventions, blinding, powerful placebo effects (even stronger than an inert pill) and variations in acupuncture administration. The aforementioned problems may contribute to bias, and researchers systematically attempt to solve these problems. The present review aimed to suggest techniques to design high-quality studies, minimize the placebo effect and optimize acupuncture administration in acupuncture studies. If these problems are addressed, then the results of acupuncture studies may be different.

Self‐Acupressure for Older Adults With Symptomatic Knee Osteoarthritis: A Randomized Controlled Trial

“…First, theoretically, sham interventions should not be distinguishable from the active ones and should be inert . However, evidence suggests that sham acupuncture (and likely acupressure) is a procedure that is not inert and is a more effective analgesic than a placebo pill . For example, one study of acupuncture in patients with irritable bowel syndrome shows that the sham intervention had a dose‐dependent response, i.e., greater improvement in pain for patients receiving a greater dose of sham acupuncture .…”

“…Another side of the protocol argument is that our sham intervention may be too good. It should be noted that leaders within the acupuncture field have failed to agree upon what constitutes an appropriate sham control , which is applicable for acupressure studies. We used non‐acupoint stimulation, which was the most commonly used sham control in acupressure trials .…”

Comparative effectiveness of electro-acupuncture versus gabapentin for sleep disturbances in breast cancer survivors with hot flashes: a randomized trial

“…45 The search for potential mechanisms of acupuncture is still in the early stages and work is currently ongoing to help researchers design trials to better understand its effect. 46,47 …”

Acupuncture – Basic Research and Clinical Application

“…The main purpose to conduct a clinical RCT is to prevent bias or manipulation of results in medical studies [217,[234][235][236]. Such biases originate from several sources.…”